Managing temptation in obesity treatment: A neurobehavioral model of intervention strategies

Abstract

Weight loss outcomes in lifestyle interventions for obesity are primarily a function of sustained adherence to a reduced-energy diet, and most lapses in diet adherence are precipitated by temptation from palatable food. The high nonresponse and relapse rates of lifestyle interventions suggest that current temptation management approaches may be insufficient for most participants. In this conceptual review, we discuss three neurobehavioral processes (attentional bias, temporal discounting, and the cold-hot empathy gap) that emerge during temptation and contribute to lapses in diet adherence. Characterizing the neurobehavioral profile of temptation highlights an important distinction between temptation resistance strategies aimed at overcoming temptation while it is experienced, and temptation prevention strategies that seek to avoid or minimize exposure to tempting stimuli. Many temptation resistance and temptation prevention strategies heavily rely on executive functions mediated by prefrontal systems that are prone to disruption by common occurrences such as stress, insufficient sleep, and even exposure to tempting stimuli. In contrast, commitment strategies are a set of devices that enable individuals to manage temptation by constraining their future choices, without placing heavy demands on executive functions. These concepts are synthesized in a conceptual model that categorizes temptation management approaches based on their intended effects on reward processing and degree of reliance on executive functions. We conclude by discussing the implications of our model for strengthening temptation management approaches in future lifestyle interventions, tailoring these approaches based on key individual difference variables, and suggesting high-priority topics for future research.

Keywords: Commitment; Diet adherence; Executive function; Food reward; Lifestyle intervention; Obesity; Temporal discounting.

Figure 1

Due to hyperbolic temporal discounting, an individual’s preference for a large, delayed reward (e.g., weight control) can reverse if a smaller but immediate reward (e.g., dessert) becomes available. These preference reversals (occurring at the intersection of the two valuation curves), are characteristic of impulsive, short-sighted decisions.

Figure 2

Diagram of dietary lapses under temptation. Encountering palatable food cues elicits enhanced attentional focus on food, and “hot” visceral states associated with a preference for immediate gratification. Due to the cold-hot empathy gap, individuals have difficulty appreciating these changes in advance. It is as though multiple selves (current and future) with competing priorities and different behavioral tendencies exist within the same individual at different times. Different sets of temptation management strategies are likely to be effective in cold versus hot states.