Identifying the mechanisms through which behavioral weight-loss treatment improves food decision-making in obesity

Abstract

Objectives: Behavioral weight loss (BWL) programs are the recommended treatment for obesity, yet it is unknown whether these programs change one's ability to use self-control in food choices and what specific mechanisms support such change. Using experimental economics methods, we investigated whether changes in dietary behavior in individuals with obesity following BWL are driven by one or more of the following potential mechanisms: changes in the perception of the 1) health or 2) taste of food items, and/or 3) shifting decision weights for health versus taste attributes. Therefore, we compared these mechanisms between obese participants and lifetime normal weight controls (NW) both before and after BWL.

Methods: Females with obesity (N = 37, mean BMI = 33.2) completed a food choice task involving health ratings, taste ratings, and decision-making pre- and post-standard BWL intervention. NW controls (N = 30, BMI = 22.4) completed the same task.

Results: Individuals with obesity exhibited increased self-control (selecting healthier, less tasty food choices) post-treatment. However, their rates of self-control remained significantly lower than NW. We found no differences in initial health perceptions across groups, and no changes with treatment. In contrast, taste ratings and the relative value of taste versus health decreased following treatment. Although, post-treatment participants continued to perceive unhealthy foods as tastier and used less self-control than NW controls, they showed significant improvements in these domains following a BWL intervention.

Conclusions: To help individuals improve dietary decisions, additional research is needed to determine how to make greater changes in taste preferences and/or the assignment of value to taste versus health attributes in food choices.

Keywords: Behavioral economics; Behavioral weight loss intervention; Decision-making; Obesity; Treatment.

Figure 1

Frequency of selecting foods across each health-taste combination. The percentage of trials in which participants responded “yes” for each food type are displayed for individuals with obesity pre- and post-treatment as well as normal weight control participants. Statistical analyses were conducted using non-linear mixed models with logit functions. Significant differences are marked with asterisks. Error bars represent standard error.

Figure 2. Mean Taste Ratings

Mean taste ratings are plotted for OB pre-treatment, OB post-treatment, and NWC participants. Significant differences are marked with asterisks. Error bars represent standard error.