A New Paradigm for the Study of Eating: Cognitive Behavioral Nutrition
Most people have a general idea of what qualifies as nutritious food and the steps involved with weight gain or weight loss. The primary question is how to make it easier to adhere to the behaviors, and form a thought process that makes eating nutritious foods more likely? How do I make it easier? I don’t want to have to think too much about it (thus, a natural default to be a cognitive miser- Stanovich, 2009; thinking hard is energy expensive- cognitive resources must be allocated to an array of tasks- most would rather not aim those resources at the task of contemplating what and how much to eat). Cognitive behavioral nutrition may provide answers to that question.
Understanding the underpinning mechanisms of metabolism, weight loss, protein synthesis, catabolic and anabolic processes, bioenergetic systems, chemical senses, flavor characteristics, environmental influences, variety effect, sensations, ketosis, etc…, are difficult tasks. However, understanding the complexity of the mechanisms mentioned above is not required in an effort to drop weight and enhance nutrition. Recipe knowledge, knowing the strategies to produce desired outcome, will suffice. It isn’t a bad thing to have at least a moderate understanding of the complexities, but it isn’t essential and is unreasonable to expect that level of understanding.
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 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 CBN. I suspect the majority aren’t referring to CBN; at this point, it isn’t a widely used term. In addition to standard nutrition recommendations, CBN addresses the home food environment and suggests how the 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 calories and lower in nutritional value. Eating nutritious foods doesn’t have to be hard (optimally developed food environment means less thinking required when eating nutritious foods). 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.
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, but they aren’t the only thing that matter. It is possible to consume excessive calories while eating nutritious foods of various sorts.
A topic that often surfaces when discussing awareness and eating is lack of awareness. We have studied a component of this in our research (Hale & Varakin, 2016). Being unaware of external factors’ influence on food consumption has important implications in regards to controlling eating behavior. If unaware of how external factors influence consumption, it will be difficult to control eating behavior. In a recent study, Dr. Varakin and I directly tested whether people are generally unaware of external factors’ influence on food consumption, using the variety effect as a test case (Hale & Varakin, 2016). In our study we investigated whether or not participants would eat more M&M’s from a bowl containing a single color versus a bowl containing a variety of colors. We were also interested in whether or not people who eat more M&M’s from the multi-color bowl would be aware they did so, and in addition, if they would indicate they ate more due to variety. Awareness, as discussed in our study, refers to a subjective state of being cognizant or conscious of something (Reber, 1985). People often fail to accurately report factors that influence their thinking or behaviors (Nisbett & Wilson, 1977). This was shown by a review of the existing literature and set of Nisbett & Wilson’s own experiments. Nisbett and Wilson inferred that individuals are sometimes unaware of the existence of a stimulus that influences their behavior, are unaware of the response, and are unaware that the stimulus has affected the response. Other research has shown that perception (organization of sensations into meaningful patterns, interpretation of stimuli) can occur in the absence of awareness (Merikle et al., 2001). The information you are aware of is the information that shows up in working memory. The results of our study showed participants ate more M&M’s from the multi-color bowl than the single-color bowl. Participants who ate more from the multi-color bowl were more likely to mention variety as a reason for the increased consumption than those who did not eat more from the multi-color bowl. These results suggest that people are often aware of the variety effect, and are therefore inconsistent with the idea that people are generally unaware of how at least one external factor influences food consumption. Suggesting that individuals might be aware (conscious of) the variety effect in regards to food shouldn’t be taken to mean that other factors that influence eating are available to awareness. More research involving various measures of awareness is in order.
At Eastern Kentucky University (EKU) we are examining an array of factors associated with eating. Studies involve standard nutrition protocols, as well as those involving standard social / cognitive / behavioral examinations of eating. We are interested in the comprehensive, interdisciplinary study of eating in humans.
I receive a lot of questions regarding CBN. I include CBN lectures in some of the college courses I teach. 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. CBN is developing and requires more research in an attempt to build a strong model that can be used to promote better eating strategies.
- 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.. Nutrition)
- CBN: receives stand nutrition 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) (participants 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 strategies may lead to weight loss in some people, and make eating better easier. Eating plans of various types can be beneficial. Future research needs to include comparisons between CBN strategies (CBN is a model not a specific diet plan- but an array of different strategies with similar general structures and outcome objectives) and various types of eating plans across a range of contexts. Hopefully CBN will be another alternative that ensures better nutrition.
References are available upon request