Research reportThe influence of restrained and external eating patterns on overeating
Introduction
The phenomenon of food craving (“an irresistible urge to consume a specific food”) (Waters, Hill, & Waller, 2001; Weingarten, 1990) has been implicated as an important factor influencing appetite control (Blundell & Finlayson, 2004; Strachan, Ewing, Frier, Harper, & Daery, 2004; Waters et al., 2001). Positive associations have been shown between food cravings and excessive overeating (Hetherington & Macdiarmid, 1995), BMI (Delahanty, Meigs, Hayden, Williamson, & Nathan, 2002; Rodin, Manuso, Granger, & Nelbach, 1991), snacking behaviour (Basdevant, Craplet, & Guy-Grand, 1993), binge eating and bulimia (Greeno, Wing, & Shiffman, 2000; Waters, Hill, & Waller, 2001) and low compliance with weight reducing programmes (Delahanty et al., 2002). In relation to dietary compliance, sustained adherence to a diet, rather than diet type, has been shown to be the key predictor of weight loss and cardiac risk (factor) reduction (Dansinger, 2005) and this is important in the context of the ever-changing diet climate and industry. Increasing adherence to any one diet shows that the efficacy of weight loss and maintenance programmes will vary between individuals (Hill, 2005) and is a major challenge for public health interventions. Thus, explanations of interpersonal differences in dietary adherence are of importance.
There is evidence of a link between dietary restraint and food craving, with restrained eaters often reporting higher food craving scores and showing higher levels of disinhibition and binge eating than unrestrained eaters (Cepeda-Benito, Fernandez, & Moreno, 2003; Hill, Weaver, & Blundell, 1991; Nammi, Saisudha, Chinnala, & Boini, 2004). The interpretation of scores of restraint, however, has depended very much upon the choice of restraint scale, with different scales reflecting unsuccessful (Three factor eating questionnaire, TFEQ; Revised restraint scale, RSS) or successful (Dutch eating behaviour questionnaire, DEBQ) restraint (Heatherton, Herman, Polivy, King, & McGree, 1988; Lowe, 1993; Mela & Rogers, 1998; Rogers & Smit, 2000). Moreover, the correlation between restraint and food craving incorporates the usual complication of uncertainty over cause and effect. I.e. food cravings may be either a consequence of or part of the aetiology of long-term dietary restraint and/or short term dieting.
The ability of external cues to elicit physiological reactivity, leading to increased food intake, has been extensively investigated (Nederkoorn, Smulders, Havermans, & Jansen, 2004; Nederkoorn, Smulders, & Jansen, 2000; Van Strien & Ouwens, 2003) and cue reactivity/externality is recognised as a salient aspect of eating behaviour, arguably influenced by learning and experience (Gibson, 2001). There is an ongoing discussion of the link between obesity trends and the environment (Cordain et al., 2005; Rogers, 1999) and it is becoming increasingly difficult to resist environmental cues, which may override any homeostatic control of food intake. The interindividual differences in susceptibility to weight gain (Blundell et al., 2005; Maes, Neale, & Eaves, 1997) may be due, in part, to variability in response to environmental triggers (Blundell & Finlayson, 2004). For example, it has been demonstrated that response to a variety of external cues is heightened in restrained eaters (Cools, Schotte, & McNally, 1992; Ogden & Wardle, 1990).
Incentive-associated stimuli are a powerful stimulus for desire, and often effective in reinitiating motivated behaviour. It has been suggested that environmental cues associated with foods that are craved produce neural representations of the craved foods together with a desire to seek and consume the food, explained by Pavlovian and/or instrumental models of food craving (Zellner & Edwards, 2005). For instance, the sight of food can lead to craving, even when in a state of satiation (Cornell, Rodin, & Weingarten, 1989), supporting a conditioned-incentive model of food craving. Alternatively, stimuli that signal food delivery have also been suggested to cause withdrawal and other compensatory-like responses in the same way as drug cues, for example in conditioned cephalic phase insulin release (Brand-Miller, Holt, de Jong, & Petocz, 2003; Teff, 2000; Teff, Levin, & Engelman, 1993), supporting a conditioned-drive model. Moreover, extinction studies where the conditioned stimulus (food cue) is repeatedly presented without the unconditioned stimulus (food) support Pavlovian models. It is well established that highly palatable foods are associated with high hedonics (Blundell et al., 2005; Drewnowski & Greenwood, 1983); thereby providing a rewarding pleasure response. Therefore, anticipation of hedonics (the reinforcing outcome) would be expected to increase craving, supporting an instrumental component (Zellner & Edwards, 2005). The link between externality, conditioning and food craving has been supported by recent evidence of hyperactivity in the orbitofrontal cortex, an area of the cortex involved in stimulus–stimulus association learning, concomitant with the experience of food craving (Rolls, 1999; Uher et al., 2005).
In the light of the above, this study aimed to demonstrate a greater association between food craving and external eating behaviour scores, in comparison with emotional and restrained eating scores, as assessed by the DEBQ. The use of the White FCI (White, Whisenhunt, Williamson, Greenway, & Netemeyer, 2002) as a reliable and valid measure of general and specific food cravings facilitates the investigation of which food groups are paramount in such positive associations. In addition, the study aimed to test a mediation model, in which we expected to see a positive statistical relationship between externality and BMI, explained by a positive association between food craving and both externality and BMI. Thus food craving is hypothesised to be an important intervening causal variable, on a causal pathway between responsivity to environmental cues (which may be of genetic or learned behaviour aetiology) and the development of obesity.
Section snippets
Sample size
As the aim of the current study was to test the individual predictors within a regression model, a sample size of 104+k was estimated, where k is the number of predictors (Green, 1991). In this study, the influences of BMI and gender, along with the DEBQ-measured restraint, external and emotional eating as predictors were explored; thus our sample size was sufficient when considered as a whole. It is clear that this is an oversimplification, as the sample size required will depend on the effect
Results
There were significant differences between cravings for different food groups (P<0.01). The greatest mean craving score was for carbohydrate foods and this was significantly higher than that for sweets (P<0.03), which was significantly greater than the mean craving for fats and fast food fats (P< 0.01; P< 0.01). There was no significant difference between mean scores for fats and fast food fats.
When analysing data by gender (Table 1), a similar trend was seen in males, but this did not reach
Discussion
This study demonstrated firstly heightened association between food craving and external eating scores, in comparison with emotional and restrained eating scores, among a mixed-age sample of both males and females. More specifically this was in relation to total food cravings and cravings for high fat foods in both genders.
Initial correlations of BMI with both total craving and high-fats subscale scores in this study are in agreement with White et al. (2002) in terms of validating the FCI and
Acknowledgements
This study was supported by a BBSRC studentship.
References (53)
- et al.
Snacking patterns in obese French women
Appetite
(1993) - et al.
Is susceptibility to weight gain characterised by homeostatic or hedonic risk factors for overconsumption?
Physiology and Behaviour
(2004) - et al.
Resistance and susceptibility to weight gain: Individual variability in response to a high-fat diet
Physiology and Behavior
(2005) - et al.
Cocoa powder increases postprandial insulinemia in lean young adults
Journal of Nutrition
(2003) - et al.
Relationship of gender and eating disorder symptoms to reported cravings for food: Construct validation of state and trait craving questionnaires in spanish
Appetite
(2003) - et al.
Origins and evolution of the Western diet: Health implications for the 21st century
American Journal of Clinical Nutirtion
(2005) - et al.
Stimulus-induced eating when satiated
Physiology and Behavior
(1989) - et al.
Cream and sugar: Human preferences for high-fat foods
Physiology and Behavior
(1983) - et al.
Menstrual cycle effects in women with premenstrual syndrome
European Neuropsychopharmacology
(1996) - et al.
Pleasure and excess: Liking for and overconsumption of chocolate
Physiology and Behavior
(1995)
Obesity treatment: Does one size fit all?
American Journal of Clinical Nutrition
The experience of food craving: A prospective investigation in healthy women
Journal of Psychosomatic Research
Food craving, dietary restraint and mood
Appetite
Cue reactivity and regulation of food intake
Eating Behaviours
Exposure to binge food in bulimia nervoas: Finger pulse amplitude as a potential measure of urge to eat and predictor of food intake
Appetite
Cephalic phase responses, craving and food intake in normal subjects
Appetite
Cognitive restraint and sensitivity to cues for hunger and satiety
Physiology and Behaviour
Food cravings in young and elderly adults
Appetite
Food cravings in relation to body mass index, restraint and estradiol levels: A repeated measures study in healthy women
Appetite
Food craving and food “addiction”: A critical review of the evidence from a biopsychosocial perspective
Pharmacological Biochemistry and Behavior
Food cravings during acute hypoglycemia in adults with type 2 diabetes
Physiology and Behaviour
Nutritional implications of the cephalic-phase reflexes: Endocrine responses
Appetite
Effect of left prefrontal repetitive transcranial magnetic stimulation on food craving
Biological Psychiatry
Counterregulation in female obese emotional eaters: Schachter, Goldman, and Gordon's (1968) test of psychosomatic theroy revisited
Eating Behaviours
The phenomenology of food cravings
Appetite
Food cravings in a college population
Appetite
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