Effect of weight loss intervention on the association between eating behaviour measured by TFEQ-18 and dietary intake in adults

Abstract

Associations between eating behaviour (cognitive restraint, emotional eating and uncontrolled eating) and dietary intake (energy, energy nutrients and fibre) were assessed in overweight or obese adults (body mass index >27 kg/m², n = 49) before and after weight loss intervention in a randomized follow-up study lasting 18 months. Counselling was either intensive or short-term. Eating behaviour was assessed using the three-factor eating questionnaire-18 and dietary intake with 5-day food records at 0 and 18 months. The only difference in dietary intake between the groups was higher protein intake (% of energy, E%) in the short-term group at 18 months (18.7 ± 3.1 E% vs. 17.1 ± 1.7 E%). Cognitive restraint was associated with lower energy intake at 0 and 18 months (r = −0.34, r = −0.36, respectively) and higher intakes of carbohydrates (r = 0.39), sucrose (r = 0.33) and fibre (r = 0.44) and a lower intake of fat (r = −0.43) at 18 months. Those with the highest cognitive restraint at 18 months had the lowest energy and fat intake, the highest carbohydrate and fibre intake and the greatest weight loss. The results suggest that enhancing cognitive restraint could be a target for improving weight loss counselling, although further evaluation of the causal relationship would be needed in order to find the best practices for enhancing cognitive restraint.

Introduction

Overweight and obesity are common public health problems in the western world. Eating fewer calories, eating less fat and exercising more are the most common weight loss strategies employed in the United States, applying to about 50% of weight losers (Kruger, Galuska, Serdula, & Jones, 2004). By contrast, a change in diet or physical activity alone is not sufficient to achieve a sustained weight loss, but instead a total change in lifestyle is needed (Westenhofer, von Falck, Stellfeldt, & Fintelmann, 2004). Weight loss is in any case difficult to maintain (Anderson, Konz, Frederich, & Wood, 2001) and new ideas are needed in order to develop more effective forms of counselling.

Psychological factors involved in eating behaviour are important determinants of food choices and may thus affect weight loss (Bellisle, 2003). We recently reported that high cognitive restraint (control over food intake in order to influence body weight) together with low uncontrolled eating (overall difficulties in the regulation of eating) and emotional eating (overeating during dysphoric mood states), as measured by TFEQ-18, are associated with maintained weight loss in the long term (Keränen et al., 2009). The associations of given factors with eating behaviour and success in achieving weight loss have been studied earlier using TFEQ questionnaires of various kinds, and although the scores reported are not comparable, on account of methodological differences, the psychological traits in eating behaviour that have been identified are similar. High restraint with respect to eating is associated with successful, maintained weight loss (Chaput et al., 2007, Drapeau et al., 2003, Foster et al., 1998, Sarlio-Lähteenkorva and Rissanen, 1998, Svendsen et al., 2008, Vogels and Westerterp-Plantenga, 2007, Westerterp-Plantenga et al., 1998), while episodes of loss of control over eating (high disinhibition) are associated with increased body weight and obesity (Dykes et al., 2004, Fogelholm et al., 1999, Lindroos et al., 1997, Provencher et al., 2003). Keskitalo et al. (2008) noted that BMI is not associated with ratings applied to the consumption of or liking for fatty foods use but with eating behaviour, which is in turn associated with such ratings. Thus there may be a complex relation between diet and BMI that is mediated in part by eating behaviour.

The association between dietary intake and eating behaviour has been studied to a lesser extent, however. Fogelholm et al. (1999) demonstrated in their follow-up study that a high score on cognitive restraint is associated with a lower energy intake whereas high disinhibition is associated with an excessive energy intake, as also reported in a few cross-sectional studies (de Castro and Lilenfeld, 2005, Provencher et al., 2003, Sarlio-Lähteenkorva and Rissanen, 1998). More knowledge of the associations between eating behaviour and dietary intake, especially among overweight adults, would be needed in order to develop more effective weight loss interventions.

We hypothesized that (1) eating behaviour with a sufficiently high degree of cognitive restraint and sufficiently low levels of emotional eating and disinhibition/uncontrolled eating is associated with the recommended dietary intake for achieving weight loss, (2) intensive counselling improves dietary intake. To test these hypotheses, the associations between eating behaviour and dietary intake were assessed and differences in dietary intake between counselling groups of overweight or obese adults were studied before a 6-month weight loss intervention and after the subsequent 12-month follow-up period.