Weakened biological signals: Highly-developed eating schemas amongst women are associated with maladaptive patterns of comfort food consumption

Evidence-Based Digital Tools for Weight Loss Maintenance: The NoHoW Project

BACKGROUND

Effective interventions and commercial programmes for weight loss (WL) are widely available, but most people regain weight. Few effective WL maintenance (WLM) solutions exist. The most promising evidence-based behaviour change techniques for WLM are self-monitoring, goal setting, action planning and control, building self-efficacy, and techniques that promote autonomous motivation (e.g., provide choice). Stress management and emotion regulation techniques show potential for prevention of relapse and weight regain. Digital technologies (including networked-wireless tracking technologies, online tools and smartphone apps, multimedia resources, and internet-based support) offer attractive tools for teaching and supporting long-term behaviour change techniques. However, many digital offerings for weight management tend not to include evidence-based content and the evidence base is still limited. The Project: First, the project examined why, when, and how many European citizens make WL and WLM attempts and how successful they are. Second, the project employed the most up-to-date behavioural science research to develop a digital toolkit for WLM based on 2 key conditions, i.e., self-management (self-regulation and motivation) of behaviour and self-management of emotional responses for WLM. Then, the NoHoW trial tested the efficacy of this digital toolkit in adults who achieved clinically significant (≥5%) WL in the previous 12 months (initial BMI ≥25). The primary outcome was change in weight (kg) at 12 months from baseline. Secondary outcomes included biological, psychological, and behavioural moderators and mediators of long-term energy balance (EB) behaviours, and user experience, acceptability, and cost-effectiveness.

IMPACT

The project will directly feed results from studies on European consumer behaviour, design and evaluation of digital toolkits self-management of EB behaviours into development of new products and services for WLM and digital health. The project has developed a framework and digital architecture for interventions in the context of EB tracking and will generate results that will help inform the next generation of personalised interventions for effective self-management of weight and health.

The NoHoW protocol: a multicentre 2×2 factorial randomised controlled trial investigating an evidence-based digital toolkit for weight loss maintenance in European adults

INTRODUCTION

Obesity and associated diseases place a severe burden on healthcare systems. Behavioural interventions for weight loss (WL) are successful in the short term but often result in weight regain over time. Self-regulation of eating and activity behaviours may significantly enhance weight loss maintenance (WLM) and may be effectively augmented by contextual behavioural approaches to emotion regulation. The NoHoW trial tests the efficacy of a theoretically informed, evidence-based digital toolkit using a mobile-enabled website, activity trackers and Wi-Fi scales for WLM aiming to target (1) self-regulation and motivation, and (2) emotion regulation in adults who achieved clinically significant (≥5%) WL in the previous 12 months (initial body mass index (BMI) ≥25 kg/m²).

METHODS AND ANALYSIS

The study is an 18-month, 3-centre, 2×2 factorial single-blind, randomised controlled trial, which recruited 1627 participants achieving ≥5% WL between March 2017 and March 2018. Participants are randomly allocated to one of four arms: (1) self-monitoring only (self-weighing and activity tracker), (2) self-regulation and motivation, (3) emotion regulation or (4) combined self-regulation, motivation and emotion regulation. Participants attend four clinical investigation days at 0, 6, 12 and 18 months and are instructed to use the digital toolkit for 18 weeks during the first 6 months and at their discretion for the remaining 12 months. The primary outcome is change in weight (kg) at 12 months from baseline. Secondary outcomes are body composition (eg, bioimpedance analysis), health biomarkers (glycated haemoglobin, lipids, blood pressure, hair cortisol), dietary intake, physical activity, sleep, motivational, self-regulatory, emotion regulatory moderators/mediators of WLM, engagement, user experience, acceptability and cost-effectiveness of the interventions.

ETHICS AND DISSEMINATION

Ethical approval was granted by Institutional Ethics Committees at the Universities of Leeds (17-0082; 27 February 2017), Lisbon (17/2016; 20 February 2017) and Capital Region of Denmark (H-16030495, 8 March 2017). Results will be published in scientific journals.

TRIAL REGISTRATION NUMBER

ISRCTN88405328.

The association of conformity to feminine norms with women's food consumption after a negative mood induction

The current study examined the relation between women's food intake and their conformity to feminine norms after a negative mood induction, as well as the potential moderating role of expressive suppression. Female participants (N = 197) watched a sad movie clip, partook in a taste test in which they consumed potato chips and chocolate, and completed a survey with questions designed to assess conformity to feminine norms and the use of expressive suppression in daily life. Regression analyses revealed that increased conformity to the feminine norm of modesty was associated with reduced food intake, whereas conformity to the feminine norms of thinness and appearance were not. Expressive suppression did not moderate any of these relations. Overall, this study affirms the importance of understanding how overarching cultural norms such as femininity influence women's food consumption.

Emotional reinforcement as a protective factor for healthy eating in home settings

BACKGROUND

According to the literature, meals consumed at home are healthier than those consumed away from home (AFH), but reasons underlying this protective effect have not been fully understood. Emotional reinforcement of healthy eating patterns at home is examined as a putative contributing mechanism.

OBJECTIVE

This study examined expectations for within-individual emotional reinforcement of healthy eating at home, reflected in reports of 1) more intense positive and less intense negative affects after healthier meals than at baseline at home (and not in AFH settings) and 2) more intense positive and less intense negative affects reported before a meal being predictive of healthier meals than at baseline at home (and not in AFH settings).

DESIGN

A total of 160 nonobese women reported their eating behavior and momentary emotional states every 2 h, 6 times/d over 10 observation days. We examined observations with meals (breakfast, lunch, or dinner). The participants indicated how momentary eating patterns compared with their own baseline eating patterns (healthier, equal, or less healthy). Concurrent (after meal) and lagged (before meal) emotion scores were specified.

RESULTS

At-home meals were followed by more intense positive emotions and less worry than were AFH meals. As expected, home meals that were healthier than a person's baseline meals were followed by more intense positive emotions, with a relation of opposite direction being observed in AFH settings. At home, more intense premeal positive emotions cued healthier next-meal eating patterns than did those at baseline, with no such relation being observed in AFH settings.

CONCLUSION

The home is a privileged environment that nurtures healthy eating and in which healthier food choices trigger and are triggered by more positive emotions.

Psychosocial stressor effects on cortisol and ghrelin in emotional and non-emotional eaters: influence of anger and shame

Food consumption in stressful situations vary as a function of individual difference factors (e.g., emotional vs. non-emotional eating), and may be related to hormonal responses elicited by the stressful event. These hormonal responses may be tied to specific emotions elicited by the stressful event. The present investigation examined the emotional and hormonal (cortisol, ghrelin) responses of high and low emotional eaters following a laboratory stressor (Trier Social Stress Test; TSST). Women (n=48) either high or low in emotional eating status were tested in a TSST or served as controls during which blood samples were taken for analysis of cortisol and ghrelin, both of which have been implicated in eating and in response to stressors. The TSST promoted elevated cortisol levels, being somewhat more pronounced in emotional than in non-emotional eaters. Both shame and anger were provoked by the TSST, and although both these emotions were correlated with cortisol levels, only anger significantly mediated the relationship between the stressor and cortisol levels. As well, baseline ghrelin levels in low emotional eaters exceeded that of high emotional eaters, and increased moderately in response to the stressor situation, irrespective of emotional eating status. Interestingly, when provided with food, ghrelin levels declined in the non-emotional eaters, but not in emotional eaters. The possibility is offered that the lack of a decline of ghrelin in emotional eaters may sustain eating in these individuals.

Feeding Your Feelings: Emotion Regulation Strategies and Emotional Eating

The process by which emotions affect eating behavior emerges as one of the central unresolved questions in the field of emotional eating. The present studies address the hypothesis that the regulation strategies people use to deal with these emotions are responsible for increased eating. Negative emotions were induced and intake of comfort food and non—comfort food was measured by means of taste tests. Emotion induction was preceded by measuring individual differences in emotion regulation strategies (Study 1) or by instructions to regulate emotions in either an adaptive (reappraisal) or maladaptive (suppression) manner (Study 2). Study 3 also entailed a control condition without any regulation instructions. Relative to reappraisal and spontaneous expression, suppression led to increased food intake, but only of the comfort foods. Emotions themselves were not responsible for this effect. These findings provide new evidence that the way in which emotions are regulated affects eating behavior.

Sustained self-regulation of energy intake. Loss of weight in overweight subjects. Maintenance of weight in normal-weight subjects

Background

Dietary restraint is largely unsuccessful for controlling obesity. As an alternative, subjects can easily be trained to reliably recognize sensations of initial hunger (IH) a set of physiological sensations which emerge spontaneously, not necessarily at planned mealtimes, and may be the afferent arm of a homeostatic system of food intake regulation. Previously we have reported that IH is associated with blood glucose concentration (BG) below 81.8 mg/dL (4.55 mmol/l), (low blood glucose, LBG), and that a pattern of meals in which IH is present pre-meal (IHMP) improved insulin sensitivity, HbA1c and other cardiovascular risk factors. Here we report the effect upon weight in overweight and normal weight subjects.

Objective

To investigate whether the IHMP is associated with sustained loss of weight in overweight subjects over a 5 month period.

Methods

Seventy four overweight subjects (OW: BMI > 25) and 107 normal weight (NW) subjects were randomly allocated to either trained (OW: N = 51; NW N = 79) or control (OW: N = 23; NW: N = 28) groups. All subjects were allocated post-randomization into either low or high mean pre-meal BG groups (LBG and HBG groups) using a demarcation point of 81.8 mg/dL.

Results

A significant longitudinal decrease was found in body weight (trained NW: -2.5 ± 4.6 kg; OW -6.7 ± 4.5 kg; controls: NW +3.5 ± 4.0 kg and OW -3.4 ± 4.0 kg; P = 0.006 and 0.029) and in energy intake, mean BG, standard deviation of diary BG (BG as recorded by subjects' 7-day diary), BMI, and arm and leg skin-fold thickness in (OW and NW) HBG subjects. OW LBG subjects significantly decreased body weight (trained: -4.0 ± 2.4 kg; controls: -0.4 ± 3.7 kg; P = 0.037). 26 NW LBG subjects showed no longitudinal difference after training as did 9 control subjects.

Conclusion

Over a 5 month period the IHMP resulted in significant loss of weight in OW subjects compared to controls practicing dietary restraint. NW subjects maintained weight overall, however NW HBG subjects also lost weight compared to controls.