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

A systematic review of interventions targeting modifiable factors that impact dietary intake in athletes

Appropriate dietary intake has been found to positively impact athletes' performance, body composition and recovery from exercise. Strategies to optimise dietary intake often involve targeting one or more of the many factors that are known to influence dietary intake. This review aims to investigate the types and effectiveness of interventions used to impact modifiable factors of dietary intake in athletes. MEDLINE, CINAHL, SPORTDiscus and Web of Science were searched from inception to May 2022 for intervention studies that measured dietary intake with a quantitative tool and explored at least one factor thought to influence the dietary intake of adult athletes. Study quality was assessed using the ADA Quality Criteria Checklist: Primary Research. Twenty-four studies were included. The most common interventions focused on nutrition education (n 10), macronutrient adjustment (n 7) and physical activity (n 5). The three most common factors thought to influence dietary intake addressed were nutrition knowledge (n 12), hunger and appetite (n 8), and body composition (n 4). Significant changes in dietary intake were found in sixteen studies, with nutrition education interventions returning significant results in the largest proportion of studies (n 8). Study quality within this review was mostly average (n 4 < 50 %, n 19 50-80 %, n 1 > 80 %). As studies included were published between 1992 and 2021, interventions and factors explored in older studies may require up-to-date research to investigate possible differences in results due to time-related confounders.

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.

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.

Four main barriers to weight loss maintenance? A quantitative analysis of difficulties experienced by obese patients after successful weight reduction

BACKGROUND

Weight maintenance remains to be a challenge for patients in a reduced obese state and it has been recommended to provide them more individualized support. For this purpose it is crucial to understand the barriers patients are experiencing after weight loss. Many have been identified by qualitative studies. We evaluated if a quantitative assessment of patient perspective during weight maintenance can help identify major barriers that refer to actual regain.

METHODS

Follow-up data were analyzed from patients attempting weight maintenances after successful completion of a nonsurgical weight loss and lifestyle intervention for morbid obesity. The data were acquired at mandatory follow-up assessments and included rating of 26 probable difficulties. A principal component analysis was carried out to explore whether these difficulties could be grouped into meaningful factors. Associations with socio-demographics, follow-up time, and weight changes were evaluated.

RESULTS

Data from 88 out of 102 patients were available (baseline BMI 49.5 ± 7.4 kg/m²; 12-month weight loss 24.3 ± 9.6%; follow-up time 1.48 ± 0.6 years). Four solid factors, composed of 21 items and explaining 56% of the variance were extracted and interpreted as 'Hedonic Hunger', 'Mental Distress', 'Binge Eating', and 'Demoralization'. Weight regain (12.4 ± 12%) was correlated with each factor, most closely with 'Mental Distress' (r = 0.38). When controlling for age and follow-up time, 'Binge Eating' was the most important predictor (adj. R² = 0.297).

CONCLUSIONS

A quantitative assessment of patient perspective during the first years after weight loss can help identify valid barriers to weight loss maintenance.

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.

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.

Evaluation of a Lifestyle Change Worksite Weight Management Program Across Multiple Employers and Sites

OBJECTIVE

The aim of the study was to assess weight loss outcomes among participants (N = 1090) of a weight management program across multiple worksites (N = 10) in a retrospective analysis.

METHODS

Weekly classes focused on diet, exercise, and behavior change. One employer provided incentives for weight loss and two incentivized weight loss and class attendance.

RESULTS

Mean weight loss (N = 1090; 79.3% female) was -2.9% (SD = 3.0%). Average number of classes attended was 6.87/10 (SD = 2.9) and was significantly correlated with percent weight change (r = -0.46; P < 0.001). Participants incentivized for attendance attended significantly more classes (M = 7.5, SD = 2.8) than did those not so incentivized (M = 6.4, SD = 2.9, P < 0.001), but did not lose more weight (P = 0.24). Participants incentivized for weight loss did not lose significantly more weight than those not so incentivized (P = 0.26).

CONCLUSIONS

These data support the effectiveness of this worksite program. Utilizing incentives to promote class attendance may be beneficial for increasing engagement in similar programs.

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.

Psychometric Evaluation of Dietary Self-Efficacy and Outcome Expectation Scales in Female College Freshmen

Lifestyle interventions commonly measure psychosocial beliefs as precursors to positive behavior change, but often overlook questionnaire validation. This can affect measurement accuracy if the survey has been developed for a different population, as differing behavioral influences may affect instrument validity. The present study aimed to explore psychometric properties of self-efficacy and outcome expectation scales—originally developed for younger children—in a population of female college freshmen ( N = 268). Exploratory principal component analysis was used to investigate underlying data patterns and assess validity of previously published subscales. Composite scores for reliable subscales (Cronbach’s α ≥ .70) were calculated to help characterize self-efficacy and outcome expectation beliefs in this population. The outcome expectation factor structure clearly comprised of positive (α = .81-.90) and negative outcomes (α = .63-.67). The self-efficacy factor structure included themes of motivation and effort (α = .75-.94), but items pertaining to hunger and availability cross-loaded often. Based on cross-loading patterns and low Cronbach’s alpha values, respectively, self-efficacy items regarding barriers to healthy eating and negative outcome expectation items should be refined to improve reliability. Composite scores suggested that eating healthfully was associated with positive outcomes, but self-efficacy to do so was lower. Thus, dietary interventions for college students may be more successful by including skill-building activities to enhance self-efficacy and increase the likelihood of behavior change.