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PubMed2001

[Cognitive restraint in obesity. History of ideas, clinical description].

AN EXPLANATION OF DISAPPOINTING RESULTS: Handling obesity and moderate overweight with dietary prescriptions or cognitive and behavioral therapies gives unsatisfying results. For some, such treatments even have the drawback of aggravating eating behavioral patterns, not to mention other psychopathological disorders. We believe, on the contrary, that such disappointing results and troubles may be explained by the cognitive restraint theory. COGNITIVE RESTRAINT THEORY: After the radical questioning of a psycho-genic origin to obesity, the efforts made to lose weight have gradually been held responsible for the psychopathological troubles observed in the cases of overweight patients. Herman and Polivy thus consider that slimming diets bring about a state of cognitive restraint, i.e. a way of eating ruled by beliefs of all kinds in the various consequences on the patients' weight of alimentary habits and choices, as opposed to inner criteria of hunger and satiety. DIFFERENT STATES: A person in a state of cognitive restraint can either experience inhibition without loss of control, or a loss both of inhibition and of control. In the former case, one can distinguish: a) a voluntarist stage in which the individual deliberately chooses not to heed his hunger and satiety sensations in order to privilege rules that are supposed to allow him/her to control his/her weight; b) an unconscious stage during which physiological sensations are blurred, and eating habits ruled by unconscious cognitive processes and emotions. The individual thus ends up organising his eating behaviour around his/her fear of lacking, the frustration/guilt doublet and troubles in the comforting pattern. Such a state of inhibition is frequently interspersed with losses of control, described as hyperphagic or bulimic bouts and compulsive eating. THERAPEUTIC STRATEGIES: Certain authors, facing the necessity to bring down their patients' weight, tend nevertheless to advocate restrictive methods, or seem to consider that in spite of the above-mentioned drawbacks, cognitive restraint remains the only extant method to lose weight. An alternative therapeutic strategy is definitely worth exploring: one that consists precisely in helping the overweight patient to deliver him/herself from cognitive restraint. The first target could thus be to restore eating habits in conformity with personal tastes and with the patient's own personal hunger and satiety physiological regulation systems. This implies a questioning of dysfunctioning cognitive processes, and a thorough investigation of upholding factors such as self-esteem or emotional and relational troubles.

Cognition↗

PubMed2002

Caffeine-reinforced conditioned flavor preferences in rats.

In 4 experiments, rats were trained to associate 1 of 2 differently flavored solutions with caffeine. During later 2-bottle extinction tests, they consistently preferred flavors that had been previously mixed with 2 lower (0.25 and 0.125 mg/ml), but not 2 higher (0.5 and 0.75 mg/ml), caffeine concentrations. Hunger during conditioning increased the size of these preferences, but neither preexposure to unflavored caffeine nor hunger during the choice test had any effect on them. Because caffeine is noncaloric, this last finding strengthens the hypothesis that hunger enhances the expression of only calorie-based conditioned flavor preferences. More fundamentally, the present results represent the first clear evidence that, through Pavlovian conditioning, rats can develop preferences for flavors associated with caffeine.

Animals↗

PubMed1978

[Acid-base balance during dosed fasting of schizophrenic patients with residual manifestations of organic lesions of the central nervous system].

The indices of acid-alkaline blood balance was studied in the dynamics of dosed hungering in 29 patients with sluggish schizophrenia and 16 patients with residual signs oforganic lesions of the CNS. There were differences in the pH index, standard and buffer bicarbonates alkaline deficiency which indicated to different degrees of acidosis in this group of patients. Significant differences in the acid-alkaline indices during hunger were seen in the different groups of patients depending upon the existence or absence of hypothalamic disorders (without consideration of their nosological affinity). The existence of hypothalamic disorders requires a more careful consideration when prescribing hunger therapy (the first session should not exceed 10-14 days).

Acid-Base Equilibrium↗

PubMed1988

The interaction of metergoline, a 5-HT receptor blocker, and dexfenfluramine in human feeding.

Use of the 5-HT antagonist metergoline (MTG) has shown that dexfenfluramine (d-FF) influences food intake in animals via serotoninergic neurones. This study examined the interaction between d-FF and MTG in humans. Healthy male volunteers reported singly at 8:45 A.M. on four weekly occasions following an overnight fast. At 9:00 A.M. they received 30 mg d-FF or matching placebo and at 11:00 A.M. 4 mg MTG or placebo. Hunger and satiety were assessed hourly using visual analog scales (VAS). Subjects had access to a 4-channel automated food dispenser (AFD) from 1:15 to 3:15 P.M. Delivery and recording of each portion of known energy value was contingent on an appropriate button push. Subjects were offered two nonsweet snacks, plus fruit and a chocolate biscuit chosen to each subject's preference. Results for 13 subjects are reported. d-FF reduced hunger VAS, MTG had no effect on hunger and did not attenuate the effect of d-FF. d-FF reduced total food intake by 1306 kJ (312 kcal p less than 0.01) at 120 min. MTG increased food intake and attenuated the effect of d-FF on food intake but not significantly. d-FF markedly reduced the intake of nonsweet food; this was attenuated by MTG which alone had no effect on nonsweet food. d-FF had no effect on the intake of sweet tasting food during the first hour; by 120 min it had reduced energy intake by 342 kJ (82 kcal, t = 1.34, n.s.).(ABSTRACT TRUNCATED AT 250 WORDS)

Drug Interactions↗

PubMed1984

The clinical pharmacology of appetite suppressant drugs.

One way of gaining a greater understanding of the central mechanisms underlying hunger and the regulation of feeding behaviour in humans is to examine the actions and interactions on hunger and food intake of drugs with known or presumed pharmacological modes of action. To this end we have undertaken a number of studies which fall into three main categories: the mechanisms by which amphetamine anorexia is induced; the possible role of endogenous opioids in feeding; the action of amino acids thought to be involved in the regulation of feeding. In this field the potential for cross-fertilization between basic scientists working with laboratory animals and clinical scientists working with human subjects exists. For example, the clinical pharmacologist has been able to test out hypotheses on human subjects which could only have been developed using laboratory animals. Furthermore, using human subjects it is possible to extend the field of inquiry into an exploration of the subjective dimensions of appetite and hunger.

Animals↗

PubMed1984

Non-organic failure to thrive: a developmental perspective.

Like other segments of the child's development, eating behavior follows a sequential pattern. To understand the infant's or child's feeding problems which can lead to failure to thrive or dwarfism we propose that a child's progression be studied through three stages of development: homeostasis, attachment and separation-individuation. Specific feeding problems can arise at each of these stages of development and consequently impede the child's weight gain. During the period of homeostasis the infant learns to regulate himself, to suck, to swallow and to time the onset and termination of feedings by giving signals of hunger and fullness. If he is unable to master these, he cannot be fed effectively. Failure to master these basic feeding skills interferes with the next developmental task of attachment and also impedes development of motor skills, language and affective engagement. During the period of attachment, the infant establishes distinct interactional patterns with his caretakers. Lack of engagement between mother and infant leads to lack of pleasure and lack of appetite or even to severe dysfunctional feeding patterns like vomiting and rumination. Feeding problems in the third developmental stage of separation and individuation can arise because of maladaption in the attachment phase or because of new difficulties which center around issues of autonomy vs. dependency. At this stage, the infant learns means-end differentiation and begins to understand that his actions elicit certain consequences. If the infant's struggle between autonomy and dependency gets caught in the feeding situation, the infant's emotional needs can dictate his eating behavior. The infant refuses to eat either to have his emotional hunger for mother's attention met or to assert his autonomy and to express his anger toward her. In order for the infant to learn to differentiate between his physiological feelings of hunger and his emotional need states, the caregiver needs to give contingent responses by offering food when the infant is hungry and comfort when the infant is distressed. Feeding problems which can create, co-exist with, or result from a growth problem must be considered within a developmental context. As the infant progresses through the developmental stages of homeostasis, attachment, and separation, he masters phase-appropriate feeding skills which help him to progress from reflex sucking to autonomous feeding. Early identification of maladaptive feeding behavior will assist the pediatrician in making timely interventions.

Child↗

PubMedDate not supplied

[The extinction of conditioned food reflexes acquired based on the dominant].

Extinction of alimentary conditioned responses, elaborated on the basis of the hunger dominant, when the animal, despite the realization of one-eye blinking reaction, did not receive food, took place in the course of 4-8 experiments. This process was of undulatory character. At the initial stage of extinction the manifestation of the swallowing and chewing reactions intensified, the amplitude of the blinking reaction of the trained eye increased and often acquired a tonic form, blinking of two eyes appeared, the general motor activity of the animal raised. At the end of extinction, when the goal-directed blinking reaction was absent, the number of the swallowing and chewing movements lowered, the general motor activity of the animal was decreased. It is suggested that at the first stage of extinction growing excitation takes place in the motivational "hunger centre". The process irradiates to other centres, as a result the behavioural reactions under study are realized. At the end of extinction the concentration of excitation takes place, leading to and absence of activation of the temporary connection between the "hunger centre" and the "blinking centre".

Acoustic Stimulation↗

PubMed1993

Dietary fat and appetite control in obese subjects: weak effects on satiation and satiety.

The present study assessed the capacity of both high fat and high carbohydrate (CHO) foods to lead to overconsumption in 12 obese women (mean BMI = 42 kg/m2). Subjects were provided with either a low (527 kcal) or high (985 kcal) energy meal at midday. Energy intake was then measured in a later ad libitum dinner meal in which subjects ate from a range of either high fat or high CHO foods. Energy intake following exposure to these meals was then assessed using food intake diary records which were kept for the rest of the day and for the following 24 h. The energy manipulations at lunch gave rise to different levels in the rated intensity of hunger. At the dinner meal subjects consumed an average of 937 kcal following the high energy lunch and 1026 kcal following the low energy lunch (an increase of 10%). However, average intake from the high CHO dinner meal was only 677 kcal compared to 1336 kcal from the high fat dinner meal (an increase of 97%). Consequently the most important variable influencing dinner meal size was not level of hunger but the nutrient content of the range of foods consumed. Analysis of dinner meal intake revealed a significant interaction between lunch meal size and dinner meal type. This means that when hunger level was high subjects over-ate on the high fat but not the high CHO foods. Average post-dinner intakes following the high fat and high CHO meals did not differ significantly.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1995

The effect of non-absorbable fat on energy and fat intake.

One of the main issues with respect to the usefulness of fat-replacers is their effectiveness. The question is whether or not people compensate for the "missing" energy due the replacement of fat by the fat-substitute. The present paper is concerned with the results of a number of studies carried out on the effects of the fat-replacer sucrose-polyester on food intake. Sucrose-polyester (SPE) is a substance with similar sensory and physical-chemical properties as fat, but it contains no metabolizable energy, because it is not digested in the human gastrointestinal tract. In the first two short-term studies, we replaced the fat by SPE in croissants. Thirty-three subjects in the first study and 34 subjects in the second study consumed 2 1/2 croissants, either with fat or SPE. After ingestion they rated subjective feeling of hunger, and recorded their ad libitum food intake. The results of both studies showed that the croissants with SPE had a similar satiating effect as the croissants with fat. In two subsequent short-term studies, we added either fat, SPE or water to warm meals served as lunch. The high water and high SPE lunches contained about 450 kcal, whereas the high fat lunches contained about 900 kcal. After ingestion of the lunches, subjects (39 in study 3; 35 in study 4) recorded their feelings of hunger. Two hours after the lunches, subjects were presented with an attractive buffet from which they could eat ad libitum. The results showed that hunger and food intake were similar after the water, SPE and fat lunches. The subjects did not detect the 450 kcal energy difference in the lunches. The last two studies with SPE lasted for 12 days. The results of these two longer-term studies were similar to the results of the short-term studies. There was little energy compensation and no fat compensation. It is concluded that fat replacers can be helpful in reducing fat and energy intake.

Adult↗

PubMed1998

Effects of exercise on appetite control: loose coupling between energy expenditure and energy intake.

The relationship between physical activity and energy intake (food consumption) can take a number of forms, depending on the intensity, duration and frequency of the activity, and upon the degrees of fitness and physiological status of the individual. At extremes of energy expenditure such as those found in long distance cyclists, voluntary energy intake may be sufficient to balance the enormous daily expenditure; this is due to an entraining effect. Under more normal situations, there is a widely held belief that physical activity is a poor strategy for losing weight, since the energy expended drives up hunger and food intake to compensate for the energy deficit incurred. Recent studies in both normal weight and obese individuals show that substantial periods of exercise do not increase hunger and do not drive up food intake. Comparisons between sedentary and normally active individuals, or between enforced periods of rest or strenuous activity, generate little or no effect on levels of hunger or daily energy intake, indicating a rather loose physiological coupling between energy expenditure and food intake. This view generates an optimistic view of the role of exercise in weight loss and weight control, as it indicates that intake is not automatically driven up to compensate for energy expended. Reasons why physical activity often produces disappointing effects, rise from inappropriate food choices, a desire for self-reward after exercise and misjudgements about the relative rates at which energy can be expended (by exercise) or taken in (by eating). This means that physical activity will be most beneficial for weight control, if carried out in conjunction with a low energy dense diet or with judicious control of eating.

Appetite↗

PubMed1996

Alcohol reinforcement and neuropharmacological therapeutics.

The pleasant subjective effects produced by alcohol undoubtedly reinforce drinking behaviour. Alcohol positively reinforces or rewards drinking by producing a mild euphoria. Alcohol also has anxiolytic effects that negatively reinforce drinking. The reinforcing effects of alcohol are mediated by several neurochemical systems, with dopamine and serotonin playing major roles in reward and the gamma-aminobutyric acid-benzodiazepine receptor system playing a major role in negative reinforcement. Research from our laboratory suggests that the behavioural effects of alcohol change when blood alcohol levels are changing and that these changes correspond to alterations of specific neurochemical systems. Behavioural activation and reward effects appear to occur as blood alcohol concentrations (BACs) increase. Depressive and aversive effects of alcohol occur during the period when BACs decrease. The observed correlation between behavioural and neuropharmacological changes and alcohol consumption suggest that alcohol produces a unique cascade over time that may provide clues to its long-sought specific mechanisms of action. In alcohol-dependent individuals, chronic exposure to alcohol may alter the function and communication between the liver, brain and other vital organ systems involved in hunger and the maintenance of nutrition. Under such conditions, the importance of alcohol in the diet may be enhanced such that hunger signals in the alcohol-dependent individual motivate the consumption of alcohol. Therefore, hunger for alcohol may provide an additional source of reinforcement. Endogenous opioid mechanisms may be important in this form of alcohol reinforcement.

Alcohol Drinking↗

PubMed2003

Behavior therapy and sibutramine for the treatment of adolescent obesity: a randomized controlled trial.

CONTEXT: Adolescent obesity is becoming a national public health problem. Weight-loss medications including sibutramine facilitate weight control in adults and could be used with obese adolescents in combination with behavior therapy (BT). OBJECTIVE: To examine whether increased weight loss in obese adolescents is induced when sibutramine is added to a family-based, behavioral weight control program. DESIGN, SETTING, AND PARTICIPANTS: Randomized, double-blind, placebo-controlled trial consisting of 82 adolescents aged 13 to 17 years with a body mass index (BMI) of 32 to 44 conducted from March 1999 to August 2002 at a university-based clinic for 6 months, followed by open-label treatment during months 7 to 12. INTERVENTIONS: For the first 6 months, participants received either BT and sibutramine or BT and placebo. From months 7 to 12, all participants received sibutramine in open-label treatment. MAIN OUTCOME MEASURES: Percentage change in BMI; systolic and diastolic blood pressure and pulse; and hunger. RESULTS: In intention-to-treat analysis at month 6, participants in the BT and sibutramine group lost a mean (SD) of 7.8 kg (6.3 kg) and had an 8.5% (6.8%) reduction in BMI, which was significantly more than weight loss of 3.2 kg (6.1 kg) and reduction in BMI of 4.0% (5.4%) in the BT and placebo group. Significantly greater reductions in hunger (P =.002) also were reported by participants who received BT and sibutramine. From months 7 to 12, adolescents initially treated with sibutramine gained 0.8 kg (10.5 kg) with continued use of the medication, whereas those who switched from placebo to sibutramine lost an additional 1.3 kg (5.4 kg). Medication dose was reduced (n = 23) or discontinued (n = 10) to manage increases in blood pressure, pulse rate, or other symptoms. CONCLUSIONS: The addition of sibutramine to a comprehensive behavioral program induced significantly more weight loss than did BT and placebo. Until more extensive safety and efficacy data are available, medications for weight loss should be used only on an experimental basis in adolescents and children.

Adolescent↗

PubMed1998

Personality and dimensions of dietary restraint.

OBJECTIVE: Given that dietary restraint and associated dietary behavior may predispose individuals to frank eating disorders, and that differences in personality profiles have been observed across subtypes of eating disorders, we sought to address whether aspects of restrained eating (cognitive restraint, disinhibition, and susceptibility to hunger) could be distinguished using the Temperament and Character Inventory (TCI). METHOD: One hundred and one women aged 18-45 selected at random from the community completed the Diagnostic Interview for Genetic Studies (DIGS), the TCI, and the Three Factor Eating Questionnaire (TFEQ). RESULTS: Novelty seeking (NS) was significantly positively correlated with disinhibition. Self-directedness (SD) was negatively correlated with the total TFEQ score, disinhibition, and susceptibility to hunger. Self-transcendence (ST) correlated positively with total TFEQ score and cognitive restraint. DISCUSSION: These findings suggest that individuals with character traits denoting low SD and high ST may be particularly reactive and susceptible to societal messages pertaining to the ideology of slenderness.

Adolescent↗

PubMed1993

Cephalic phase insulin release in bulimia.

Cephalic phase secretions are associated with the sight, smell, and taste of food, as opposed to its postingestional consequences. These secretions are thought to influence metabolism and eating behavior. Cephalic phase insulin release (CPIR), in particular, might be related to hunger and overeating. It was hypothesized that bulimics, who often show endocrine abnormalities, may have an altered CPIR that, in turn, might be related to the precipitation and maintenance of binges. This study investigated whether (1) the profile or magnitude of the CPIR in bulimics differs from that of non-eating disordered controls, (2) food ingestion alters subsequent CPIR, and (3) mood and desire to binge are related to CPIR. Findings indicated little abnormality in bulimics' profile of insulin secretion. Although biological variables were not related to hunger or desire to binge, for bulimics, dysphoric moods were. The results may suggest more complex determinants of binge eating than physiological state alone.

Adult↗

PubMed1977

System organization of alimentary behavior in the newborn and the developing cat.

This review deals with the structural, behavioral, and EEG correlates of searching for food and food intake. Data were collected on freely behaving kittens of 1 to 60 days of age with chronically implanted electrodes. The 1st manifestations of hunger involve activation of limbic-reticular structures and electroencephalographic (EEG) activity consisting of fast oscillations of 30-40-60 cps, correlated with general behavioral arousal as manifested by motor restlessness and vocal reactions. The more specific behavior form of hunger--feeding motivation--involves structures that include the motor and parietal cortex, amygdala, and medial hypothalamus; the EEG activity consists of high-amplitude, slow waves of 3-6 or 6-8 cps; and the behavioral correlate is purposeful search for the mother's teat or food. Satiation is associated with activity of the synchronizing structures in the forebrain and lower brain stem, as well as in the relay nuclei that transmit the sensory flow from oral afferents; EEG activity consists of regular rhythms of 10-14 and 2-4 cps; and the behavioral correlate is the act of feeding.

Age Factors↗

PubMed1998

Reasons for initiation and cessation of eating in obese men and women and the affective consequences of eating in everyday situations.

Reasons for the initiation and termination of eating were investigated in 78 female and 36 male obese subjects following a weight control programme. Self-monitoring diaries were completed during a 24-h period, in which subjects selected the main reason for starting and stopping an eating episode. Additionally, subjects recorded mood before and after eating using visual analogue scales. Hunger was chosen as a reason to start eating in only 20% of cases. Environmental cues such as mealtime were selected as the main reason for the initiation of the majority of eating episodes. In contrast, self-assessments such as "I felt I had eaten enough" was the main reason for terminating eating (39.4%). Gender differences in the reasons for initiating eating revealed a greater tendency for men to initiate eating for environmental reasons than women, whereas the opposite was found for the termination of eating, with women more likely to stop eating for environmental reasons than men. Changes in affect during eating revealed a significant decline in negative emotions such as tension and tiredness, and in the heavier subjects a trend for increased happiness was observed following eating. As hunger was less commonly reported as a reason to start eating than external reasons, treatment strategies for the obese might benefit by targeting individual reasons for meal initiation.

Affective Symptoms↗

PubMed1999

Eating patterns in French subjects studied by the "weekly food diary" method.

The "weekly food diary" was translated and adapted for use by French subjects. This validated method requires subjects to record every food and drink intake over 1 week, with several descriptors of the physical, psychological and social circumstances. Ten male [age 23. 6+/-2.3 years, body mass index (BMI) 20.7+/-0.6] and 16 female (age 23.3+/-0.6 years, BMI 20+/-0.6) students completed four weekly diaries over 1 year, one per season. Data were processed using a specially designed software. Breakfast was important, (about 400 kcalories). Lunch and dinner were almost equal in energy content but alcohol was consumed mainly with dinner. Meal size correlated positively with premeal hunger, number of people present, duration of premeal interval and time of day. Postmeal satiety correlated positively with meal size, aftermeal stomach content, and negatively with time of day, postmeal hunger and duration of sleep the preceding night. These observations allow hypotheses to be developed about mechanisms of intake in a French population and cross-cultural comparisons to be made.

Adult↗

PubMed1999

Individual differences in the use of pleasantness and palatability ratings.

Previously we have suggested that individual subjects interpret the phrase "palatable food" in different ways. To test the consistency of the use of this term, 50 male volunteers consumed a simple lunch on two occasions, once with a more palatable food and once with a more bland version. Ratings of hunger, fullness, pleasantness and palatability were completed at the start and end of each meal. Overall, subjects ate slightly more of the palatable food. The difference in intake between conditions correlated with differences in pleasantness and palatability but not hunger at the start of eating. Rated pleasantness of the food declined between the start and end of the meal in most subjects, but changes in palatability were more variable, with a significant minority showing no change across the meal. Detailed analysis confirmed the existence of two populations of responses, one where pleasantness and palatability were synonymous, and one where palatability was rated as a constant property of a food. The existence of two interpretations of the term palatability in common English usage cautions against the use of this term as a reliable means of evaluating hedonic responses to foods in appetite studies.

Adolescent↗