Elsevier

Physiology & Behavior

Volume 224, 1 October 2020, 113018
Physiology & Behavior

Appetitive traits as targets for weight loss: The role of food cue responsiveness and satiety responsiveness

https://doi.org/10.1016/j.physbeh.2020.113018Get rights and content

Highlights

  • Some individuals have a susceptibility to overeat in today's food environment.

  • Food cue responsiveness and satiety responsiveness are important appetitive traits.

  • Both appetitive traits are related to overeating and weight gain.

  • Satiety responsiveness has been linked to weight loss maintenance.

  • Regulation of Cues program targets food cue responsiveness and satiety responsiveness.

Abstract

Individuals with overweight or obesity (OW/OB) are at increased risk for significant physical and psychological comorbidities. The current treatment for OW/OB is behavioral weight loss, which provides psychoeducation on nutrition and physical activity, as well as behavior therapy skills. However, behavioral weight loss is not effective for the majority of the individuals who participate. Research suggests that overeating, or eating past nutritional needs, is one of the leading causes of weight gain. Accumulating evidence suggests that appetitive traits, such as food cue responsiveness and satiety responsiveness, are associated with overeating and weight in youth and adults. The following review presents the current literature on the relationship between food cue responsiveness, satiety responsiveness, overeating, and OW/OB. Research suggests that higher food cue responsiveness and lower satiety responsiveness are associated with overeating and OW/OB cross-sectionally and longitudinally. Emerging data suggest that food cue responsiveness and satiety responsiveness may exist along the same continuum and can be targeted to manage overeating and reduce weight. We have developed a treatment model targeting food cue responsiveness and satiety responsiveness to reduce overeating and weight and have preliminary feasibility, acceptability, and efficacy data, with testing currently being conducted in larger trials. Through programs targeting appetitive traits we hope to develop an alternative weight loss model to assist individuals with a propensity to overeat.

Introduction

Obesity is highly prevalent in the United States as approximately one third of children and two thirds of adults have overweight or obesity (OW/OB). [1,2] OW/OB is associated with cardiovascular disease, type 2 diabetes, cancer, osteoarthritis, psychological impairment, poor quality of life and all-cause mortality. [3,4] Medical care for individuals with OB costs nearly $150 billion across the United States, [5] and these costs are expected to rise by $48–66 billion per year by the year 2030. [6] Considering the high prevalence rates, rising medical costs, and significant comorbidities, it is essential that more potent models are developed to treat OW/OB effectively.

The current empirically supported treatment for adults with OW/OB is behavioral weight loss (BWL). [7], [8], [9], [10], [11], [12] BWL includes dietary and caloric recommendations, guidelines for physical activity, and behavior therapy skills to adhere to treatment recommendations. Although BWL is effective and provides clinically significant weight loss for some adults, [10] BWL is not effective for all individuals. Up to 50% of participants in BWL treatment programs fail to achieve meaningful weight loss. [11] Moreover, BWL is even less effective in providing long-term weight-loss maintenance, as 65% of participants no longer meet the initial 7% weight-loss goal 4 years post-treatment. [12] These results could be due to heterogeneity and a lack of consideration for individual characteristics that can impact treatment response. [13,14] Thus, it is imperative to understand the individual characteristics that predict treatment outcomes in the short and long term, and to develop novel treatments to address mechanisms associated with non-response.

Eating past nutritional needs, or overeating, is one of the most proximal drivers of OB rates [15,16] and is considered more important than metabolic changes. [17], [18], [19] Rates of overeating are especially high in OW/OB samples, with up to 80% of adults with OW/OB endorsing overeating regularly. [20] Overeating is a complex process which is influenced by individual behavior, the environment, genes, physiology, and neural processes. However, societal advances have created an “obesogenic” environment that encourages excess energy intake and discourages energy expenditure. [21], [22], [23], [24] Calorically dense foods are easily available, highly variable, tasty, relatively inexpensive, and portable. [25], [26], [27], [28], [29] Overeating in today's environment is incredibly easy, especially for those who have a propensity to overeat.

Section snippets

Behavioral Susceptibility to Overeating

Interestingly, not everyone who lives in this environment has OW/OB. In fact, within the same family there can be weight discordant children. It is possible that some individuals have a behavioral susceptibility to overeat. Behavioral susceptibility was first described by Stanley Schachter who hypothesized that individuals with OW/OB, compared to individuals with a healthy weight, are more reactive to external cues to eat and less sensitive to internal satiety signals. [30,31] Jane Wardle and

Assessments of Food Cue Responsiveness (FR) and Satiety Responsiveness (SR)

A variety of measures exist that assess FR and SR. Jane Wardle and colleagues developed the Child Eating Behavior Questionnaire (CEBQ) [41] several years before the BST was formally articulated. The CEBQ was initially designed to be a parent report of children's eating and includes 8 subscales: FR, SR, emotional over-eating, enjoyment of food, desire to drink, slowness in eating, emotional under-eating and food fussiness. The FR subscale includes four items that assess desires to eat outside of

Development of Food Cue Responsiveness (FR)

Changes in FR over time are considered a product of both genetic and environmental influences. Emerging quantitative genetic modeling suggests that FR may be up to 75% heritable, [77] with the most evidence to date focusing on the “high risk” FTO alleles at rs9939609 in children. [78] Presence of this FTO minor allele at rs9939609 was associated with greater consumption during an EAH task compared with children without any risk allele in multiple samples. [79], [80], [81] As these studies were

Development of Satiety Responsiveness (SR)

Conceptually, individuals will continue to eat in response to conditioned food-related cues until the intake is terminated by interoceptive satiety cues, [97] suggesting that SR is an inhibitory mechanism. SR develops early in life and is also considered to be the result of an interaction of genetic influences and factors in the environment. Several studies suggest that SR could be up to 63–72% heritable. [77,98] Genetic mutations (e.g., in the leptin gene and melanocortin 4 receptor (MC4R)

Relationship Between Appetitive Traits, Eating Behavior, and Body Weight

In both children and adults, studies suggest that FR is associated with greater food consumption, while SR is associated with less food consumption. In children, higher FR was related to faster eating rate and increased energy intake during an EAH paradigm, while higher SR was associated with lower energy intake during the EAH paradigm and lower overall energy intake measured across 5 days. [42] The Gemini Birth Cohort collected data from over 1000 families with children 16 to 21 months old and

Treatment Development of a Program Designed to Target FR and SR

Based on the theory and existing literature, we believe that FR and SR are emerging, important variables related to overeating and OW/OB and could be potential mechanisms for the development of a novel model for weight loss. We developed a treatment program that specifically targets both FR and SR, called Regulation of Cues (ROC). To target improvement in SR, we adapted Appetite Awareness Training (AAT). AAT focuses on rating hunger and satiety and learning to stop eating when physically full

Conclusion

In summary, we believe that FR and SR are important variables related to overeating and weight gain, and it is possible that these two appetitive characteristics may exist along the same continuum. We have outlined the methods for the development of these appetitive traits and how they contribute to overeating in the current food environment. In particular, we have outlined options for intervening with these two mechanisms, by focusing on improving SR by training participants to respond to

Funding

Research reported in this publication was supported by the National Institute Of Diabetes And Digestive and Kidney Diseases of the National Institutes of Health and the Department of Defense under Award Numbers: R01DK103554, R01DK094475, DOD W81XWH-18–1–0220, R01DK114794, K23DK114480. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Department of Defense.

Acknowledgements

This manuscript is based on work presented during the 2019 Annual Meeting of the Society for the Study of Ingestive Behavior, July 9–13, 2019 in Utrecht, Netherlands.

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