Treat or Enhance Cognitive Restraint in Individuals Suffering from Overweight or Obesity? Systematic Revue of the Literature

Abstract

Prior to 1975, the scientific literature mainly used to compare obese with normal-weight subjects or subjects with or without an eating disorder. This period was followed by the emergence of "unrestrained eaters", who have "normal" eating behaviors versus "restrained eaters", who are normal-weight individuals with similar eating behavioral patterns than those of obese people [2]. After this first observation, the definition of a "restrained eater" has developed and came into a consensus: it describes someone who constantly deliberately controls his food intake in order to maintain or lose weight [3]. This person could have a normal bodyweight, be overweight or even obese and the dietary control could be efficient or ineffective [4]. Here, the intention to control food intake is the main characteristic. It is not surprising that CR is most often identified in individuals AbstractCognitive Restraint, a mind control over food intake in order to lose or maintain weight, leads to harmful consequences in individuals suffering from overweight or obesity. These consequences include an alteration of internal perceptions of hunger and satiety, a disinhibition, an emotional dysregulation and a decrease in selfesteem and body satisfaction. Nevertheless, the systematic review on the subject highlights a lack of consensus. In fact, many studies suggest that flexible control, or even an increase in self-control could be efficient to lose weight and improve an individual's psychological factors. After presenting each point of view and its arguments as well as the internal validity of studies, we will discuss promising future research perspectives.

Interaction between Vegetarian Versus Omnivorous Diet and Unhealthy Eating Patterns (Orthorexia Nervosa, Cognitive Restraint) and Body Mass Index in Adults

“…Contrary to our hypothesis, we reported that omnivorous diet and cognitive restraint were directly related. Cognitive restraint could lead to an alteration of internal perceptions of hunger and satiety and/or a disinhibition [14], therefore, it can be hypothesized that cognitive restraint in individuals following an omnivorous diet may indicate disordered eating behaviors or maladaptive eating-related attitudes.…”

“…Disordered eating is characterized by a disturbed and unhealthy eating pattern that can include restrictive dieting, compulsive eating or skipping meals [13]. Cognitive restraint is defined as the intention to constantly deliberately control food intake in order to maintain or lose weight [14]. This leads to a reduction in the intake of specific macronutrients (e.g., fats or carbohydrates) or types of foods, and not to a reduction in overall caloric intake [15].…”

“…Cognitive restraint is frequently used as a marker of pathological eating behaviors [16]. Consequences of cognitive restraint are associated with: (a) dysregulation of internal perceptions of hunger and satiety which is followed by four consecutive phases: (1) low cognitive restraint-perceived food sensations and emotions and deliberately ignorance of sensations; (2) moderate cognitive restraint-perceived food sensations and emotions and lack of following the sensations due to induced negative emotions; (3) severe cognitive restraint-not perceived food sensations and emotions and struggle with maintenance of mental control (not surrendering to the emotions induction); (4) decompensated cognitive restraint-not perceived food sensations and emotions and the eating behavior is under the control of not food-evoked emotions and induced emotions; (b) disinhibition which results in the growth in food consumption (overeating); (c) emotional dysregulation-individuals that use cognitive restraint fail to reduce their anxiety levels by eating and their eating behaviors are completely managed by not food-evoked emotions or induced by food (four consecutive phases of cognitive restraint); and (d) low self-esteem and low body satisfaction [14]. Previous studies have shown the link between vegetarianism and eating-related pathology [16].…”

Relation between cognitive restraint and weight: Does a content validity problem lead to a wrong axis of care?

“…Cognitive restraint (CR) is the intention to control food intake in order to maintain or lose weight. [1][2][3] The impact of CR on weight is controversial. Many studies have shown a correlation between weight or body mass index (BMI) and CR, either negative 4,5 or positive.…”

“…It explains that restrained eaters develop an alteration in the internal perception of hunger and satiety, disinhibition, emotional dysregulation and a decrease of self-esteem and body satisfaction. 3,[7][8][9] However, many studies have shown the opposite and have therefore promoted the increase of CR to treat overweight and obesity. 10 The question still remains: should we reduce or increase CR in people affected with overweight or obesity?…”