Changes in weight control behaviors and hedonic hunger during a 12-week commercial weight loss program

Hedonic hunger, eating behavior, and food reward and preferences 1 year after initial weight loss by diet or bariatric surgery

OBJECTIVE

The objective of this study was to investigate changes in hedonic hunger, eating behavior, and food reward and preferences at 1-year (1Y) follow-up after an initial weight loss (WL) induced by a 10-week, very low-energy diet alone (controls) or in combination with bariatric surgery.

METHODS

Patients scheduled for sleeve gastrectomy or Roux-en-Y gastric bypass and controls were recruited. Body weight/composition, hedonic hunger (Power of Food Scale), eating behavior traits (Dutch Eating Behavior Questionnaire and Three-Factor Eating Questionnaire), and food reward and preferences (computerized behavioral task) were measured at baseline, 11 weeks, and 1Y follow-up.

RESULTS

Changes in anthropometric variables were comparable across groups in the initial phase (week 11), and hedonic hunger decreased overall. The bariatric-surgery groups continued to lose body weight and fat mass, whereas weight regain was seen in controls at 1Y follow-up. Decreases in emotional eating, hunger, disinhibition, and food reward and increases in dietary restraint were seen at 1Y follow-up in the bariatric-surgery groups only.

CONCLUSIONS

Continued WL with bariatric surgery is paralleled by favorable changes in eating behavior and food reward and preferences. By contrast, controls experienced weight regain at 1Y follow-up and no changes in eating behavior. These striking differences are likely to be important in the long-term WL management of individuals with severe obesity.

Randomized Controlled Trial of Effects of Behavioral Weight Loss Treatment on Food Cue Reactivity

BACKGROUND

It is not known whether behavioral weight loss can attenuate blood oxygen level-dependent responses to food stimuli.

OBJECTIVES

This randomized controlled trial assessed the effects of a commercially available behavioral weight loss program (WW, WeightWatchers) compared to a wait-list control on blood oxygen level-dependent response to food cues.

METHODS

Females with obesity ( N = 61) were randomized to behavioral weight loss or wait-list control. At baseline and follow-up, participants completed assessments that included functional magnetic resonance imaging scans to assess response to images of high-calorie foods (HCF) or low-calorie foods (LCF), and neutral objects.

RESULTS

There were no significant between-group differences in change from baseline to follow-up in any regions of the brain in response to viewing HCF or LCF. From baseline to follow-up, participants in behavioral weight loss, compared with wait-list control, reported significantly greater increases in desire for LCF. Changes in liking and palatability of LCF and liking, palatability, and desire for HCF did not differ between groups.

DISCUSSION

Behavioral weight loss was associated with increased desire for LCF without changes in neural reactivity to food cues. These results suggest that alteration of neurological processes underlying responsiveness to food is difficult to achieve through behavioral weight management alone.

Overlapping and distinct relationships between hedonic hunger, uncontrolled eating, food craving, and the obesogenic home food environment during and after a 12-month behavioral weight loss program

Hedonic hunger, reward-driven eating outside of biological need, is a newer construct in eating behavior research. During behavioral weight loss (BWL), greater improvements in hedonic hunger are associated with higher weight loss, but it remains unclear if hedonic hunger predicts weight loss independent of more well-established, similar constructs (uncontrolled eating and food craving). Research also is needed to understand how hedonic hunger interacts with contextual factors (e.g., obesogenic food environment) during weight loss. Adults (N = 283) in a 12-month randomized controlled trial of BWL were weighed at 0, 12, and 24 months, and completed questionnaires assessing hedonic hunger, food craving, uncontrolled eating, and the home food environment. All variables improved at 12 and 24 months. Decreases in hedonic hunger at 12 months were associated with higher concurrent weight loss, but not when accounting for improvements in craving and uncontrolled eating. At 24 months, reduction in craving was a stronger predictor of weight loss than hedonic hunger, but improvement in hedonic hunger was a stronger predictor of weight loss than change in uncontrolled eating. Changes to the obesogenic home food environment failed to predict weight loss, regardless of levels of hedonic hunger. This study adds novel information on the individual and contextual factors associated with short- and long-term weight control, which can help refine conceptual models and treatment strategies.

Changes in hedonic hunger and food reward after a similar weight loss induced by a very low-energy diet or bariatric surgery

OBJECTIVE

The aim of this study was to compare changes in hedonic hunger and food reward in individuals with severe obesity achieving 10% to 15% weight loss with a very low-energy diet (VLED) alone or VLED and bariatric surgery.

METHODS

Patients scheduled for sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) initiated a VLED 2 weeks prior to surgery and continued the diet for 8 weeks postoperatively. BMI-matched controls underwent a VLED for 10 weeks. Hedonic hunger was assessed with the Power of Food Scale, and food reward with the Leeds Food Preference Questionnaire, pre and post intervention.

RESULTS

A total of 44 participants completed the study: 15 SG, 14 RYGB, and 15 controls (61%, 79% and 69% females, respectively; BMI: 40.5 ± 0.5 kg/m² ; age: 43.9 ± 1.4 years). Average weight loss was 18.3 ± 0.6 kg (16%), comprising 13.5 ± 0.5 kg fat mass, with no significant differences between groups. Similar reductions in hedonic hunger were observed in all groups. Overall, food reward was similarly reduced in SG and RYGB groups, whereas controls showed little or no change.

CONCLUSIONS

Independent of modality, weight loss seems to reduce hedonic hunger, but bariatric surgery leads to several additional favorable changes in food reward and preferences.

A randomized controlled trial comparing prevention and promotion cognitive strategies in a behavioral weight-loss intervention

OBJECTIVE

Two approaches may shift attention from short-term rewards to longer-term weight-loss goals: focusing on long-term consequences of unhealthy choices (prevention) or benefits of healthy choices (promotion). This randomized controlled trial tested the impact of prevention- versus promotion-focused strategies in an internet-delivered behavioral weight-loss intervention (iBWL).

METHODS

A total of 95 participants with overweight/obesity were randomized to one of three 12-week iBWLs: (1) STANDARD (n = 31), (2) PREVENT (standard iBWL+prevention-focused training; n = 32), or (3) PROMOTE (standard iBWL+promotion-focused training; n = 32). Participants in the two enhanced arms were trained in their assigned strategy, and lessons and weekly feedback featured arm-specific content and reminders.

RESULTS

Intent-to-treat analysis revealed significant differences in weight loss and self-control use at 12 weeks (weight loss p = 0.002, self-control p = 0.0006). PREVENT was associated with 6.6% (±4.5%) weight loss and a 20.3% (±26.5%) increase in self-control, STANDARD and PROMOTE were associated with 4.4% (±4.2%) and 3.1% (±3.1%) weight losses, respectively, and neither STANDARD nor PROMOTE participants exhibited significant changes in self-control. Across arms, increased self-control was associated with greater weight loss (p = 0.0005).

CONCLUSIONS

Cognitive strategies to focus on preventing negative consequences of unhealthy choices led to greater weight loss and self-control compared with both standard iBWL and promotion-focused iBWL. Prevention strategies should be given further attention for overweight/obesity treatment.

Changes in temporal discounting, hedonic hunger, and food addiction during recovery from substance misuse

Substance use disorders (SUDs) and obesity are both chronic, relapsing, remitting disorders that arise from a heightened preference for immediate-focused rewards (i.e., steep temporal discounting). During recovery from SUDs, overweight and obese outcomes are common as individuals may replace drug rewards for food rewards. However, little has been done to investigate the neuropsychological processes underlying food reward and addiction in individuals recovering from SUDs. Using data collected from the International Quit and Recovery Registry and Amazon Mechanical Turk, we aimed to elucidate the factors that influence the attraction to palatable foods in a population in recovery from substance misuse (n = 114) as well as a population with no history of substance misuse (n = 97). We hypothesized that individuals in recovery from substance misuse would have steeper temporal discounting, an increased drive for palatable foods (i.e., hedonic hunger), and greater food addiction symptoms than non-substance users. Contrary to our hypotheses, we found that individuals in recovery from SUDs show improved outcomes in temporal discounting, hedonic hunger, and food addiction symptoms. Moreover, recovery status and temporal discounting significantly predicted these outcomes. Our findings suggest that the enhanced executive control processes needed for successful SUD recovery may transfer to other reward-related processes such as food reward and consumption. Interventions targeted at improving executive function including episodic future thinking, meditation, or exercise, may be excellent ways to support a successful recovery and improve other reward-related processes, including food consumption, to decrease the risk of overweight or obese outcomes during recovery.

Associations between hedonic hunger and BMI during a two-year behavioural weight loss trial

Objective

Prospective studies on relationships between hedonic hunger and BMI (Body Mass Index) during weight management are lacking. This study examined if hedonic hunger reduced during a behavioural weight management programme, and if hedonic hunger predicted future BMI.

Methods

Participants were 594 community-dwelling, UK-based adults(396 female; age 56.43 years, s.d. = 12.50, range 20–83 years); 490 participants (82.5%) had obesity. Participants were randomised to a 12- or 52-week behavioural weight management intervention (WW12 or WW52, respectively) or a brief self-help intervention (BI). Relationships between hedonic hunger and BMI over 24 months (baseline, 3, 12, 24 months) were analysed using an autoregressive cross-lagged model.

Results

Hedonic hunger scores decreased from 2.71 (s.d. = .91) at baseline to 2.41 (s.d. = .88) at 3 months (p < .001, CI .22 to .38), remained reduced to 24 months, and were not affected by intervention arm at any time point (p’s>.05). Baseline hedonic hunger scores predicted 3-month scores (B = .76, SE = .03, p < .001, CI .71 to .82), 3-month scores predicted 12-month scores (B = .76, SE = .03, p < .001 CI .72 to .80), and 12-month scores predicted 24-month scores (B = .72, SE = .03, p < .001, CI .64 to .77). Higher hedonic hunger at 3 months predicted higher BMI at 12 months (B = .04, SE = .02, p = .03, CI .01 to .07) but not at 24 months (p>.05). BMI at 12 months was lower in WW52 30.87kg/m², s.d. = 5.02) than WW12 (32.12 kg/m², s.d. = 5.58, p = .02, CI .16 to 2.34) and BI (32.74 kg/m², s.d. = 4.15, p = .01, CI .30 to 3.45). BMI was not affected by intervention at any other time point (p’s>.05).

Conclusion

Hedonic hunger reduced during weight management irrespective of intervention. Early reductions in hedonic hunger appear to be associated with lower BMI in the medium-term. Identifying ways to reduce hedonic hunger during weight loss could aid weight management for some people.

Food Liking but Not Wanting Decreases after Controlled Intermittent or Continuous Energy Restriction to ≥5% Weight Loss in Women with Overweight/Obesity

Food reward (i.e., liking and wanting) has been shown to decrease after different types of weight management interventions. However, it is unknown whether specific dietary modalities (continuous (CER) vs. intermittent (IER) energy restriction) have differing effects on liking and implicit wanting after weight loss (WL) and whether these changes are sustained after 1-year of no-contact. Women with overweight or obesity (age 18–55 years) were randomly allocated to controlled-feeding CER (25% daily energy restriction) or IER (alternating ad libitum and 75% energy restriction days). Study visits were conducted at baseline, post-WL (to ≥5% WL within 12 weeks) and 1-year post-WL. The main outcomes were liking and implicit wanting for 4 categories of common food varying in fat and taste assessed by the Leeds Food Preference Questionnaire. Linear mixed models were conducted on the 30 participants achieving ≥5% WL and 15 returners. After an initial WL of −5.1 ± 0.2 kg, after 1-year 2.6 ± 0.5 kg were regained. Liking but not wanting decreased after WL. Food reward after 1-year did not differ from baseline, but the high loss to follow-up prevents generalization. IER and CER did not differ in their effects on food reward during WL or at 1-year follow-up.

Food reward sensitivity, impulsivity, and weight change during and after a 3-month weight loss program

Background

Greater sensitivity to food rewards and higher levels of impulsivity (and an interaction between these variables, termed “reinforcement pathology”) have been associated with obesity in cross-sectional studies. Less is known regarding how these constructs may impact attempts at weight loss or longer-term weight loss maintenance.

Methods

We provided 75 adults (69%Female, 84%White, age = 50.8y, BMI = 31.2kg/m²) with a 3-month Internet-based weight loss program and assessed weight, food reward sensitivity (via the Power of Food Scale [PFS]), and impulsivity (via Go No-Go [GNG] and Delay Discounting [DD] computer tasks) at baseline and at Months 3, 6, 9, and 12. No additional intervention was provided Months 3–12. Multi-level mixed-effect models were used to examine changes in PFS, GNG, and DD over time and associations between these measures and weight loss/regain.

Results

Participants lost 6.0±1.1kg Months 0–3 and regained 2.4±1.1kg Months 3–12. Across time points, higher PFS scores were associated with higher weight, p = .007; however, there were no significant associations between GNG or DD and weight nor between the interactions of PFS and GNG or DD and weight, ps>.05. There were significant decreases from Months 0–3 in PFS, GNG, and DD, ps < .05; however, neither baseline values nor changes were significantly associated with weight change and there were no significant associations between the interactions of PFS and GNG or DD and weight change, ps>.05.

Conclusion

Results demonstrated an association between food reward sensitivity and weight. Further, decreases in both food reward sensitivity and impulsivity were observed during an initial weight loss program, but neither baseline levels nor improvements were associated with weight change. Taken together, results suggest that the constructs of food reward sensitivity, impulsivity, and reinforcement pathology may have limited clinical utility within behavioral weight management interventions. Future intervention studies should examine whether food-related impulsivity tasks lead to a similar pattern of results.

Functional Brain Networks: Unique Patterns with Hedonic Appetite and Confidence to Resist Eating in Older Adults with Obesity

OBJECTIVE

The purpose of this study was to determine whether baseline measures of hedonic hunger-the Power of Food Scale-and self-control for food consumption-the Weight Efficacy Lifestyle Questionnaire-were associated with network topology within two sets of brain regions (regions of interest [ROIs] 1 and 2) in a group of older adults with obesity. These previously identified brain regions were shown in a different cohort of older adults to be critical for discriminating weight loss success and failure.

METHODS

Baseline functional magnetic resonance imaging data (resting state and food cue task) were collected in a novel cohort of 67 older adults with obesity (65-85 years, BMI = 35-42 kg/m² ) participating in an 18-month randomized clinical trial on weight regain.

RESULTS

The Power of Food Scale was most related to ROI 1, which includes the visual cortex and sensorimotor processing areas during only the food cue state. During both the food cue and resting conditions, the Weight Efficacy Lifestyle Questionnaire was associated with ROI 2, which includes areas of the attention network and limbic circuitry.

CONCLUSIONS

Our findings show critical, distinct links between brain network topology with self-reported measures that capture hedonic hunger and the confidence that older adults have in resisting the consumption of food because of both intrapersonal and social/environmental cues.

Changes in weight control behaviors and hedonic hunger in a commercial weight management program adapted for individuals with type 2 diabetes

BACKGROUND

A WW (formerly Weight Watchers) program adapted for persons with type 2 diabetes mellitus (T2DM) previously was found to be more effective than standard care (SC) intervention for weight loss, improved glycemic control, and weight- and diabetes-related quality of life measures. With data from the same national trial, this study examined whether WW adapted for persons with T2DM also increased engagement in weight control behaviors and decreased hedonic hunger, each of which could contribute to improved diabetes management.

INTERVENTION AND METHODS

Individuals with T2DM (n = 563) and overweight or obesity participated in a 12-month, 16-site, randomized trial of WW with diabetes counseling or SC. Hierarchical linear modeling (HLM) evaluated whether 12-month changes in weight control behaviors (Eating Behavior Inventory; EBI) and hedonic hunger (Power of Food Scale; PFS) differed by treatment condition. If a significant treatment effect was found, 12-month changes in EBI/PFS were regressed on 12-month changes in HbA_1c and percent weight loss to explore potential treatment differences in these associations.

RESULTS

EBI scores increased significantly over the 12-months (p < 0.001), with greater improvements in WW than SC (p < 0.001). PFS decreased significantly in the 12-months (p < 0.001), with no differences between treatment groups (p = 0.15). HLM analyses that followed up on the significant treatment effect for 12-month change in EBI revealed no significant differences by treatment condition for the relationship between change in EBI scores and change in HbA_1c (p = 0.14) or percent weight loss (p = 0.32). Across all participants, 12-month improvements in EBI and PFS were related to improved HbA_1c (r = 0.22; -0.13, respectively) and greater percent weight loss (r = 0.41; -0.18, respectively) (ps < 0.01).

CONCLUSIONS

WW with diabetes counseling produced greater engagement in weight control behaviors in those with T2DM than did SC. Across both groups, improved weight control behaviors and hedonic hunger were related to improved glycemic control and weight loss.

Effect of JumpstartMD, a Commercial Low-Calorie Low-Carbohydrate Physician-Supervised Weight Loss Program, on 22,407 Adults

BACKGROUND

Commercial weight loss programs provide valuable consumer options for those desiring support. Several commercial programs are reported to produce ≥3-fold greater weight loss than self-directed dieting. The effectiveness of JumpstartMD, a commercial pay-as-you-go program that emphasizes a low-to-very-low-carbohydrate real-food diet and optional pharmacologic treatment without prepackaged meals or meal replacement, has not previously been described.

METHODS

Completer and last observation carried forward (LOCF) of clinic-measured weight loss (kg) in 18,769 female and 3638 male JumpstartMD participants.

RESULTS

Completers lost (mean ± SE) 8.7 ± 0.04 kg, 9.5 ± 0.04% with 44.5 ± 0.5% achieving ≥10% weight loss at 3 months (mo, N = 14,999 completers); 11.8 ± 0.1 kg, 12.6 ± 0.1% with 66.4 ± 0.6% achieving ≥10% weight loss at 6 mo (N = 11,805); and 11.5 ± 0.2 kg, 12.0 ± 0.2% with 57.6 ± 0.9% achieving ≥10% weight loss at 12 mo (N = 8514). LOCF estimates were -6.5 ± 0.03 kg, -7.2 ± 0.03% with 27.1 ± 0.3% achieving ≥10% weight loss at 3 mo; -7.7 ± 0.04 kg, -8.5 ± 0.04% with 36.3 ± 0.3% achieving ≥10% weight loss at 6 mo; and -7.7 ± 0.1 kg, -8.4 ± 0.1% with 34.6 ± 0.3% achieving ≥10% weight loss after 12 mo. Frequent health coach meetings was a major determinant of weight loss, with women and men attending ≥75% of their weekly appointments losing 8.8 ± 0.04 and 11.9 ± 0.1 kg, respectively, after 3 mo, 13.1 ± 0.1 and 16.5 ± 0.3 kg after 6 mo, and 16.5 ± 0.3 and 19.4 ± 0.8 kg after 12 mo. Phentermine and phendimetrazine had a minor effect in women only at 1 (6.1% greater weight loss than untreated), 2 (4.1%), and 3 mo (1.2%), but treated patients showed longer enrollment than nontreated during the first 3 (females: +0.4 ± 0.01; males: +0.3 ± 0.04 mo), 6 (females: +1.1 ± 0.04; males: +1.0 ± 0.1 mo), and 12 mo (females: +2.7 ± 0.1; males: +2.4 ± 0.2 mo). JumpstartMD produced generally greater weight loss than published reports for other real-food and prepackaged-meal commercial programs and somewhat greater or comparable losses to meal replacement diets.

CONCLUSION

A one-on-one medically supervised program that emphasized real low-carbohydrate foods produced effective weight loss, particularly in those attending ≥75% of their weekly appointments.

Psychometric evaluation of the power of food scale in a diverse college sample: Measurement invariance across gender, ethnicity, and weight status

The Power of Food Scale (PFS) is an instrument designed to examine individual differences in the drive to eat for pleasure (as opposed to in response to physiological hunger) and the effect of living in an obesogenic environment. Previous research supports the validity and reliability of the PFS, however, it had yet to be validated in an ethnically diverse college sample. The purpose of the current study was to test the factor structure and measurement invariance of the PFS across gender, ethnicity, and weight status. A sample of 432 college students completed the PFS (males=113, females = 319; non-Hispanic white=181, Hispanic=251; non-overweight=302, overweight=130). Confirmatory factor analysis was used to test a second-order, 3-factor (food available, food present, food tasted) structure of the PFS in each group separately (males, females, Hispanic, non-Hispanic white, non-overweight, and overweight) and tests of measurement invariance were conducted to test the equivalency of the measure across gender, ethnicity, and weight status. Results supported the measure's original factor structure (second-order, 3-factor model) and indicated that the measure is equivalent across each of these groups, respectively. Although the small, unbalanced groups may impact the stability of the findings, the results nonetheless suggest that the PFS is a psychometrically valid measure in a diverse college sample, and that mean comparisons on this measure are meaningful across gender, ethnicity, and weight status. Given the measurement invariance of the PFS, there is support for use of the PFS among diverse college students in future work.

Patients' reasons for weight loss and their relations to clinical weight loss outcomes in a comprehensive lifestyle intervention

OBJECTIVE

Research suggests that individuals seeking weight loss treatment do so for a variety of reasons. Limited work has explored relations of reasons for weight loss to patient characteristics or to weight loss outcomes. The current study examined these relations.

METHODS

The sample consisted of 588 patients in a 15-week fee-for-service weight loss programme. Prior to the intervention, patients completed questionnaires including items on reasons for weight loss, demographic characteristics, and a variety of weight-based characteristics. Patients' weight change outcomes were expressed as percent weight loss and also categorized into one of three previously described weight loss trajectories.

RESULTS

The results of chi-squared and t-test analyses suggested that endorsement of health concerns, mobility concerns, or another person's recommendation was associated with higher body mass index (BMI) and older age. These reasons were more likely to be endorsed by White patients than Black patients and by male patients than female patients. Endorsement of doctor recommendation was more likely to be seen among Black patients than White patients. There was no significant relation of any weight loss reason with weight loss outcome.

CONCLUSIONS

While certain reasons for weight loss were more often cited by certain patient groups, no specific reason predicted a better or worse outcome.

Association between hedonic hunger and glycemic control in non-obese and obese patients with type 2 diabetes

AIMS/INTRODUCTION

Higher hedonic hunger has been observed in obese individuals compared with those without obesity, but little is known about its association with glycemic management. We aimed to examine the association between hedonic hunger and glycemic control in non-obese and obese patients with type 2 diabetes.

MATERIALS AND METHODS

Between April and November 2016, a total of 211 type 2 diabetes patients who underwent comprehensive diabetes assessments at a university-affiliated hospital were recruited into two groups according to body mass index: non-obese (body mass index 18.5-24.9 kg/m2 ) and obese (body mass index ≥30 kg/m2 ) groups. All participants completed the Chinese version of the Power of Food Scale (PFS) for assessment of hedonic hunger. Good glycemic control was defined as glycated hemoglobin <7.0%.

RESULTS

Compared with the non-obese group, the obese group showed higher PFS aggregated and subscale 'food available' scores (both P < 0.05). After adjustment for age, sex, disease duration of diabetes and insulin use, there were positive associations of glycated hemoglobin with PFS aggregated, subscale 'food available' and 'food present' scores in the obese group (all P for trend <0.05). The PFS aggregated score was negatively associated with good glycemic control in obese type 2 diabetes patients after adjustment using logistic regression analysis (adjusted odds ratio 0.42, 95% confidence interval 0.20-0.91, P = 0.027). By contrast, such associations were not observed in non-obese type 2 diabetes patients.

CONCLUSIONS

Hedonic hunger had an independent and inverse association with good glycemic control in obese Chinese patients with type 2 diabetes, but not in their counterparts without obesity.

A narrative review of the construct of hedonic hunger and its measurement by the Power of Food Scale

INTRODUCTION

The term 'hedonic hunger' refers to one's preoccupation with and desire to consume foods for the purposes of pleasure and in the absence of physical hunger. The Power of Food Scale (PFS) was developed as a quantitative measure of this construct in 2009. Since then, over 50 published studies have used the PFS to predict appetite-related outcomes including neural, cognitive, behavioural, anthropometric and clinical measures.

OBJECTIVE

This narrative review evaluates how closely the PFS captures the construct it was originally presumed to assess and to more clearly define hedonic hunger itself.

METHODS

The measure's relationship to four domains is reviewed and summarized: motivation to consume palatable foods; level of actual consumption of such foods; body mass; and subjective loss-of-control over one's eating behaviour. Findings are synthesized to generate a more accurate understanding of what the PFS measures and how it may relate to the broader definition of hedonic hunger.

RESULTS

Results suggest that the PFS is closely related to motivation to consume palatable foods and, in extreme cases, occurrence of loss-of-control eating episodes. PFS scores are not consistently predictive of amount of food consumed or body mass.

CONCLUSIONS

Implications of these findings are discussed in the context of behavioural health, and avenues for further inquiry are identified.

Association between hedonic hunger and body-mass index versus obesity status

Obesity-associated differences in hedonic hunger, while consistently reported, have not been adequately quantified, with most studies failing to demonstrate strong correlations between Body Mass Index (BMI) and hedonic hunger indicators. Here, we quantified and assessed the nature of the relationship between hedonic hunger and BMI, in a cross-sectional study using the Portuguese version of the PFS (P-PFS) to measure hedonic hunger. Data were collected from 1266 participants belonging to non-clinical, clinical (candidates for weight-loss surgery) and population samples. Across samples, significant but weak positive associations were found between P-PFS scores and BMI, in adjusted linear regression models. However, in logistic regression models of data from the clinical and non-clinical samples, the P-PFS Food Available domain score was significantly and robustly associated with belonging to the clinical sample (OR = 1.8, 95%CI: 1.2–2.8; p = 0.008), while in the population sample it was associated to being obese (OR = 2.1, 95%CI: 1.6–2.7; p < 0.001). Thus, hedonic hunger levels are associated with obesity status with the odds of being obese approximately doubling for each unit increase in the P-PFS Food Available score.

Ineffectiveness of commercial weight-loss programs for achieving modest but meaningful weight loss: Systematic review and meta-analysis

This study collates existing evidence regarding weight loss among overweight but otherwise healthy adults who use commercial weight-loss programs. Systematic search of 3 databases identified 11 randomized controlled trials and 14 observational studies of commercial meal-replacement, calorie-counting, or pre-packaged meal programs which met inclusion criteria. In meta-analysis using intention-to-treat data, 57 percent of individuals who commenced a commercial weight program lost less than 5 percent of their initial body weight. One in two (49%) studies reported attrition ≥30 percent. A second meta-analysis found that 37 percent of program completers lost less than 5 percent of initial body weight. We conclude that commercial weight-loss programs frequently fail to produce modest but clinically meaningful weight loss with high rates of attrition suggesting that many consumers find dietary changes required by these programs unsustainable.

Improving Assessment of the Spectrum of Reward-Related Eating: The RED-13

A diversity of scales capture facets of reward-related eating (RRE). These scales assess food cravings, uncontrolled eating, addictive behavior, restrained eating, binge eating, and other eating behaviors. However, these scales differ in terms of the severity of RRE they capture. We sought to incorporate the items from existing scales to broaden the 9-item Reward-based Eating Drive scale (RED-9; Epel et al., 2014), which assesses three dimensions of RRE (lack of satiety, preoccupation with food, and lack of control over eating), in order to more comprehensively assess the entire spectrum of RRE. In a series of 4 studies, we used Item Response Theory models to consider candidate items to broaden the RED-9. Studies 1 and 2 evaluated the abilities of additional items from existing scales to increase the RED-9's coverage across the spectrum of RRE. Study 3 evaluated candidate items identified in Studies 1 and 2 in a new sample to assess the extent to which they accounted for more variance in areas less well-covered by the RED-9. Study 4 tested the ability of the RED-13 to provide consistent coverage across the range of the RRE spectrum. The resultant RED-13 accounted for greater variability than the RED-9 by reducing gaps in coverage of RRE in middle-to-low ranges. Like the RED-9, the RED-13 was positively correlated with BMI. The RED-13 was also positively related to a diagnosis of type 2 diabetes as well as cravings for sweet and savory foods. In summary, the RED-13 is a brief self-report measure that broadly captures the spectrum of RRE and may be a useful tool for identifying individuals at risk for overweight or obesity.

Energy intake highs and lows: how much does consistency matter in weight control?

Behavioural weight control programmes recommend adherence to daily energy intake goals, yet also allow for flexibility in intake across days. Evidence is lacking as to whether intake consistency is important for weight control. The current study explored the relation between day-to-day intake consistency and weight loss in the context of behavioural weight loss treatment and examined the relationship between variability in intake and several factors known to be associated with weight control success. Participants (N =  283) enrolled in a 12-month behavioural weight loss programme completed 24-h recalls of dietary intake and psychological measures. At the end of treatment, low intake variability and greater weight loss were associated, but variability was not predictive of weight loss independent of mean intake in continuous analyses. Interestingly, participants who met the programme goal of ≥10% weight loss had less intake variability compared to those who lost <10%, although groups did not differ significantly on mean intake. Results suggest that daily intake consistency may facilitate successful weight loss for some. Additionally, autonomous motivation for weight management and cognitive dietary restraint were inversely related to end-of-treatment intake variability. Additional research is needed to examine whether recommendations to limit intake variability during behavioural weight loss treatment improve long-term weight control.

Changes in cardiovascular risk factors with participation in a 12-week weight loss trial using a commercial format

OBJECTIVE

This study assessed changes in cardiovascular disease risk factors among participants in a 12-week behavioral weight loss intervention featuring a commercial format.

METHOD

132 participants were enrolled in a randomized controlled trial of a 12-week group-based lifestyle intervention that involved two structured food plan conditions. Of them, 112 (100 women and 12 men, mean BMI=31.44 ± 2.18 kg/m(2)) completed the program with post-treatment assessments. Weight and changes in risk factors (cholesterol, triglycerides, fasting blood glucose, and blood pressure) were assessed at pre- and posttreatment. Additionally, changes for each risk factor were examined among participants with baseline values of risk factors beyond recommended cut points.

RESULTS

With no weight loss differences between conditions, analyses used the combined sample. Participants lost 3.74 ± 3.16 kg (4.37 ± 3.71% of baseline weight), and exhibited significant decreases in triglyceride, total cholesterol and LDL-cholesterol levels. There were trends toward reductions in fasting glucose, systolic blood pressure, and HDL cholesterol. Among participants with elevated baseline values, significant reductions were seen on all risk factors, with the exception of HDL cholesterol.

DISCUSSION

Modest weight loss achieved via a relatively brief, non-intensive intervention using a commercial format can yield significant improvements in cardiovascular disease risk factors, particularly among individuals with initially higher-risk values.

Relations of hedonic hunger and behavioral change to weight loss among adults in a behavioral weight loss program utilizing meal-replacement products

Greater self-regulatory behavior usage is associated with greater weight loss within behavioral weight loss treatments. Hedonic hunger (i.e., susceptibility to environmental food cues) may impede successful behavior change and weight loss. Adult men and women (N = 111, body mass index M ± SD = 35.89 ± 6.97 kg/m(2)) were assessed before and after a 15-week lifestyle change weight loss program with a partial meal-replacement diet. From pre- to post-treatment, reported weight control behavior usage improved and hedonic hunger decreased, and these changes were inversely related. Individuals with higher hedonic hunger scores at baseline showed the greatest weight loss. Similarly, participants with lower baseline use of weight control behaviors lost more weight, and increased weight control behavior usage was associated with greater weight loss-particularly among individuals with low baseline hedonic hunger. Further study is warranted regarding the significance of hedonic hunger in weight loss treatments.