Perceived hunger, palatability, and adherence: A comparison of high- and low-fat diets

The Fully Understanding Eating and Lifestyle Behaviors (FUEL) trial: Protocol for a cohort study harnessing digital health tools to phenotype dietary non-adherence behaviors during lifestyle intervention

Objective

Lifestyle intervention can produce clinically significant weight loss and reduced disease risk/severity for many individuals with overweight/obesity. Dietary lapses, instances of non-adherence to the recommended dietary goal(s) in lifestyle intervention, are associated with less weight loss and higher energy intake. There are distinct "types" of dietary lapse (e.g., eating an off-plan food, eating a larger portion), and behavioral, psychosocial, and contextual mechanisms may differ across dietary lapse types. Some lapse types also appear to impact weight more than others. Elucidating clear lapse types thus has potential for understanding and improving adherence to lifestyle intervention.

Methods

This 18-month observational cohort study will use real-time digital assessment tools within a multi-level factor analysis framework to uncover "lapse phenotypes" and understand their impact on clinical outcomes. Adults with overweight/obesity (n = 150) will participate in a 12-month online lifestyle intervention and 6-month weight loss maintenance period. Participants will complete 14-day lapse phenotyping assessment periods at baseline, 3, 6, 12, and 18 months in which smartphone surveys, wearable devices, and geolocation will assess dietary lapses and relevant phenotyping characteristics. Energy intake (via 24-h dietary recall) and weight will be collected at each assessment period.

Results

This trial is ongoing; data collection began on 31 October 2022 and is scheduled to complete by February 2027.

Conclusion

Results will inform novel precision tools to improve dietary adherence in lifestyle intervention, and support updated theoretical models of adherence behavior. Additionally, these phenotyping methods can likely be leveraged to better understand non-adherence to other health behavior interventions.

Trial Registration

This study was prospectively registered https://clinicaltrials.gov/study/NCT05562427.

Sodium intake and high blood pressure among adults on caloric deficit: a multi-year cross-sectional analysis of the U.S. population, 2007-2018

Small studies have shown reduced sodium-sensitivity of blood pressure in obese adolescents on a caloric deficit. We aimed to explore the association between mean daily sodium intake and prevalent hypertension among a nationally representative sample of U.S. adults on a calorie deficit. We used a design-based regression model to explore the association between sodium intake and prevalent hypertension. We also conducted sensitivity analyses using multiple imputation chained equations and propensity score matching. We also measured the effect of a binary exposure derived from the widely recommended threshold of 2.3 grams of sodium intake per day. Among 5756 individuals, we did not detect any significant association between increased sodium and the odds of hypertension (OR: 0.97; 95% CI: 0.90; 1.05). All our sensitivity analyses are consistent with our main findings. People on a calorie deficit-a component of healthy weight loss-without malnutrition saw no benefit in reduced sodium intake to lower blood pressure. These results highlight the need to explore new population-specific strategies for sodium intake reduction, including new dietary prescription approaches to improve dietary adherence and reduce the risk associated with sodium-deficient diets.

Changes in food reward during weight management interventions - a systematic review

BACKGROUND

Does food reward increase or decrease during weight management attempts? Excessive food intake is the main behavioural determinant of obesity; therefore, a better understanding of food reward and its relationship with food intake and weight outcomes could contribute to more effective weight management solutions.

METHODS

This systematic review assessed the role of changes in food reward (directly or indirectly measured) during weight management interventions. Four databases were searched for articles published until April 2018 involving weight management interventions (all types and designs) in healthy adults with overweight or obesity.

RESULTS

Of 239 full-text articles assessed, 17 longitudinal studies were included. Twelve studies reported a significant change in food reward over time. When compared with control interventions, dietary, pharmacological, behavioural and cognitive interventions were effective in decreasing liking and/or wanting for high-energy food using a range of methodologies to assess food reward. Three studies reported that decreased food reward was associated with improved weight management outcomes.

CONCLUSION

Food reward appears to decrease rather than increase during weight management interventions. Future studies specifically targeting the hedonic aspects of food intake (liking/wanting) are needed to gain a better understanding of how to uncouple the obesogenic relationship between food reward and overeating.