August 24, 2018

In the past 50-60 years there has been an increase in obesity. Some suggest that increases in obesity are driven by genetic and psychological factors. Both of those variables are unlikely to be the key driving forces regarding obesity.

“[G]enetic factors cannot account for the sharp increase in the prevalence of obesity in society. The genes within a population relevant to weight do not change appreciably in 50 years. Some psychological factors may also play a role in obesity, including impulsivity, anxiety, and a tendency among some people to eat during negative emotional states. But here, too, there is no reason to believe that these characteristics have become more prevelant in recent decades. Therefore, genetic and psychological factors cannot account for the rise in obesity” (Arkowitz & Lilienfeld, 2017, p.244). What has changed drastically in recent times is the food environment, and exposure to calorie dense, cheap foods that are heavily marketed and easy to access. And, the food environment changes are accompanied by lack of physical activity (Brownwell & Horgen, 2003).

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. For some people telling them what to eat and when to eat it isn’t enough; they may require environmental conditions that induce better eating, while reducing the occurrence of environmental factors that are associated with increased consumption, and or lower quality nutrition.

Cognitive Behavioral Nutrition

After my first meeting with Geza Bruckner, University of Kentucky Professor & Researcher, in 2009 my thoughts about eating changed. Bruckner introduced me to research showing factors other than those commonly discussed by nutritionists may have a large impact on eating. A wide range of factors contribute to eating. After an extensive literature search it became apparent to me that the standard paradigm for the study of nutrition was incomplete, and needed expansion. The term “cognitive behavioral nutrition” was coined by myself and colleagues in 2012. CBN is the interface between nutritional science and social / behavioral science. CBN involves the development of comprehensive eating plans- nutritional aspects, learning mechanisms and the myriad of factors driving food consumption. It is important to point out that CBN is the term myself and colleagues use in describing a protocol that includes the essentials I have just mentioned.  Others may follow the principles underpinning CBN, but not refer to those principles as being those of CBN. That is fine; in fact, I suspect the majority aren’t referring to CBN. At this point, it isn’t a widely used term. Okay, enough about technicalities of terminology. In addition to standard nutrition recommendations, CBN addresses the home food environment and suggests how the holistic food environment can be structured to make it more conducive to nutritious eating. Structuring the food environment in the appropriate way makes it easier to eat nutritious foods, and less likely to consume food higher in cals…, and lower in nutritional value. Eating nutritious foods doesn’t have to be hard -cognitively draining (right environment less thinking required). Keith Stanovich, cognitive scientist, points out humans are cognitive misers; they don’t like to think hard. It follows that an environment that is conducive to nutritious eating is an environment where eating  requires minimal cognitive effort.

Although in the early stages of development, CBN is already impacting how people view eating and how they design nutrition plans.  As an example, one of my colleagues from India informed me that by using principles key to CBN a couple of athletes he works with are better able to manage their eating; they also had a much easier time making weight for a recent competition.  I receive a lot of questions, via e-mail, regarding CBN. I include CBN lectures in the psychology courses I teach, and I have spoken about the topic in various gyms and as part of a graduate program in Clinical Nutrition at the University of Kentucky. In the near future expect CBN certification programs and maybe other educational programs.

Environmental factors influence consumption norms by subtly suggesting an appropriate, or normal amount to consume or use. People often under estimate the amount of calories consumed, and environmental factors may make calorie counting more difficult. Package size, distracting stimuli, food type, and meal size can have a negative impact on calorie monitoring. The “health halo effect” is a primary factor associated with food type, and a factor influencing why consuming  nutritious foods may lead to over eating. People may feel that the consumption of a healthy food compensates for the less healthy side items, drinks, or additives they consume along with the healthy food. As an example, individuals may eat a low calorie sub, but in addition eat high calories additives (mayonnaise) and add a dessert to the meal. Calories matter. It is possible to consume excessive calories while eating nutritious foods of various sorts.

In- Home Food Environment

The food environment is any area where you are generally exposed to food. The area maybe be large for some, while not so big for others. The In- Home Food Environment are areas of the home where you are generally exposed to food.  I designed an assessment tool (H-Assessment: Home Food Environment) that can be used in an effort to restructure the home food environment. The H-Assessment: Home Food Environment, is a modified version of Brain Wansink’s (author of Slim By Design)- In-Home Slim-by-Design Self-Assessment Scorecard. The H-Assessment, is a shorter, easier to use version. The items included are the items I feel are the most important, and they are presented using short phrases that are easy to understand.  The assessment I use  consists of 64 items.

With the proper structure of the in home food environment nutritious foods become more tempting and non-nutritious foods less tempting. This type of environmental structure ensures that nutritious eating becomes automatic (little thinking needed). I provide the assessment in-person, to people living in my area, or it can be used as a self assessment.

When using the assessment a statement (item) that is true receives a checkmark. When the assessment is complete the checkmarks are added together. Users attempt to construct the home environment to maximize the number of checkmarks. The assessment addresses the following areas: Kitchen – Refrigerator – Freezer- Dishware – Pantry – Counter- Dining Table – TV Room – Home Office.

Some people are not receptive of the idea of making changes to the food environment. Generally, I can predict who will make the suggested changes. If a client counters each suggestion with a statement such as “but” or a comment implying that the suggestion is irrelevant to them, they  probably won’t make the needed changes. When I suggested no television in the kitchen, to a mother of four, she said “we don’t watch the television anyways, so it doesn’t matter.” As a response to many other recommendations she replied in a similar fashion. In a follow up phone call, a few weeks later, she said, she had made a few changes. Her response is a typical response for those not willing to do much to change the in home food environment.

Those willing to make changes, generally, ask lots of questions and score relatively high on the assessment. I was pleased with a recent follow up visit to the home of a couple, that are former  training clients. They made a lot of changes that were suggested my first visit. They switched the candy bowl on the counter for a fruit bowl, removed the television from the kitchen, replaced the high calorie foods on the center shelf of the refrigerator with nutritious foods, purchased smaller plates and got rid of the big plates. In every area of the house where food is encountered they made changes.  When asked how these changes influenced eating they both said eating better just seems easier (paraphrased). That is a key objective- making eating better, less cognitively demanding.

Some homes are hard to restructure (structure and layout makes it hard to eat nutritious). As an example, consider the following scenario: a couple of my clients (husband and wife) decided, in an effort to drop more weight, they needed an in-home food assessment. They live in a relatively large house with four kids. Their food environment was bad because: there was a television in the kitchen, cookies and candy bars were on the kitchen counter, no nutritious foods were visible in the kitchen, high calorie foods were on center shelves in refrigerator and freezer & were in clear containers, large bowls and short wide glasses were in the front of cabinet, smaller bowls and tall thin glasses were hard to reach (they were hidden behind larger bowls and short wide glasses), the dining room table wasn’t useable- it seemed to be a storage space for magazines and books, there were containers of candy in home office and TV room and no nutritious food options in site.  While conducting the assessment I made recommendations and provided  brief explanations. Often, the husband or wife would counter my suggestion with the assertion “that’s just not realistic.” The clients weren’t willing to compromise. We haven’t spoke about the assessment since it was conducted. I still consult with them regarding training, however we don’t talk about eating.

Below are sample items from the assessment:


No television in kitchen

No lounging on comfortable chairs or other sitting devices in kitchen

Watching TV is distracting and may result in poor  food monitoring. The kitchen should be for eating; avoid lounging and hanging out in the kitchen. The kitchen is associated with eating, so kitchen time may unavoidably lead to food time.  

Refrigerator and Freezer

Precut vegetables, fruits, lean proteins and other nutritious options on center shelf

Nutritious options are in see through containers or clear wrap

Placing nutritious foods on the center shelf makes them easier to access. They are the first things you see when you open the refrigerator or freezer, and  with little thought you are eating nutritious foods. Clear containers make food  easily visible, and  high visibility might persuade consumption     


Plates are 9 to 10 inches in diameter

Glasses are tall and thin

A 6oz serving of meat looks much different on a plate that is 10 inches vs. a plate that is 12 inches. Serving meat on the 10 inch plate leads to the perception of a bigger piece of meat; this  creates a visual illusion called the Size-Contrast Illusion.Another visual illusion that is relevant to eating is the Horizontal-Vertical Illusion  A study published in the British Medical Journal found when bartenders were asked to pour a shot (1.5 ozs.) in either a  tall skinny glass or short wide glass they poured more in the short wide glass. They poured an average of 2.1 ounces in the short wide glass, 37 percent more than their target, and they poured almost exactly 1.5 ounces in the tall skinny glass      


Minimize high calorie or indulgent type foods on counter

Low calorie nutritious foods on counter

High calorie foods on the counter makes them convenient and you may eat them without evening noticing. However, low calorie, nutritious foods on the counter may also contribute to convenience and increase the likelihood of consumption; and you might consume them without even noticing

Dining table

Eating occurs at designated table

Serving bowls for foods other than vegetable dishes are Not sitting on the table

Eating at the table can increase your awareness of what you are eating and decrease the amount of time spent eating, which both may contribute to less eating. By placing high calorie dishes a fair distance from the table you will be less likely to indulge in these foods.  It is inconvenient  get up and walk away from the table or have to reach to get the food, and either of these acts increase your awareness of what you are eating and can lead to better food monitoring.

TV Room and Home Office

Snacks are eaten from bowls, not from bags or original containers

Any empty snack or candy wrappers are left within view until snacking is over

Eating from containers makes it difficult to monitor how much is being eaten, especially if the container is large. Empty wrappers in plain view serve as a reminder of how much you have eaten and may signal it’s time to stop eating.

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

Be attentive to what you are eating, minimize distractions

Strive to maximize number of checks on the list

The number of checks received for the assessment vary greatly. A perfect score is not required to benefit from the recommendations provided with the assessment. The objective is to maximize the number of checks, and gradually alter the in home food environment. Some people have suggested that in an effort to make eating nutritious easier people should stock their home with only nutritious foods. This strategy might work for some people. However, it is important to recognize nutritious foods sometimes contain high calories. Salmon and nuts are nutritious, but high calorie. Also, foods that are nutritious but low calorie can also contribute to weight gain.  A large consumption of  low calorie foods can result in too many calories.

Future directions

Key Questions (Hale, 2018, Nutrition & Cognition Lecture, Gen. Psychology Course):

  • How do we manipulate the environment so it becomes more practical to adhere to a quality eating plan?
  • How to apply what we know about learning mechanisms to eating behavior?
  • How to design eating plans for long term weight loss and maintenance?

Future Research

  • The current model of obesity treatment is a failure. In order to develop optimal eating plans and understand the factors the influence the development of obesity it is important to apply a multidisciplinary approach.
  • It has been suggested that the amount eaten in any given eating episode depends less on internal need state (as conceptualized as specific bio-markers) and more on environmental contextual factors (Heteringon, 2007).

CBN vs. Standard Nutrition

  • CBN- is concerned with the development of comprehensive eating plans- nutritional aspects, learning mechanisms and the myriad of factors driving food consumption
  • Standard Nutrition- focus on energy contents, nutrient content of food and physiological response to eating
  • Study comparing CBN and Standard Nutrition

Weight loss as the outcome variable (CBN compared to Stand.. Nutr..)

  • CBN: receives stand nutr… and strategies to improve eating behaviors & H-Assessment: Home Food Environment    Standard nutrition: receives info. on what to eat
  • Weighed: baseline, 4 weeks and 8 weeks (possibly 12 weeks) (p’s are randomly assigned to groups)
  • Will there be a difference in weight?

It is important that proponents of CBN do not exaggerate the importance of this approach to eating. CBN and related modes of eating may lead to weight loss in some people, and they may make eating better easier. Eating plans of various types can be beneficial. Future research needs to include comparisons between CBN and various  types of eating plans, across a range of contexts. We hope that CBN will be another alternative that ensures better nutrition.

References are available upon request

Free scholarly papers (full paper) upon request:

Caffeine And Attention

Why Are You Eating That

Expectations Do Not Always Influence Food Liking

Awareness Of The Influence A Variety Of Food Has On Food Consumption