Abstract
Why are some individuals more vulnerable to persistent weight gain and obesity than are others? Some obese individuals report factors that drive overeating, including lack of control, lack of satiation, and preoccupation with food, which may stem from reward-related neural circuitry. These are normative and common symptoms and not the sole focus of any existing measures. Many eating scales capture these common behaviors, but are confounded with aspects of dysregulated eating such as binge eating or emotional overeating. Across five studies, we developed items that capture this reward-based eating drive (RED). Study 1 developed the items in lean to obese individuals (n = 327) and examined changes in weight over eight years. In Study 2, the scale was further developed and expert raters evaluated the set of items. Study 3 tested psychometric properties of the final 9 items in 400 participants. Study 4 examined psychometric properties and race invariance (n = 80 women). Study 5 examined psychometric properties and age/gender invariance (n = 381). Results showed that RED scores correlated with BMI and predicted earlier onset of obesity, greater weight fluctuations, and greater overall weight gain over eight years. Expert ratings of RED scale items indicated that the items reflected characteristics of reward-based eating. The RED scale evidenced high internal consistency and invariance across demographic factors. The RED scale, designed to tap vulnerability to reward-based eating behavior, appears to be a useful brief tool for identifying those at higher risk of weight gain over time. Given the heterogeneity of obesity, unique brief profiling of the reward-based aspect of obesity using a self-report instrument such as the RED scale may be critical for customizing effective treatments in the general population.
Highlights
The fundamental causes of obesity are complex and linked to family history, genetic predispositions, and their interaction with the toxic food environment [1]
We chose to develop this index of rewardbased eating drive (RED) in the context of a prospective study following lean to obese individuals that used multiple eating measures – the Relationships of Energy and Nutrition to Obesity (RENO) Diet Heart Study (RDHS)
To test whether RED was longitudinally associated with changes in Body Mass Index (BMI) from baseline to year eight, we regressed BMI assessed at year eight onto RED assessed at baseline, and accounted for the baseline BMI assessment
Summary
The fundamental causes of obesity are complex and linked to family history, genetic predispositions, and their interaction with the toxic food environment [1]. Many report an excessive drive to eat characterized by a trio of complaints – feeling a lack of control over eating, eating rapidly without experiencing satisfaction or satiation, and preoccupation with thoughts about food These strong drives tend to be in response to the natural reward of highly palatable foods (foods high in fat, sugar, and salt). This trio, which emerged from clinical phenomenology of the common habitual and compulsive drive to overeat, was developed amidst extensive discussions with obese individuals, dieters, and clinicians, and has been expounded in the popular press under the label ‘‘conditioned hypereating’’ [6]. We focus on developing a brief measure to tap this normative but compulsive syndrome of strong eating drive
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