Appetitive trait interventions may improve weight loss for certain adults
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Interventions based on regulation of cues with or without behavioral weight loss could serve as alternative weight loss approaches for adults who struggle with food responsiveness, according to findings published in JAMA Network Open.
“Regulation of cues (ROC) teaches reliance on internal cues to decrease overeating, whereas behavioral weight loss (BWL) focuses on external management skills to decrease overeating,” Kerri N. Boutelle, PhD, a professor of pediatrics and psychiatry at the University of California, San Diego, and colleagues wrote.
According to Boutelle, BWL alone is not sufficient for individuals with high food responsiveness who are unable to resist food or stop thinking about food. Therefore, the researchers “designed an alternative approach to address this clinical need,” she said in a press release.
Boutelle and colleagues enrolled 271 adults in a randomized clinical trial conducted from December 2015 to December 2019. Participants were enrolled if they were aged 18 to 65 years, had a BMI of 25 to 45 kg/m² and did not meet other exclusion criteria such as having type 2 diabetes.
Among the study cohort, the mean age was 46.97 years, the mean BMI was 34.59 kg/m², 81.6% were women and 61.9% were white. They were randomly assigned to one of four intervention groups: ROC, ROC combined with BWL (referred to as ROC+), BWL or an active comparator.
The interventions included 26 90-minute group treatments with an exercise goal of at least 150 minutes of moderate or vigorous physical activity per week. Specifically, ROC involved psychoeducation, experiential learning, coping skills and self-monitoring, according to Boutelle and colleagues. Active comparator included psychoeducation, assertiveness training, conflict management skill building and mindfulness.
The researchers assessed the efficacy of each approach over 12 months of treatment and 12 months of follow up, with evaluations conducted at baseline, mid-treatment, posttreatment, 6-month follow up and 12-month follow up. Participants received small financial incentives at each evaluation.
Overall, the ROC, ROC+ and BWL interventions resulted in significantly lower BMIs after 12 months (ROC: BMI = 1.18; 95% CI, 2.1 to 0.35; ROC+: BMI = 1.56; 95% CI, 2.43 to -0.67; BWL: BMI = 1.58; 95% CI, 2.45 to 0.71). However, Boutelle and colleagues reported that participants’ BMIs at the end of treatment were not significantly different for the ROC or ROC+ groups compared with BWL. Yet, the BMIs of participants in the active comparator group were substantially higher (BMI = 1.58; 95% CI, 0.72 to 2.45).
In addition, the researchers found that food responsiveness was a moderator of treatment effects, with more weight loss observed among participants who scored higher in food responsiveness in the ROC and ROC+ groups.
“Our findings suggest that the appetitive mechanisms targeted by ROC may be especially critical for weight loss among individuals who have trouble resisting food and could be used in a personalized medicine approach,” Boutelle said.
References:
Boutelle KN, et al. JAMA Netw Open. 2022;doi:10.1001/jamanetworkopen.2022.12354.
New weight-loss intervention targets instinctive desire to eat. https://ucsdnews.ucsd.edu/pressrelease/new-weight-loss-intervention-targets-instinctive-desire-to-eat. Published May 18, 2022. Accessed May 19, 2022.
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Fatima Cody Stanford, MD, MPH, MPA, MBA, FAAP, FACP, FAHA, FAMWA, FTOS
In a recent study in JAMA Network Open, Boutelle and colleagues conducted a randomized controlled trial to evaluate appetitive traits of food responsiveness and satiety responsiveness utilizing a ROC approach. In this study, they determined that the ROC, ROC+ and BWL achieved more weight loss than the active comparator group. This study demonstrates that we should actively listen to patient cues to drive dietary management. However, this is outside of the scope of primary care providers. A typical PCP visit lasts for 15 minutes. In this short time, the PCP must address a host of chronic issues. Additionally, most PCPs are not trained in nutrition. As such, work of this nature will reside in the domain of the registered dietitian (RD). The key lesson for PCPs is to refer to RDs appropriately to ensure their patients get the dietary guidance they deserve.
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