August 1, 2011

New Approach to Obesity Counseling

(Ivanhoe Newswire) -- New research suggests counseling for obese patients should focus on the neurobehavioral process.

Currently, dietary counseling for obesity focuses on the notion of personal choice and will power. Researchers from Rush University Medical Center in Chicago say a better focus is neurobehavioral processes -- ways in which the brain controls eating behavior in response to cues in the environment.

"Typically, overweight and obese patients receive education about dietary contributions to weight gain, and they are simply encouraged to fight the powerful urge to eat the delicious foods that are available almost everywhere in the environment, and instead, make dietary choices consistent with weight loss," Brad Appelhans, Ph.D., clinical psychologist and obesity researcher in the Rush University Prevention Center and lead author of the article, was quoted as saying. "Yet, we know this approach rarely works. Even highly motivated and nutritionally informed patients struggle to refrain from highly palatable foods that are high in sugar, salt and unhealthy fats."

The new counseling model includes a framework that clarifies how personal choice is affected by biological and environmental factors. The three neurobehavioral processes in obesity include:

1. Food reward: Food reward is mediated by the mesolimbic dopamine system. This includes both the experience of pleasure a person receives from eating and the motivational drive to obtain and consume highly palatable foods. The sensitivity combined with easy access to snacks and fast food restaurants makes a person vulnerable to overeating and weight gain.

2. Inhibitory Control: Controlling behavior despite a strong motivation to eat is mediated by the brain's prefrontal cortex. This is a person's ability to suppress urges to eat high-calorie foods.

3. Time Discounting: This is a person's tendency to devalue delayed rewards. The immediate pleasure from eating has a greater effect on decision-making than the more delayed health benefits of weight loss.

The researchers recommend several strategies. Some of these include:

"¢ To combat food reward, patients can remove high fat foods from home and work environments.

"¢ Patients can limit the impact of reward on food choice by shopping with a grocery list or buying groceries online.

"¢ Patients should practice stress management techniques because stress promotes overeating and obesity.

"¢ Patients should avoid buffets and restaurants that challenge inhibitory control.

"¢ Patients should focus on achieving short-term goals such as cooking a healthy dinner three nights a week rather than focusing on long-term weight loss goals.

SOURCE:  The Journal of the American Dietetic Association, August 1, 2011