A team reported that people who responded most to food lost more weight and, importantly, were more successful at keeping pounds off using a new alternative weight-loss intervention aimed at improving a person’s response to internal hunger cues and their ability to resist food. Led by experts from UCSD in the May 18, 2022 online issue of JAMA network is open.
“There are individuals who respond very well to dietary guidelines. That is, they cannot resist food and/or cannot stop thinking about food. Behavioral weight loss skills are not sufficient for these individuals, so we designed an alternative approach to meet this clinical need,” said first author Keri N. Butyl. , Ph.D., professor at the University of California, San Diego in the Herbert Werthem School of Public Health and Human Longevity Sciences and in the School of Medicine’s Department of Pediatrics.
Approximately 74% of adults in the United States are overweight or obese. Behavioral weight loss programs, which include counting calories, were the first treatment. But not everyone responds, and most people regain the weight they lost.
For those who find it difficult to resist food, losing weight can be quite a challenge. This nutritional response is genetic and shaped by both environmental and individual factors.
In the Randomized Clinical Trial to Provide Adult Collaborative Interventions for Perfect Changes (PACIFIC), researchers compared their intervention, called cue-regulation, with a behavioral weight loss program, a control group, and a control group combining cue-regulation and a behavioral program.
Weight loss was comparable after 24 months between individuals in both the signaling list and the behavioral weight loss program.
However, participants in the “signaling regulation” stabilized their weight and kept it off while participants in the other groups regained their weight mid-treatment when clinic visits were reduced to monthly.
“Our findings suggest that the mechanisms of appetite targeted by the signaling list may be particularly critical for weight loss among individuals who have difficulty with food resistance and could be used in a personalized medicine approach,” Butell said.
According to the Centers for Disease Control and Prevention, overweight and obesity are risk factors for heart disease, stroke, type 2 diabetes, and some types of cancer, all of which are among the leading causes of preventable death.
Over a 12-month period, 271 adults aged 18 to 65 years attended 26 group therapy sessions. All were asked to do at least 150 minutes of moderate or vigorous physical activity per week.
The signaling regulation intervention did not prescribe diet participants. Instead, she trained to use natural cues about when to eat instead of focusing on calories, boosted tolerance to cravings, and focused on blocking urges to eat palatable foods when you’re not physically hungry.
Palatable foods – usually foods that contain large amounts of sugar or fat with added salt and flavors – stimulate the brain’s reward system and can be especially difficult to resist.
The control arm provided nutritional education, social support, and mental training. A behavioral weight loss program described a diet, calorie-restricted foods, reinforced avoidance of overeating, and an emphasis on calorie restriction. The combined program combined a focus on diet and energy intake from a behavioral weight loss program with regulating cues, including hunger cues for management.
“Individuals who need help losing weight can seek out a ‘signal regulation’ program if behavioral weight loss doesn’t work for them, if they feel they have difficulty resisting eating, or if they never feel full,” Butell said.
Signal regulation is being presented in another randomized clinical trial called Hunger Solutions and Eating Regulation and at the University of California, San Diego Center for Healthy Eating and Activity Research, which is being administered by Buttel.
Co-authors are: Dawn M. Eichen, David R. Strong, Dong-Jin Eastern Kang-Sim, Cheryl L. Rock, all from UC San Diego; Carol B, Peterson, University of Minnesota; WBS Marcus, Brown University.
This research was funded in part by the National Institutes of Health (R01DK103554, UL1TR001442).