Reducing variety enhances effectiveness of family-based treatment for pediatric obesity
Introduction
Repeated consumption of a food within a meal is associated with habituation and reduction in energy intake for that food (Epstein, Temple, Roemmich, & Bouton, 2009). Presenting a variety of foods slows down the rate of habituation and increases energy intake for high energy or low energy dense foods (Epstein, Robinson, et al., 2009, Temple, Giacomelli, Roemmich and Epstein, 2008). These effects can persist over days, resulting in long-term habituation (Epstein, Carr, Cavanaugh, Paluch, & Bouton, 2011). Obese people consume a greater variety of particular categories of high energy dense foods than leaner peers (McCrory et al., 1999).
Raynor and colleagues have attempted to translate reducing variety into adult weight control. In comparison to recent weight losers, those who showed long-term success consumed less variety in foods, especially for food groups high in fat density (Raynor, Jeffery, Phelan, Hill, & Wing, 2005). From 0 to 6 months, participants in an 18 month behavioral weight loss program showed decreased variety of high-fat foods which was related to weight loss, and maintenance of weight loss (Raynor, Jeffery, Tate, & Wing, 2004). Raynor and colleagues found reduced hedonics but no differences in consumption over four days (Raynor & Wing, 2006) and reduced hedonics but no differences in weight loss over eight weeks for those consuming reduced variety of snack foods (Raynor, Niemeier, & Wing, 2006). Reducing variety of high energy dense snack foods reduced energy intake, but showed no differences in 18 month weight change (Raynor, Steeves, Hecht, Fava, & Wing, 2012).
This study was designed to develop more powerful approaches to translate research on dietary variety to interventions with families building upon laboratory research on habituation (Epstein, Robinson, et al., 2009, Epstein, Temple, Roemmich and Bouton, 2009, Epstein et al., 2011, Temple, Giacomelli, Roemmich and Epstein, 2008) and field/clinical research on variety (Raynor, 2012, Raynor and Wing, 2006, Raynor et al., 2004, Raynor et al., 2005, Raynor et al., 2006, Raynor et al., 2012). This pilot research extends the research by Raynor and colleagues by utilizing a family-based approach for obese children and their parents, which can engage social support to encourage behavior change, by reducing variety across all meals and snacks, rather than focusing only on snacks, and by using leftovers to repeat meals across days and repeat foods over different meal occasions, such as eating leftover dinner for lunch the next day. The aims of the pilot study were to assess effects of variety of both child and parent weight loss, and to assess whether reduced variety of high energy-dense foods was associated with weight loss.
Section snippets
Participants and design
Participating families had 8–12 year-old children over the 85th Body Mass Index (BMI = kg/m2) percentile, who were not taking weight altering drugs, were reading at or above a third grade level, and had one overweight/obese (BMI ≥ 25) parent willing to attend treatment meetings. Neither family member was participating in an alternative weight control program, or had current dietary or exercise restrictions or psychiatric problems. Twenty-four families were randomized to family-based treatment (FBT,
Results
No differences were observed in child or parent characteristics (Table 1). Greater reductions in child percent overweight (p = 0.02) and parent BMI (p = 0.02) were observed for FBT + Variety than FBT (Fig. 1). Changes in child percent overweight and parent BMI were related (r = 0.51, p = 0.018). Average adherence was not different between groups for children (3.1 ± 0.6 vs. 3.4 ± 0.80, p = 0.55) or parents (3.4 ± 0.6 vs. 3.7 ± 0.5, p = 0.33). Group differences in fat calories were observed at the family level (FBT +
Discussion
This pilot study suggests that reducing variety can enhance treatment effects for children and parents participating in FBT. The treatment took advantage of multiple ways to repeat food tastes, and was designed to simplify the process of weight loss, by making shopping easier, and reducing cooking and the number of meals prepared. Limiting variety over multiple food groups, rather than just snacks, and repeating entrees, using leftovers, repeating meal plans and controlling portion size of
Role of funding sources
This research was funded in part by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases UO1 DK088380 awarded to Dr. Epstein. NIDDK had no role in study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the manuscript for publication.
Contributors
LHE designed the study, CK developed the protocol along with LHE, HR and TOD, RAP and LHE conducted statistical analyses, LHE wrote the first draft of the manuscript and all authors contributed to and have approved the final manuscript.
Conflict of interest
Dr. Epstein is a consultant to Kurbo Health. None of the other authors have any conflict of interests to declare.
Acknowledgments
This research was registered at http://www.clinicaltrials.gov as NCT01208870. This research was funded in part by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases UO1 DK088380 awarded to Dr. Epstein. Appreciation is expressed to Jessica O'Neil, Aris Otminski, YanYan Sze, Angela Marusewski, Erin Brewer-Spritzer, Alyssa Melber, and Amanda Sherman for assistance in running the study. Dr. Epstein is a consultant to and has equity in Kurbo. The other authors have no
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