Identifying the mechanisms through which behavioral weight-loss treatment improves food decision-making in obesity

Abstract

Objectives Behavioral weight loss (BWL) programs are the recommended treatment for obesity, yet it is unknown whether these programs change one’s ability to use self-control in food choices and what specific mechanisms support such change. Using experimental economics methods, we investigated whether changes in dietary behavior in individuals with obesity following BWL are driven by one or more of the following potential mechanisms: changes in the perception of the 1) health or 2) taste of food items, and/or 3) shifting decision weights for health versus taste attributes. Therefore, we compared these mechanisms between obese participants and lifetime normal weight controls (NW) both before and after BWL. Methods Females with obesity (N=37, mean BMI=33.2) completed a food choice task involving health ratings, taste ratings, and decision-making pre- and post-standard BWL intervention. NW controls (N=30, BMI=22.4) completed the same task. Results Individuals with obesity exhibited increased self-control (selecting healthier, less tasty food choices) post-treatment. However, their rates of self-control remained significantly lower than NW. We found no differences in initial health perceptions across groups, and no changes with treatment. In contrast, taste ratings and the relative value of taste versus health decreased following treatment. Although, post-treatment participants continued to perceive unhealthy foods as tastier and used less self-control than NW controls, they showed significant improvements in these domains following a BWL intervention. Conclusions To help individuals improve dietary decisions, additional research is needed to determine how to make greater changes in taste preferences and/or the assignment of value to taste versus health attributes in food choices.

BOLD activity during emotion reappraisal positively correlates with dietary self-control success

“…The difference in self-control success between challenge types is consistent with previous reports, but the pattern of response times differs (Hare et al, 2009;Demos et al, 2017). In previous studies, self-control response times were generally slower or not significantly different than decisions that did not present a self-control challenge.…”

Training in cognitive strategies reduces eating and improves food choice

“…This suggests that ROC-T can be effective despite a greater baseline preference for unhealthy foods. Prior work has shown that higher BMI is associated with greater food cue-reactivity and craving (50), more unhealthy food choices (51), and increased food consumption after depletion (52). However, this work provides additional information about how individuals with high BMI make food choices, and demonstrates no BMI-related differences in the efficacy of cognitive regulation of craving.…”

“…(iii) Importantly, all the food images shown during the Choice Tasks were snack foods because (iv) participants were explicitly told that some choices were going to be selected at random and that they would have to eat some of the food items that they picked. Thus, following prior work (24,25,51), we reinforced the instruction that they should choose only the foods they truly preferred (SI Appendix, SI Methods). Finally, (v) participants only rated craving (to save time), and (vi) during the Choice Tasks, each image was paired with every other image, which resulted in 153 choices, of which 72 compared healthy vs. unhealthy foods, similar to Studies 3 and 4.…”

Changes in food reward during weight management interventions – a systematic review

“…Two main higher‐order constructs were outlined: liking and wanting. ‘Liking’ was the most reported (16 out of 17 studies) and covered two different notions ‘overall palatability’ and ‘liking for a specific food at this moment’ . For the latter notion, ‘liking’ measures were labelled as such in six studies but also included different terms such as ‘tastiness’ ‘food preferences’ , ‘pleasantness’ and ‘palatability’ .…”

“…‘Liking’ was the most reported (16 out of 17 studies) and covered two different notions ‘overall palatability’ and ‘liking for a specific food at this moment’ . For the latter notion, ‘liking’ measures were labelled as such in six studies but also included different terms such as ‘tastiness’ ‘food preferences’ , ‘pleasantness’ and ‘palatability’ . ‘Specific food’ referred to different food labelling such as low/high‐fat , low/high fat and sweet/savoury , healthy/unhealthy , low/high‐carbohydrate , energy dense and low/high‐calorie food .…”