Journal of Diabetes and Obesity
Eating Behavior Associated With Weight Regain after Dietary Intervention in Obese Female
- 1Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
- 2Division of Community and Family Medicine, Jichi Medical School, Tochigi, Japan
- 3Hyogo Preventive Medical Center, Hyogo, Japan
- 4Department of Food Science and Nutrition, School of Human Science and Environment, University of Hyogo, Hyogo, Japan
- 5Kyoto Sangyo University, Kyoto, Japan
- 6Institute for Health Care Science, Health Care Science Center, Suntory Wellness Limited, Kyoto, Japan
- 7HE Center, R&D Support Division, Suntory Business Expert Limited, Kyoto. Japan
- 8Safety Science Institute, Quality Assurance Division, Suntory Business Expert Limited, Kyoto. Japan
Naoki Sakane, M.D., Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fushimi-ku, Kyoto 612-8555, Japan, Tel: 075-641-9161; Fax: 075-645-2781; E-mail: firstname.lastname@example.org
Sakane, N., et al. Eating Behavior Associated With Weight Regain after Dietary Intervention in Obese Female. (2016) J Diabetes Obes 3(2): 1- 4.
© 2016 Sakane, N. This is an Open access article distributed under the terms of Creative Commons Attribution 4.0 International License.
KeywordsObese female; Weight regain; Weight management
The aim of this study was to test the association of eating behavior with weight loss and weight regain after dietary intervention in obese females. Twenty-nine obese females were included in this study. Eating behavior using the Three-Factor Eating Questionnaire (TFEQ), which measures uncontrolled eating, emotional eating, and cognitive restraint eating, was tested for its association with weight loss (baseline to 3 months) and weight regain (3 to 15 months). Uncontrolled and emotional eating at the baseline was associated with weight regain, although cognitive restraint eating was associated with weight loss. Information on eating behavior may help to identify people who require additional support to maintain a reduced body weight after dietary intervention in obese females.
The increase of obesity is a serious problem throughout the world since obesity is a risk factor for various diseases, such as diabetes mellitus, cardiopulmonary disorder, osteoarthritis, and cancer. Weight management modifies the risk of these diseases[1-3], while the methods remain to be established[4-6]. Eating behaviors is referred to as one of the components of weight management. In fact, psychological variables were reported to be associated with weight loss[7,8].
Clinical studies are limited using objective scores of eating behavior in association with weight management. The three-Factor Eating Questionnaire (TFEQ) measures uncontrolled eating, emotional eating, and cognitive restraint eating behavior[9-11]. The TFEQ is a psycho-marker of weight loss.
The aim of this study was to investigate the association of eating behavior using the TFEQ score with weight changes during dietary intervention among obese females.
Materials and Methods
Subjects who met the following criteria were recruited: 1) Japanese adults aged 20 - 70 years, 2) female sex, and 3) obese (defined based on ≥ 25 kg/m² body mass index (BMI) using the WHO Western Pacific Regional Office criteria[13,14]). Those with the following criteria were excluded: 1) past history of allergic reaction to soy products and dietary supplementation products, 2) advised against a low-calorie diet because of disease, 3) alcoholism, 4) a smoking habit, 5) pregnancy, 6) lactating state, and 7) inadequate state because of clearly severe diseases (i.e., heart diseases). The study originally included a weight-loss phase and a weight maintenance phase (this phase was directly after the prior weight-loss phase), and, this time, participants recruited in both phases were analyzed.
Intervention program contents were described in detail previously. Briefly, all subjects received a low-calorie diet for weight loss, replacing one daily meal with a soy-based drink (180 kcal of calories; total fat: 1.5 g, carbohydrate: 16 g, and protein: 25 g) for 2 months (dietary intervention in the weight-loss phase). Those who showed ≥ 5% weight loss following the low-calorie diet were followed up with supplements for 1 month (supplementary intervention in the weight loss phase). From 3-month intervention to 15 months, subjects did not receive any dietary intervention (follow-up period in the weight maintenance phase).
Parameters and outcomes
The body weight was measured with a standardized protocol in the morning at the baseline (0 months), after the weight loss phase (3 months after baseline) and after the weight maintenance phase (15 months after the weight-loss phase). The height wasmeasured at the baseline. The BMI was calculated as the weight (in kilograms) divided by the height (in meters) squared. Eating behaviors were measured using the TFEQ 18 (TFEQ-R18).
With power (1-beta level) of 80% at an alpha (significance) level of 5% to detect a difference of 0.5 in the correlation coefficient with a change of the BMI, a sample size of 16 was estimated.
Changes in parameters from the baseline to weight-loss phase or weight maintenance phase were examined using the pairedt-test for continuous variables. The correlation between eating behaviors and weight changes in each phase was examined using the Pearson correlation test. Multiple linear regression analysis for weight changes was performed to examine the correlation between eating behaviors and weight changes in each phase. The adjusted factors included the age and eating behaviors. We selected eating behavior variables of the cognitive restraint score in the weight-loss phase and emotional eating score in the weight maintenance phase because each score was correlated with other scores and these scores were most significantly correlated with weight changes in each phase. STATA version 13 (Stata ORp., College Station, TX, USA) were used for sample size and data analyses. P < 0.05 was considered significant.
In total, there were 29 study subjects (mean age: 50.1 ± 8.8 years, mean BMI: 28.3 ± 3.3 kg/m²1). The mean weight loss in the weight-loss phase was -4.6 ± 2.3 kg and the mean weight gain in the weight maintenance phase was 1.6 ± 3.6 kg (Table 1).
Table 1: Variables at baseline, and in post-intervention and follow-up periods.
|Variables||Baseline (0 months)||Weight-loss phase(0 to 3 months)||Weight maintenance phase (3 to 15 months)|
|Bodyweight, kg||69.2 (8.0)||64.6 (7.5)||66.2 (9.3)|
|Difference from the prior state||-||-4.6 (2.3)*||1.6 (3.6)|
|Body mass index, kg/m2||28.3 (3.3)||26.4 (3.2)||27.1 (4.0)|
|Difference from the prior state||-||-1.9 (0.9)*||0.7 (1.5)*|
|Uncontrolled eating (out of 36)||20.3 (5.0)||18.8 (4.2)||19.9 (4.0)|
|Difference from the prior state||-||-1.6 (5.0)||1.1 (3.4)|
|Emotional eating (out of 12)||6.6 (2.4)||6.6 (2.2)||6.8 (2.8)|
|Difference from the prior state||-||0.0 (1.9)||0.2 (2.1)|
|Cognitive restraint eating (out of 24)||13.8 (2.6)||17.0 (2.4)||14.5 (2.3)|
|Difference from the prior state||-||3.2 (3.1)*||-2.5 (2.2)*|
N =2 9. Data are presented as the means (standard deviations). * p < 0.05
At the baseline, uncontrolled eating scores were positively associated with the emotional eating score, but negatively associated with the cognitive restraint score (not shown). The average cognitive restrain score was significantly decreased after dietary intervention, but increased during the follow-up period. Cognitive restraint eating scores were positively correlated with weight loss (Table 2). Uncontrolled eating and emotional eating scores at the baseline and in the follow-up period were positively correlated with weight regain, while at post-intervention they were not correlated with regain. In multiple linear regression analysis, the age was negatively correlated with weight change in the weight-loss phase, while the emotional eating score was positively associated with the weight maintenance phase (Table 3).
Table 2: Correlation of variables measured and initial bodyweight, weight loss, and weight regain.
|Variables||Weight-loss phase (baseline to 3 months)||Weight management phase ( 3 to 15 months)|
|Initial bodyweight, kg||-0.340||0.389*|
|Initial body mass index, kg/m2||-0.117||0.385*|
|Weight loss (baseline to 3 months)||N.A.||-0.242|
|Cognitive restraint eating|
*P < 0.05. NA, not applicapable.
Table 3: Multiple linear regression analysis of weight changes.
|Variables||Variables in weight-loss or weight maintenance phase||Standardized regression coefficient||t||P-value|
|Weight changes||Weight-loss phase: age||0.581||3.708||0.001|
|Weight maintenance phase Emotional eating||0.531||3.256||0.003|
|BMI changes||Weight-loss phase: age||0.534||3.281||0.003|
|Weight maintenance phase Emotional eating||0.537||3.309||0.003|
Variables include age, initial BMI, and cognitive restraint eating score in weight-loss phase.
Variables include age, initial BMI, weight loss, and emotional eating score in weight maintenance phase.
This study shows that high uncontrolled and emotional eating scores predicted weight regain after weight loss in obese females. Dalle et al. reported that successful weight loss was associated with increased dietary restraint and reduced disinhibition in obese patients seeking weight-loss treatment. However, uncontrolled and emotional eating at post-intervention did not predict weight regain. Therefore, we must assess eating behavior before starting a weight-loss program to identify people who may gain weight. The strength of this study included the use of a validated questionnaire. There are several limitations of this study. The study included a small sample-size and a 1-year follow-up.
In summary, high uncontrolled eating and emotional eating scores predict weight regain after weight loss in obese females. Further research including a large sample, different population, and varying genetic backgrounds are needed to clarify these issues.
This work was in part supported by JSPS KAKENHI Grant Number 15K08580, and the Japanese Council for Science, Technology and Innovation, SIP (Project ID 14533567), “Technologies for creating next-generation agriculture, forestry and fisheries” (funding agency: Bio-oriented Technology Research Advancement Institution, NARO).
NS, the project leader, was involved in all aspects of the study. KE, MY, YK and SH designed the study and prepared the intervention. Kokoro Tsuzaki, NN and TM designed the study and coordination of the intervention. KK prepared the draft and coordination of the intervention. Kaoru Takahashi performed the statistical analyses. All authors have read and approved the final version of the manuscript.
Conflict of Interest:
This work was in part supported by the funding of Suntory Wellness Limited (Osaka, Japan).
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