People who were highly responsive to food lost more weight and, more importantly, were able to keep the pounds off more successfully using a new alternative weight-loss intervention that aims to assess a person’s response to internal hunger stimuli and their ability to eat to resist, a team led by experts from the University of California San Diego (UCSD) reported in the May 18, 2022 online issue JAMA network open.
“There are people who react very strongly to food stimuli. That means they can’t resist food and/or can’t stop thinking about food. Behavioral weight loss skills are not sufficient for these individuals, so we developed an alternative approach to address this clinical need,” said first author Kerri N. Boutelle, PhD, professor at UC San Diego in the Herbert Wertheim School of Public Health and Human Longevity Science and in the School of Medicine Department of Pediatrics.
Approximately 74% of adults in the United States are overweight or obese. Behavioral weight loss programs that include calorie counting are top choices. However, not everyone responds and most people regain the weight they lost.
For those who have a hard time resisting food, weight loss can be especially challenging. This responsiveness to food is hereditary as well as shaped by environmental and individual factors.
In the Providing Adult Collaborative Interventions for Ideal Changes (PACIFIC) randomized clinical trial, researchers compared their intervention called Regulation of Cues to a behavioral weight loss program, a control group, and a cohort that combined Regulation of Cues with the behavioral program.
Weight loss was comparable between subjects in both the Regulation of Cues and Behavioral weight loss programs at 24 months.
However, participants in the cue regulation arm stabilized and maintained their weight, while participants in the other groups regained weight during treatment, when clinic visits were reduced to monthly.
“Our results suggest that the appetizing mechanisms targeted by cue regulation may be particularly critical for weight loss in individuals who have difficulty resisting food and could be used in a personalized medicine approach,” said Boutelle.
According to the Centers for Disease Control and Prevention, being overweight and obese are risk factors for heart disease, stroke, type 2 diabetes and some cancers, all of which are among the leading causes of preventable death.
Over a period of 12 months, 271 adults aged 18 to 65 took part in 26 group treatments. They were all asked to get at least 150 minutes of moderate- or vigorous-intensity physical activity per week.
The Regulation of Cues intervention did not prescribe a diet for the participants. Instead, it trained the use of natural cues for when to eat rather than focusing on calories, increased tolerance for cravings, and focused on inhibiting the urge to eat tasty foods when not physically hungry.
Tasty foods—usually foods high in sugar or fat with salt and flavors—stimulate the brain’s reward system and can be particularly difficult to resist.
The control arm offered nutrition education, social support, and mindfulness training. The behavioral weight loss program prescribed a diet, restricted high-calorie foods, increased avoidance of evidence of overeating, and focused on calorie restriction. The combined program integrated the focus on nutrition and energy intake from the behavioral weight loss program with cue management, including addressing hunger cues.
“People who need help with weight loss can enroll in the Regulation of Cues program if behavioral weight loss hasn’t worked for them, if they feel they are having trouble resisting food, or if they are never feel full,” Boutelle said.
Regulation of cues is offered in another randomized clinical trial called Solutions for Hunger and Regulating Eating and at the UC San Diego Center for Healthy Eating and Activity Research, of which Boutelle is a director.
Reference: “Effect of a Novel Intervention Targeting Appetitive Characteristics on Body Mass Index in Overweight or Obese Adults: A Randomized Clinical Trial”, May 18, 2022, JAMA network open.
Co-authors include: Dawn M. Eichen, David R. Strong, Dong-Jin Eastern Kang-Sim, and Cheryl L. Rock, all from UC San Diego; Carol B, Peterson, University of Minnesota; and Bess Marcus, Brown University.
This research was funded in part by the National Institutes of Health (R01DK103554, UL1TR001442).