Abstract
BackgroundDietary restraint is largely unsuccessful for controlling obesity. As an alternative, subjects can easily be trained to reliably recognize sensations of initial hunger (IH) a set of physiological sensations which emerge spontaneously, not necessarily at planned mealtimes, and may be the afferent arm of a homeostatic system of food intake regulation. Previously we have reported that IH is associated with blood glucose concentration (BG) below 81.8 mg/dL (4.55 mmol/l), (low blood glucose, LBG), and that a pattern of meals in which IH is present pre-meal (IHMP) improved insulin sensitivity, HbA1c and other cardiovascular risk factors. Here we report the effect upon weight in overweight and normal weight subjects.ObjectiveTo investigate whether the IHMP is associated with sustained loss of weight in overweight subjects over a 5 month period.MethodsSeventy four overweight subjects (OW: BMI > 25) and 107 normal weight (NW) subjects were randomly allocated to either trained (OW: N = 51; NW N = 79) or control (OW: N = 23; NW: N = 28) groups. All subjects were allocated post-randomization into either low or high mean pre-meal BG groups (LBG and HBG groups) using a demarcation point of 81.8 mg/dL.ResultsA significant longitudinal decrease was found in body weight (trained NW: -2.5 ± 4.6 kg; OW -6.7 ± 4.5 kg; controls: NW +3.5 ± 4.0 kg and OW -3.4 ± 4.0 kg; P = 0.006 and 0.029) and in energy intake, mean BG, standard deviation of diary BG (BG as recorded by subjects' 7-day diary), BMI, and arm and leg skin-fold thickness in (OW and NW) HBG subjects. OW LBG subjects significantly decreased body weight (trained: -4.0 ± 2.4 kg; controls: -0.4 ± 3.7 kg; P = 0.037). 26 NW LBG subjects showed no longitudinal difference after training as did 9 control subjects.ConclusionOver a 5 month period the IHMP resulted in significant loss of weight in OW subjects compared to controls practicing dietary restraint. NW subjects maintained weight overall, however NW HBG subjects also lost weight compared to controls.
Highlights
Dietary restraint is largely unsuccessful for controlling obesity
A significant longitudinal decrease was found in body weight and in energy intake, mean blood glucose concentration (BG), standard deviation of diary BG (BG as recorded by subjects’ 7-day diary), body mass index (BMI), and arm and leg skin-fold thickness in (OW and normal weight (NW)) high baseline BG (HBG) subjects
26 NW low baseline BG (LBG) subjects showed no longitudinal difference after training as did 9 control subjects
Summary
Dietary restraint is largely unsuccessful for controlling obesity. As an alternative, subjects can be trained to reliably recognize sensations of initial hunger (IH) a set of physiological sensations which emerge spontaneously, not necessarily at planned mealtimes, and may be the afferent arm of a homeostatic system of food intake regulation. We have trained subjects to reliably recognize comparable eating-related sensations that we group under the term initial hunger (IH) [11] The necessity for such interoceptive information in homeostatic regulation has been recognized elsewhere [12,13,14,15]. We train subjects to adjust their meal-by-meal energy intake to ensure the pre-meal attainment of IH and its associated low BG concentration, three times per day We term this routine the Initial Hunger Meal Pattern (IHMP) [16]. We suggest that IH is not conditioned by mealtime or other external cue and that the IHMP represents unconditioned eating This contention is supported by our observation that in the early days of training subjects find that IH arises unexpectedly, often occurring at times far from usual mealtimes
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