From October 31–November 2, I represented Fors Marsh Group (FMG) at ObesityWeek, the annual joint meeting of The Obesity Society (TOS) and the American Society of Metabolic and Bariatric Surgery (ASMBS). I was particularly excited to attend ObesityWeek because it is the preeminent conference in the obesity field and brings together leading researchers and advocates. As a behavioral health scientist with a focus on obesity research, it’s always exciting to discover new advances and practical approaches that inform my own research as well as interventions and policy. And, as FMG continues to build our portfolio of food, nutrition, and obesity work, the conference provided an opportunity to network and identify ways to apply our own health research and social marketing expertise to advance and support the work done by federal and state agencies.
One theme that emerged during the conference was the impact of implicit and unconscious predictors of food choice on eating behavior. In particular, Dr. Ashley Gearhardt’s presentation on the power of food cues, "Hard-wired: Why People Can’t Ignore the Food Environment," was informative and innovative. Her research shows that when participants watched commercials for highly palatable fast foods (e.g., hamburgers and French fries), they were more likely to crave those items and choose them for lunch than when they viewed commercials for healthier food items or non-food items. Interestingly, participants were not aware of the effect that these food commercials had on their cravings or food choices.
Understanding the effects of food cues on eating has important implications for obesity prevention research. As a society, we are constantly bombarded with cues for highly palatable foods. We see these cues in online and print ads, television shows and commercials, in the checkout aisle at our grocery stores, on billboards, and even in our kitchens.
My presentation at ObesityWeek, "More eating competence is associated with lower BMI, but only for women with lower food reward sensitivity," examined the extent to which the power of food cues on eating behaviors was stronger for some people than others. We tested this question in pregnant women for whom healthy eating and healthy weight have important implications for maternal and fetal health outcomes.
Food reward sensitivity represents the neurological reward response to food cues in the environment. In other words, in the presence of food cues, such as tasting or viewing a cupcake, people with higher food reward sensitivity have greater activation in the reward regions of their brains. Many people have higher food reward sensitivity, and my research shows that it is associated with overeating and a higher consumption of highly palatable, discretionary foods. Eating competence represents a cluster of cognitive and behavioral attributes that are often incorporated into behavioral weight loss interventions. Thus, theoretically, those with higher eating competence should have lower body mass indexes (BMI). The goal of our research was to examine whether this association remained for pregnant women with higher food reward sensitivity.
My study used data from the Eunice Kennedy Shriver National Institute of Child Health and Human Development’s Pregnancy Eating Attributes Study (PEAS). The PEAS sample consisted of 450 women who were recruited during the first 12 weeks of pregnancy and were followed until one year postpartum. Findings show that for women with lower food reward sensitivity, better eating competence was associated with lower pre-pregnancy BMI, as expected. However, for women with higher food reward sensitivity, eating competence was no longer associated with pre-pregnancy BMI. This means that typical behavioral weight loss strategies, such as eating competence, may be less effective for those with higher food reward sensitivity.
Taken together, this research emphasizes the importance of understanding implicit and unconscious predictors of eating behavior, such as food cues, and identifying populations for whom they are most impactful, such as those with higher food reward sensitivity. It suggests that we need to develop more effective weight management strategies that account for these unconscious barriers to healthy eating.
Research from ObesityWeek as well as the research I have conducted identifies two potential pathways to help mitigate the effect of food cues on our eating and weight. The first is helping people become more internally motivated to avoid unhealthy foods. Self-Determination Theory suggests that as motivation to engage in a behavior is internalized, people will be more likely to maintain that behavior in the face of barriers. Right now, most of us have external motivation; we generally know that we should avoid unhealthy foods and we recognize that it is important, but internalized motivation would involve making the behavior part of our identity or values (e.g., "I am a person who avoids unhealthy foods"/ "Avoiding unhealthy foods is important to me").
FMG’s research for FDA’s Real Cost campaign led to messaging designed to increase internal motivation to avoid smoking by demonstrating how smoking interfered with teenagers' immediate internally motivated goals, such as appearance and sense of independence. There is potential to use these same strategies to help people internalize healthy eating motivation. For example, The Whole 30 eating program emphasizes intrinsically motivating goals such as "food freedom," "not being held hostage by food," and "making food fun again." In designing a social marketing campaign to build internal motivation to engage in healthy eating behaviors, we could apply principles and lessons learned from the Real Cost campaign.
The second pathway forward is facilitating healthy eating by mitigating the effects of food cues on eating and weight. This pathway could be school-level policies that remove vending machines with sugar-sweetened beverages or snacks high in added sugar, fat, or salt. It could be as simple as keeping unhealthy, tempting foods out of the home or storing them out of sight in cabinets and making healthy fruits and vegetables easily available. Individual interviews and focus group would help us identify the most effective and least invasive strategies to minimize cues for highly palatable foods in people’s home, school, and work environments. The research findings could then inform the creation of multimedia materials to provide tips and guidelines for consumers, educators, and businesses.