July 21, 2016

The standard nutritional approach to eating focuses on energy content, nutrient content of food and physiological response to eating.  The standard social / behavioral approach to eating has a focus on eating behaviors, patterns of eating, learning and factors influencing consumption (Quandt. In Shils et al.,1999).   The nutritional approach doesn’t pay enough attention to eating behaviors, while the social / behavioral approach doesn’t pay enough attention to nutrition.  The standard models for studying nutrition and designing nutritional plans are incomplete.   An improved model should be more attentive to factors influencing eating behavior and learning mechanisms.  Thus, a need for cognitive behavioral nutrition.

Cognitive Behavioral Nutrition

(CBN) is the interface between nutritional science and social / behavioral science.  CBN is concerned with the development of comprehensive eating plans- nutritional aspects, learning mechanisms and the myriad of factors driving food consumption.  In addition to standard nutrition recommendations, CBN provides strategies to improve eating behaviors, addresses the home food environment and suggests how the food environment can be structured to make it more conducive to nutritious eating.

Understanding why we eat what we eat can have a positive impact on controlling eating behavior.  Eating behavior is an important factor involved with bodyweight and health issues.  Excess weight is associated with increased mortality, morbidity, cardiovascular diseases, type 2 diabetes, hypertension, stroke, gallbladder diseases, osteoarthritis, sleep apnea, respiratory problems and some types of cancer (Must et al., 1999; National Institutes of Health et al., 1998; World Health Organization, 1998).  The National Center for Health Statistics shows that 68.7 percent of Americans are overweight, with a little more than 34 percent being obese and slightly less than 6 percent being “extremely obese” (Reuters, 2009).  Calorie balance plays a key role in weight maintenance.  With consistent calorie consumption below maintenance level weight loss can be expected.  Obesity related conditions can be significantly improved with a loss of 5%- 10% of total weight (National Institutes of Health et al., 1998).

Eating behavior is an element of culture, ideational values, social gatherings, pleasure systems, and identification and so on.  Food progresses from being a source of nutrition, to a sensory pleasure, an aesthetic experience, a source of meaning, and often a moral entity (Rozin, 1996). The importance of food and its relation to our everyday functioning cannot be overstated.  It is essential to address a myriad of factors that influence eating behavior.

Mental shortcuts to eating

Food heuristics are mental shortcuts used in relation to food related issues. Examples of food heuristics: low carb diets, low fat diets, traditional bodybuilder diets and volumetric eating. These examples often lead to calorie deficits without having to count calories.  To be clear, just because one doesn’t count calories doesn’t mean they aren’t important.  Not being conscious of caloric consumption is the norm.  Diets/ eating plans that result in weight loss are diets that create calorie deficits and those that result in weight gain are those involving calorie surplus.  As few as 1 in 20 dieters maintain weight loss.  It appears that a mindful regulation may not be the antidote for weight loss.  It may be more conducive to develop better heuristics, thus a bias towards eating less and more nutritious (Wansink, 2009).  Eating strategies are needed that require minimal cognitive effort (Wansink, 2014).  Humans are cognitive misers; they don’t like to think hard.

Factors influencing eating behavior

Some of the key factors influencing eating behavior: Food likes / dislikes, Evaluative conditioning, Expectations, Variety and Sensory specific satiety, Eating w/ others and Macronutrient content.

The evidence concerning the impact of food likes on eating behavior is not completely in agreement, but the preponderance of evidence suggests that food likes play a major role in eating (Beauchamp & Mennella, 2009).  Consumption of pleasurable foods  are associated with activation of brain reward mechanisms (Berridge, 2009).  Evaluative conditioning is defined as a change in the liking of a stimulus (conditioned stimulus) that results from  pairing with other  negative or positive stimuli (Hofmann et al., 2010).  Food preferences change and they are susceptible to evaluative conditioning throughout life.  Liking for unsweetened vegetables and unfamiliar teas increases after they have been consumed sweetened on a number of occasions (Eertmans et al., 2001).

Different expectations related to food may lead to different brain activity, thus affecting outcomes (responses / reactions).  In one study graduate students  attending a wine and cheese reception perceived the flavor of the wine and cheese as better when the wine was labeled California vs. North Dakota- even though the only difference in wine was label (Wansink, 2007).  The larger the variety of food the more food consumed (Rolls et al.1981).  The premise that increasing the variety of food can increase consumption has been found in both genders and across a wide range of ages (Wansink, 2014).  In a recent study (Hale & Varakin, 2016) it was found participants watching a humorous video ate more M&M’s from a bowl containing multiple colors than a bowl containing a single color (even though there is no difference in flavor).  Sensory specific satiety is often implicated as one of the primary mechanisms underlying the variety effect (Levitsky, 2005).  Sensory specific satiety refers to a decrease in pleasure with continuous consumption of the same food or flavor relative to an unconsumed food (Havermans et al., 2009).  With continuous consumption of the same food we like it a little less with each bite.

People tend to eat a similar amount as the person(s) eating with them (Herman et al., 2005).  Research shows people eat more when they eat with more people (De castro, 2000; Vartanian et al., 2008).  Protein is generally found to be more satiating than fat or carbohydrate.  Poppitt and colleagues (1998) investigated satiating hierarchy of fat, carbohydrate, protein and alcohol. They found that protein had a significant effect on short-term hunger with participants being less hungry after protein consumption.

Other factors

Evidence shows the hormones leptin, ghrelin, peptide YY, and cholecystokinin has a role in the regulation of appetite, which influences eating behavior  (Orr & Davy, 2005).  These hormones affect important regions of the brain that are involved with the regulation of food intake and energy balance. These regions of the brain include the arcuate nucleus (ARC), which is readily accessible to circulating hormones, the primary hypothalamic site of food intake regulation. And two main neuronal subsets located in the ARC that are responsible for relaying information about energy balance from peripheral hormones to various regions of the brain. These regions are classified as either orexigenic (appetite stimulating) or anorexigenic (appetite suppressing). Insulin is another hormone that has been shown to affect appetite, and subsequent eating behavior.  It has been shown that selective genetic disruption of insulin signaling in the brain leads to increased food intake in animals (Bruning et al., 2000).  From this finding is has been inferred that intact insulin signaling in the central nervous system is a requirement for normal body weight regulation (Freedman et al., 2001).

Food Environment

The food environment is any context or area (zone) where you are exposed to food.  Five zones account for more than 75% of what we and our families eat (Wanskink, 2014).  The 5 zones: home, restaurants, grocery stores, workplace and your kids’ school.  Wansink addresses each zone in his book – Slim By Design (2014).  Wansink illustrates strategies to improve eating for each zone.  The intent of the strategies is to make it easier to eat nutritious foods .  With the appropriate structure nutritious foods become more tempting and non-nutritious foods less tempting.

The impetus for designing an assessment tool (H-Assessment: Home Food Environment) that can be used in an effort to design a better in home food environment is Wansink’s- In-Home Slim-by-Design Self-Assessment Scorecard– (Wansink, 2014, pp. 60-63).  The assessment I use consists of 64 items.  From the assessment “Each true statement receives a checkmark. Add the checkmarks when assessment if complete. The more checkmarks you receive the better.  Strive to set up the home food environment to maximize the number of checkmarks.”

Key points: H-Assessment: Home Food Environment

Modify different areas of the home where food consumption is likely

Make nutritious foods more tempting while making non-nutritious foods less tempting

Being attentive to what you are eating, minimize distracters

Strive to maximize number of checks on the list

The current strategy for treating obesity is a failure.  A comprehensive approach to eating is essential in an effort to create long-term, successful eating plans.  Telling people what to eat, and educating them on the nutrient status of foods is not enough.  A comprehensive approach requires a mutli-disciplinary effort.

References are available upon request

If you are interested in hosting a seminar, a phone consultation, in home food environment assessment (offered to central and eastern KY. residents) or a personalized cognitive behavioral nutrition plan contact me:  [email protected]