Use of an operant task to estimate food reinforcement in adult humans with and without BED

Changes in food preferences and ingestive behaviors after glucagon-like peptide-1 analog treatment: techniques and opportunities

BACKGROUND

Glucagon-like peptide-1 (GLP-1) analogs are approved for the treatment of obesity in adults and adolescents. Reports have emerged that the weight loss effect of these medications may be related to changes in food preferences and ingestive behaviors following the treatment. Understanding the mechanisms which impact ingestive behavior could expand opportunities to develop more refined and personalized treatment options for obesity.

METHODS

Recent studies investigating the relationship between GLP-1 analogs and ingestive behaviors were retrieved from PubMed using the search terms: "obesity," "food preference," "taste," "ingestive behavior," "weight loss medication," "anti-obesity medication," "GLP-1 analog," "tirzepatide," "liraglutide," "semaglutide." Measurement tools were studied to compare variables used to assess food intake behavior. The main outcomes from each study were analyzed to evaluate the current standing and future directions of appetitive, ingestive, and consummatory behaviors and their association with GLP-1 analogs.

RESULTS

Thus far, studies have primarily explored the weight loss phase and report decreased short-term appetite and food intake upon treatment. However, research during the weight maintenance phase and objective measurements of food intake are notably sparse. Additionally, verbal reports have been primarily used to examine food intake, which can be susceptible to subjectivity.

CONCLUSIONS

Elucidating the relationship between GLP-1 analogs and ingestive behavior could reveal additional parameters which contribute to their anti-obesity effects. To better understand these mechanisms, it is imperative to consider objective measurements of food intake in future studies. Several measurement tools have been adapted to measure variables of food behavior in humans, and each must be carefully considered with their strengths and limitations to develop optimal investigations.

A mechanistic staging model of reward processing alterations in individuals with binge-type eating disorders

Altered reward processing is thought to characterize binge-type eating disorders, but the exact nature of these alterations is unclear. A more fine-grained understanding of whether specific aspects of reward processing contribute to the development or maintenance of binge eating may point to new therapeutic targets and personalized treatments. The incentive sensitization theory of addiction proposes that repeated use of a substance increases the desire to approach a reward ('wanting') but not pleasure when consuming the reward ('liking'), suggesting that reward processes driving addiction change over time. We hypothesize that the same may be true for binge eating. Further, consistent with the maladaptive scaling hypothesis, reward processing may be heightened for multiple reinforcers in at-risk individuals but become tuned toward food once binge eating is initiated. In this article, we propose a mechanistic staging model of reward processing in binge-type eating disorders that synthesizes existing data and posits that alterations of reward processing depend on illness stage and reward type. We outline translational methods for testing key hypotheses and discuss clinical implications. Considering reward processing alterations in relation to illness stage has the potential to improve treatment outcomes by ensuring that the mechanisms targeted are personalized to the individual patient. PUBLIC SIGNIFICANCE: Individuals with binge-type eating disorders experience alterations in their desire for, and pleasure from, food. We believe that the exact nature of these alterations in reward processing change over the course of illness-from the at-risk state to an established illness. If true, treatments for binge-type eating disorders that target reward processing should be personalized to the illness stage of the patient.

Examining weight suppression as a transdiagnostic factor influencing illness trajectory in bulimic eating disorders

Recent research indicates that weight suppression (WS: defined as the difference between highest lifetime and current weight) prospectively predicts illness trajectory across eating disorders characterized by binge eating, including AN binge-purge subtype (ANbp), bulimia nervosa (BN), and binge eating disorder (BED), collectively referred to as bulimic eating disorders. Through a series of studies, we have developed a model to explain the link between WS and illness trajectory in bulimic eating disorders. Our model posits that WS contributes to reduced circulating leptin, which leads to reduced postprandial glucagon-like peptide 1 (GLP-1) response. Diminished leptin and GLP-1 function contribute to alterations in two reward-related constructs in the Research Domain Criteria (RDoC): reward value/effort and reward satiation. Respectively, these changes increase drive/motivation to consume food and decrease ability for food consumption to lead to a state of satiation/satisfaction. Combined, these alterations increase risk for experiencing large, out-of-control binge-eating episodes. The following review presents evidence that contributed to the development of this model as well as preliminary findings from an on-going project funded to test this model.

Increasing Chocolate's Sugar Content Enhances Its Psychoactive Effects and Intake

Chocolate elicits unique brain activity compared to other foods, activating similar brain regions and neurobiological substrates with potentially similar psychoactive effects as substances of abuse. We sought to determine the relationship between chocolate with varying combinations of its main constituents (sugar, cocoa, and fat) and its psychoactive effects. Participants consumed 5 g of a commercially available chocolate with increasing amounts of sugar (90% cocoa, 85% cocoa, 70% cocoa, and milk chocolates). After each chocolate sample, participants completed the Psychoactive Effects Questionnaire (PEQ). The PEQ consists of questions taken from the Morphine-Benzedrine Group (MBG), Morphine (M,) and Excitement (E) subscales of the Addiction Research Center Inventory. After all testing procedures, participants completed the Binge Eating Scale (BES) while left alone and allowed to eat as much as they wanted of each of the different chocolates. We found a measurable psychoactive dose⁻effect relationship with each incremental increase in the chocolate's sugar content. The total number of positive responses and the number of positive responses on the E subscale began increasing after tasting the 90% cocoa chocolate, whereas the number of positive responses on the MBG and M subscales began increasing after tasting the 85% cocoa chocolate sample. We did not find a correlation between BES scores and the total amount of chocolate consumed or self-reported scores on the PEQ. These results suggest that each incremental increase in chocolate's sugar content enhances its psychoactive effects. These results extend our understanding of chocolate's appeal and unique ability to prompt an addictive-like eating response.

Adiposity and binge eating are related to liking and wanting for food in Brazil: A cultural adaptation of the Leeds food preference questionnaire

The Leeds Food Preference Questionnaire (LFPQ) measures separable psychological components of food reward (Liking and Wanting). In this study a cultural adaptation of the LFPQ for a Brazilian population (LFPQ-BR) was examined by comparing liking and wanting scores in fasted and fed states and their association with adiposity and disturbed eating. A culturally adapted food picture database was validated by an online questionnaire completed by 162 individuals. Cluster analysis verified if the foods were accurately perceived in terms of sweetness, fat and calorie content. Subsequently, 48 male (N = 21) and female (N = 27) adults with mean Body Mass Index 26.6 (0.9) kg/m², and mean age 32.8 (1.4) years, were evaluated by the LFPQ-BR before and after a fixed test meal. The Binge Eating Scale was used to measure binge eating symptoms. There was a decrease in explicit liking, implicit wanting, and explicit wanting scores for food in general in the fed condition. The implicit and explicit wanting and explicit liking scores for high-and-low fat savoury food decreased and for high-and-low fat sweet foods increased to a greater extent after the savoury test meal. Body Mass Index was found to predict implicit wanting for high fat relative to low fat foods. Binge eating symptoms predicted high fat sweet explicit liking and explicit wanting in the fed condition. Finally, high fat sweet preference was found to be sex-related as females had greater implicit wanting for high fat sweet foods in fasted and fed states. The results presented here indicate that the LFPQ-BR is a useful instrument for the evaluation of liking and wanting for food in Brazil.

Rigor and reproducibility via laboratory studies of eating behavior: A focused update and conceptual review

OBJECTIVE

The eating behavior of individuals with eating disorders has been examined in laboratory settings over the last 30 years. In this focused review, we build on prior research and highlight several feeding laboratory paradigms that have successfully demonstrated quantifiable and observable behavioral disturbances, and thereby add rigor and reproducibility to the examination of disturbances of eating behavior. This review describes the measures commonly obtained via these laboratory techniques. Supporting Information Appendices with detailed information about implementation are provided to allow for the reproducible execution of these techniques across labs.

METHODS/RESULTS

Literature documenting the existence of objective abnormalities in eating behavior among individuals with eating disorders or in comparison to healthy controls (n > 40) is briefly summarized. These protocols, conducted across at least 17 independent labs, are sensitive and reproducible, can be used to assess subjective and physiological parameters associated with eating, and elucidate the impact of treatment. Laboratory studies from patients with eating disorders compared with healthy controls reproducibly demonstrate both that patients with Anorexia Nervosa ingest fewer calories and that individuals with Bulimia Nervosa and Binge-Eating Disorder ingest more calories when asked to binge-eat.

DISCUSSION

Feeding laboratory studies have the potential for quantifying the characteristic behavioral psychopathology of patients with eating disorders, and may provide a useful tool to explore the potential utility of new treatments for individuals with Anorexia Nervosa, Bulimia Nervosa, and Binge-Eating Disorder.

Progressive ratio (PR) schedules and the sipometer: Do they measure wanting, liking, and/or reward? A tribute to Anthony Sclafani and Karen Ackroff

This paper honors the contributions made by Anthony (Tony) Sclafani and Karen Ackroff to both the Columbia University Seminar on Appetitive Behavior and to the field of ingestive behavior in general. We review their use of the progressive ratio (PR) licking paradigm, to determine whether the taste of sucrose, independent of its post-ingestive effects, is always positively reinforcing in animals. They demonstrated a monotonic increase in licking as concentration increased, and obtained results identical to those obtained with a lever-pressing paradigm, but licking was easier and more natural than lever pressing. The PR paradigm was translated to evaluate liquid food reward value in humans. An instrument (the sipometer) was devised that initially permitted a few seconds access to small amounts of a sweet beverage as the participants increased the time to obtain it in 3-5-sec increments. The device went through two refinements and currently delivers the reinforcer and measures the pressure exerted to obtain it. The sipometer is compared with other techniques for measuring motivation and reward. The use of the sipometer and the PR method are discussed in relation to the theoretical challenges inherent in measuring motivation and pleasure, from both psychological and behavioral economics perspectives, and why it is or is not important to separate these processes for both theoretical and practical applications.

A sipometer for measuring motivation to consume and reward value of foods and beverages in humans: Description and proof of principle

New methods, derived from animal work, for measuring food reward value (i.e. reinforcing value of food), and motivation (i.e. strength of desire) to consume, in humans are described and validated. A sipping device (sipometer) was developed that permits access to a liquid food or beverage on two reward schedules: continuous reinforcement (CR) and progressively increasing time spent exerting pressure on a straw (PR-schedule). In addition, a pictorial scale showing a cup, from which the 'amount wanted' could be marked was used to pre-test potential consumption. Intake, time spent sipping, breakpoint, and pressure exerted were the main dependent variables measured. Three pilot experiments were conducted. In Experiment 1, participants (n=8) consumed yogurt shakes after a 1-h or 21-h food deprivation period on both schedules. In Experiment 2, participants (n=8) sham-consumed (i.e. spit out) sweet and non-sweet beverages, utilizing both schedules. In Experiment 3, sham-consuming sweet and non-sweet beverages on both schedules and working for shake on the PR schedule were repeated, after three nights of either habitual sleep or short sleep duration (n=7) in a crossover design. In Experiment 1, participants sipped longer after 21-h vs. 1-h of food deprivation (13±3.0 vs. 8.0±2.1s; p=0.04), on the PR schedule. In Experiment 2, sham-intake (p=0.01) and sipping time (p=0.04) were greater for sweet than non-sweet beverages on the PR schedule and a similar, though not conventionally significant, effect was observed for exerted pressure (p=0.09). In both Experiment 2 and Experiment 3 after habitual sleep, on the PR schedule, cumulative pressure difference between sweet and non-sweet beverage increased with difference in amount wanted in the taste test. In contrast, after short sleep participants were less willing to work for sweet taste as their wanting increased, suggesting that sleep deprivation raises desire, but lowers behavioral output. Taken together these results demonstrate that the sipometer and associated ratings are reliable and useful measures of motivation to consume and reward value in humans. Participants were more motivated to obtain access to sweet beverages, especially when these were better liked than to obtain access to non-sweet beverages.

Appetite and body weight regulation after bariatric surgery

Bariatric surgery continues to be remarkably efficient in treating obesity and type 2 diabetes mellitus and a debate has started whether it should remain the last resort only or also be used for the prevention of metabolic diseases. Intense research efforts in humans and rodent models are underway to identify the critical mechanisms underlying the beneficial effects with a view towards non-surgical treatment options. This non-systematic review summarizes and interprets some of this literature, with an emphasis on changes in the controls of appetite. Contrary to earlier views, surgery-induced reduction of energy intake and subsequent weight loss appear to be the main drivers for rapid improvements of glycaemic control. The mechanisms responsible for suppression of appetite, particularly in the face of the large weight loss, are not well understood. Although a number of changes in food choice, taste functions, hedonic evaluation, motivation and self-control have been documented in both humans and rodents after surgery, their importance and relative contribution to diminished appetite has not yet been demonstrated. Furthermore, none of the major candidate mechanisms postulated in mediating surgery-induced changes from the gut and other organs to the brain, such as gut hormones and sensory neuronal pathways, have been confirmed yet. Future research efforts should focus on interventional rather than descriptive approaches in both humans and rodent models.

A mouse model for binge-like sucrose overconsumption: Contribution of enhanced motivation for sweetener consumption

Behavioral and neural features of binge-like sugar overconsumption have been studied using rat models. However, few mouse models are available to examine the interaction between neural and genetic underpinnings of bingeing. In the present study, we first aim to establish a simple mouse model of binge-like sucrose overconsumption using daytime limited access training in food-restricted male mice. Trained mice received 4-h limited access to both 0.5M sucrose solution and chow for 10 days. Three control groups received (1) 4-h sucrose and 20-h chow access, (2) 20-h sucrose and 4-h, or (3) 20-h chow access, respectively. Only the trained group showed progressively increased sucrose consumption during brief periods of time and developed binge-like excessive behavior. Next, we examined whether the present mouse model mimicked a human feature of binge eating known as "eating when not physically hungry." Trained mice consumed significantly more sucrose or non-caloric sweetener (saccharin) during post-training days even after they nocturnally consumed substantial chow prior to daytime sweetener access. In other trained groups, both a systemic administration of glucose and substantial chow consumption prior to the daytime limited sucrose access failed to reduce binge-like sucrose overconsumption. Our results suggest that even when caloric consumption is not necessarily required, limited access training shapes and triggers binge-like overconsumption of sweetened solution in trained mice. The binge-like behavior in trained mice may be mainly due to enhanced hedonic motivation for the sweetener's taste. The present study suggests that our mouse model for binge-like sugar overconsumption may mimic some human features of binge eating and can be used to investigate the roles of neural and genetic mechanisms in binge-like overconsumption of sweetened substances in the absence of physical hunger.

Effect of BMI and binge eating on food reward and energy intake: further evidence for a binge eating subtype of obesity

BACKGROUND

The psychological characteristics of binge eating have been proposed as a phenotype to further understanding of overconsumption and susceptibility to obesity. This study examined the influence of trait binge eating in lean and overweight or obese women on appetite, food reward and energy intake.

METHODS

25 lean and 25 overweight or obese women were categorised as either 'binge type' or 'non-binge type' based on their scores on the Binge Eating Scale. Food reward and food intake were assessed in fasted and fed conditions.

RESULTS

Overweight or obese binge types (O-B) consumed more energy than overweight or obese non-binge types (O-NB) and lean binge (L-B) and non-binge types (L-NB). Both L-B and O-B exhibited greater preference for sweet foods. In O-NB, L-B and L-NB, lower liking and wanting for sweet foods was exhibited in the fed condition compared to the fasted condition. However, in O-B wanting for sweet foods was greater when they were fed compared to when they were in a fasted state.

CONCLUSIONS

These findings provide further support for trait binge eating as a hedonic subtype of obesity. Binge types were characterised by greater intake of high-fat sweet foods and increased wanting for these foods when satiated. Additionally, these findings highlight the potential for separation in liking and wanting for food as a marker of susceptibility to overeat.

Dopamine and food addiction: lexicon badly needed

Over the last few years, the concept of food addiction has become a common feature in the scientific literature, as well as the popular press. Nevertheless, the use of the term addiction to describe pathological aspects of food intake in humans remains controversial, and even among those who affirm the validity of the concept, there is considerable disagreement about its utility for explaining the increasing prevalence of obesity throughout much of the world. An examination of the literature on food addiction indicates that mesolimbic and nigrostriatal dopamine systems often are cited as mechanisms that contribute to the establishment of food addiction. However, in reviewing this literature, it is important to have a detailed consideration of the complex nature of dopaminergic involvement in motivational processes. For example, although it is often stated that mesolimbic dopamine mediates reward, there is no standard or consistent technical meaning of this term. Moreover, there is a persistent tendency to link dopamine transmission with pleasure or hedonia, as opposed to other aspects of motivation or learning. The present article provides a critical discussion of some aspects of the food addiction literature, viewed through the lens of recent findings and current theoretical views of dopaminergic involvement in food motivation. Furthermore, compulsive food intake and binge eating will be considered from an evolutionary perspective, in terms of the motivational subsystems that are involved in adaptive patterns of food consumption and seeking behaviors and a consideration of how these could be altered in pathological conditions.

Can the reinforcing value of food be measured in bulimia nervosa?

Binge eating is a core clinical feature of bulimia nervosa (BN). Enhanced reinforcing value of food may play a role in this behavioral disturbance, but a systematic behavioral assessment of objective measures of the rewarding value of binge eating is lacking. The purpose of this study was to quantify the reinforcing value of food in BN patients as compared with normal controls. A progressive ratio (PR) computerized work task was completed under binge and non-binge instruction. The task consisted of 12 trials. The first trial required 50 keyboard taps to earn one portion of yogurt shake, and subsequent trials required progressive work increments of 200 taps for each additional portion. Completion of all 12 trials required 13,800 taps to earn 2100ml of shake. The breakpoint, defined as the largest ratio completed before a participant stopped working, was the measure of reinforcing efficacy. Ten patients and 10 controls completed the experiment. Under binge instruction, patients completed more trials and taps, and had a higher breakpoint than controls. The non-binge instruction yielded opposite findings; compared to controls, patients completed fewer trials and taps, and had a lower breakpoint. These results support the feasibility and potential utility of a PR task to quantify the reinforcing value of food in patients with BN.

Gastric bypass surgery for obesity decreases the reward value of a sweet-fat stimulus as assessed in a progressive ratio task

BACKGROUND

Obesity is among the leading causes of disease and death. Bariatric surgery is the most effective treatment of obesity. There is increasing evidence that after gastric bypass surgery, patients and animal models show a decreased preference for sweet and fatty foods. The underlying mechanism may include alterations in taste function.

OBJECTIVE

We hypothesize that a gastric bypass reduces the reward value of sweet and fat tastes.

DESIGN

In this prospective case-control study, 11 obese patients who were scheduled to undergo a gastric bypass and 11 normal-weight control subjects in the fed state clicked a computer mouse to receive a sweet and fatty candy on a progressive ratio schedule 10 wk apart (in patients, testing took place 2 wk before and 8 wk after gastric bypass surgery). Subjects worked progressively harder to obtain a food reward (reinforcer) until they stopped clicking (ie, the breakpoint), which was a measure of the reinforcer value. Breakpoints were assessed by the number of mouse clicks in the last completed ratio. The experiment was repeated in a different cohort by using vegetable pieces as the reinforcer.

RESULTS

Breakpoints in the test sessions of control subjects correlated highly for both reinforcers. The median breakpoint for candies, but not vegetables, was reduced by 50% in the obese group after gastric bypass. Patients with the largest reduction in the breakpoint had the largest decrease in BMI.

CONCLUSIONS

Gastric bypass surgery resulted in the selective reduction of the reward value of a sweet and fat tastant. This application of the progressive ratio task provided an objective and reliable evaluation of taste-driven motivated behavior for food stimuli after obesity surgery.

Rationale and consequences of reclassifying obesity as an addictive disorder: neurobiology, food environment and social policy perspectives

The rapid increase in the prevalence of obesity is a priority for investigators from across numerous disciplines, including biology, nutritional science, and public health and policy. In this paper, we systematically examine the premise that common dietary obesity is an addictive disorder, based on the criteria for addiction described in the Diagnostic and Statistical Manual (DSM) of Mental Disorders of the American Psychiatric Association, version IV, and consider the consequences of such a reclassification of obesity for public policy. Specifically, we discuss evidence from both human and animal studies investigating the effects of various types and amounts of food and the food environment in obese individuals. Neurobiological studies have shown that the hedonic brain pathways activated by palatable food overlap considerably with those activated by drugs of abuse and suffer significant deficits after chronic exposure to high-energy diets. Furthermore, food as a stimulus can induce the sensitization, compulsion and relapse patterns observed in individuals who are addicted to illicit drugs. The current food environment encourages these addictive-like behaviors where increased exposure through advertisements, proximity and increased portion sizes are routine. Taking lessons from the tobacco experience, it is clear that reclassifying common dietary obesity as an addictive disorder would necessitate policy changes (e.g., regulatory efforts, economic strategies, and educational approaches). These policies could be instrumental in addressing the obesity epidemic, by encouraging the food industry and the political leadership to collaborate with the scientific and medical community in establishing new and more effective therapeutic approaches.

Food selection and taste changes in humans after Roux-en-Y gastric bypass surgery: a direct-measures approach

It has been suggested that the weight loss seen in individuals who receive Roux-en-Y gastric bypass surgery may be due, at least in part, to changes in patient food selection, and that this change may stem from effects of the operation on the sense of taste. In this review, we evaluate the literature examining postoperative changes in food intake and food choice. While some evidence suggests that gastric bypass leads to altered food selection and taste perceptions, a clear picture regarding these changes remains to be elucidated and is blurred by inconsistencies, which may be rooted in the diverse subject pools within and between studies as well as in the indirect measures used to assess ingestive behavior. We argue that complementing current assessment tools with more direct measures of intake, food selection, and taste-related behavior might help provide some clarity and also facilitate translation between findings from animal models, in which similar measures are available, and clinical research.

Selective reduction in neural responses to high calorie foods following gastric bypass surgery

OBJECTIVE

To investigate changes in neural activation and desire to eat in response to appetitive cues from pre- to postbariatric surgery for obesity.

BACKGROUND

Roux-en-Y gastric bypass (RYGB) is the most common bariatric procedure. However, the mechanisms of action in RYGB are not well understood. A significant proportion of the resulting reduction in caloric intake is unaccounted for by the restrictive and malabsorptive mechanisms and is thought to be mediated by neuroendocrine function. Numerous investigations of postsurgical changes in gut peptides have resulted; however, changes in neural activation after RYGB surgery have not been previously investigated.

METHODS

Functional magnetic resonance imaging and verbal rating scales were used to assess brain activation and desire to eat in response to high- and low-calorie food cues in 10 female patients 1-month pre- and post-RYGB surgery.

RESULTS

Postsurgical reductions in brain activation were found in key areas within the mesolimbic reward pathway, which were significantly more pronounced in response to food cues that were high (vs. low) in caloric density. These changes mirrored concurrent postsurgical reductions in desire to eat, which were also greater in response to food cues that were high versus low in caloric density (P = 0.007).

CONCLUSIONS

Findings support the contention that RYGB surgery leads to substantial changes in neural responses to food cues encountered in the environment, provide a potential mechanism for the selective reduction in preferences for high-calorie foods, and suggest partial neural mediation of changes in caloric intake seen after RYGB surgery.

Neural correlates of individual differences related to appetite

Using neuroimaging technologies to compare normal weight and obese individuals can reveal much about the pathophysiological state of obesity but such comparisons tell us little about what makes some normal weight individuals susceptible to obesity or about important individual differences amongst obese individuals. The current review therefore reviews neuroimaging research on individual difference measures that can illuminate these important topics. After introducing three neuropsychological models of the nature of motivation to approach rewarding stimuli, neuroimaging research on measures of impulsivity, craving, binge eating, restrained eating and disinhibited eating is reviewed. Although neuroimaging research on individual differences measures of brain activity related to appetite is in its infancy, existing studies suggest that such research could enrich the understanding, prevention and treatment of disordered eating and obesity.