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Prospective relationship of rigid and flexible control and weight loss
Abstract
Background: Findings from an earlier weight reduction program indicated that control of eating behaviors could play a major role not only in weight loss, but also in weight maintenance. This study attempted to replicate the findings that in a weight reduction program high pretreatment Rigid Control ( RC) is correlated with high Body Mass Index (BMI), high pre-treatment Flexible Control (FC) is correlated with low BMI, and that FC is a better predictor of overall weight loss. Patients and Methods: 70 healthy, overweight women took part in a 22-week weight loss program with 18-month post-treatment follow-up. RC and FC, BMI, and Disinhibition (DIS) were assessed by appropriate scales at pre-treatment, week 14, post-treatment and at 6 and 18-month follow-ups. Results: Both RC and FC were associated with DIS, but neither was correlated with BMI. Also, the present study did not replicate the finding that higher pre-treatment FC would be associated with greater overall weight loss; in fact, high levels of pre-treatment FC were actually detrimental to weight loss. Conclusion: In general, this study provided contradictory findings regarding the role of FC in weight loss. However, the lack of replication could be due to many factors, such as different diet programs. Further research needs to be conducted in order to better comprehend the prospective relationship of RC and FC of eating behaviors and their implications.
... For example, while higher rigid control related to higher negative affect, lower body appreciation, poor interoceptive awareness, more binge eating, and higher food preoccupation, higher flexible control related to higher positive affect, higher body appreciation, better interoceptive awareness, less binge eating, and lower food preoccupation (Tylka et al., 2015). Similarly, higher rigid control has been found to correlate positively and higher flexible control to correlate negatively with disinhibited eating and body mass index (BMI; Meule, Westenhöfer, & Kübler, 2011;Timko, Oelrich, & Lowe, 2007;Timko & Perone, 2005;Westenhoefer, Broeckmann, Munch, & Pudel, 1994;Westenhoefer et al., 1999;Zyriax et al., 2012). Thus, it appears that flexible control is a more adaptive and functional dieting strategy with more favorable outcomes than rigid control. ...
Background
Cognitive restraint of eating can be subdivided into rigid control and flexible control of eating behavior. Flexible control appears to be a more favorable dieting strategy as it relates to lower disinhibited eating and body mass index (BMI), while the opposite is found for rigid control. Yet, previous findings also suggest interactive effects between the two such that rigid control is particularly related to higher BMI when flexible control is low.
Participants and procedure
Data from a previously reported study (Meule, Westenhöfer, & Kübler, 2011) were reanalyzed to examine such interactive effects (N = 615, 76% female).
Results
Higher rigid control was particularly associated with more frequent and intense food cravings, lower perceived self-regulatory success in weight regulation, and higher BMI at low levels of flexible control. A moderated serial multiple mediation model revealed that rigid control had an indirect effect on BMI through food cravings and perceived self-regulatory success, particularly when flexible control was low. These interactive effects could largely be replicated in a second study with female participants (n = 70).
Conclusions
The current findings replicate and extend previous reports in that high flexible control may “compensate” for high rigid control, that is, attenuate the effect of rigid control on eating behaviors and body weight. They also provide insights into the mediating mechanisms that link rigid and flexible control of eating behavior with BMI.
... However, there have been inconsistent findings regarding correlates of rigid and flexible control in intervention studies. In some studies, no association was found between rigid or flexible control and weight loss (Burgmer, Grigutsch, Zipfel, Wolf, de Zwaan, & Husemann, 2005;Timko, Oelrich, & Lowe, 2007). Contrarily, often both rigid and flexible control were increased after weight management interventions and were associated with weight loss (McGuire, Jeffery, French, & Hannan, 2001;Teixeira et al., 2010) or binge eating abstinence (Downe, Goldfein, & Devlin, 2009). ...
Food craving refers to an intense desire to consume a specific kind of food of which chocolate is the most often craved one. It is this intensity and specificity that differentiates food craving from feelings of hunger. Although food craving and hunger often co-occur, an energy deficit is not a prerequisite for experiencing food craving, that is, it can also occur without being hungry. Food craving often precedes and predicts over- or binge eating which makes it a reasonable target in the treatment of eating disorders or obesity. One of the arguably most extensively validated measures for the assessment of food craving are the Food Cravings Questionnaires (FCQs), which measure food craving on a state (FCQ-S) and trait (FCQ-T) level. Specifically, the FCQ-S measures the intensity of current food craving whereas the FCQ-T measures the frequency of food craving experiences in general. The aims of the present thesis were to provide a German measure for the assessment of food craving and to investigate cognitive, behavioral, and physiological correlates of food craving. For this purpose, a German version of the FCQs was presented and its reliability and validity was evaluated. Using self-reports, relationships between trait food craving and dieting were examined. Cognitive-behavioral correlates of food craving were investigated using food-related tasks assessing executive functions. Psychophysiological correlates of food craving were investigated using event-related potentials (ERPs) in the electroencephalogram and heart rate variability (HRV). Possible intervention approaches to reduce food craving were derived from results of those studies.
Methods: The FCQs were translated into German and their psychometric properties and correlates were investigated in a questionnaire-based study (articles #1 & #2). The relationship between state and trait food craving with executive functioning was examined with behavioral tasks measuring working memory performance and behavioral inhibition which involved highly palatable food-cues (articles #3 & #4). Electrophysiological correlates of food craving were tested with ERPs during a craving regulation task (article #5). Finally, a pilot study on the effects of HRV-biofeedback for reducing food craving was conducted (article #6).
Results: The FCQs demonstrated high internal consistency while their factorial structure could only partially be replicated. The FCQ-T also had high retest-reliability which, expectedly, was lower for the FCQ-S. Validity of the FCQ-S was shown by positive relationships with current food deprivation and negative affect. Validity of the FCQ-T was shown by positive correlations with related constructs. Importantly, scores on the subscales of the FCQ-T were able to discriminate between non-dieters and successful and unsuccessful dieters (article #1). Furthermore, scores on the FCQ-T mediated the relationship between rigid dietary control strategies and low dieting success (article #2). With regard to executive functioning, high-calorie food-cues impaired working memory performance, yet this was independent of trait food craving and rarely related to state food craving (article #3). Behavioral disinhibition in response to high-calorie food-cues was predicted by trait food craving, particularly when participants were also impulsive (article #4). Downregulation of food craving by cognitive strategies in response to high-calorie food-cues increased early, but not later, segments of the Late Positive Potential (LPP) (article #5). Few sessions of HRV-biofeedback reduced self-reported food cravings and eating and weight concerns in high trait food cravers (article #6).
Conclusions: The German FCQs represent sound measures with good psychometric properties for the assessment of state and trait food craving. Although state food craving increases during cognitive tasks involving highly palatable food-cues, impairment of task performance does not appear to be mediated by current food craving experiences. Instead, trait food craving is associated with low behavioral inhibition in response to high-calorie food-cues, but not with impaired working memory performance. Future studies need to examine if trait food craving and, subsequently, food-cue affected behavioral inhibition can be reduced by using food-related inhibition tasks as a training. Current food craving and ERPs in response to food-cues can easily be modulated by cognitive strategies, yet the LPP probably does not represent a direct index of food craving. Finally, HRV-biofeedback may be a useful add-on element in the treatment of disorders in which food cravings are elevated. To conclude, the current thesis provided measures for the assessment of food craving in German and showed differential relationships between state and trait food craving with self-reported dieting behavior, food-cue affected executive functioning, ERPs and HRV-biofeedback. These results provide promising starting points for interventions to reduce food craving based on (1) food-cue-related behavioral trainings of executive functions, (2) cognitive craving regulation strategies, and (3) physiological parameters such as HRV-biofeedback.
... However, there have been inconsistent findings regarding correlates of rigid and flexible control in intervention studies. In some studies, no association was found between rigid or flexible control and weight loss (Burgmer, Grigutsch, Zipfel, Wolf, de Zwaan, & Husemann, 2005;Timko, Oelrich, & Lowe, 2007). Contrarily, often both rigid and flexible control were increased after weight management interventions and were associated with weight loss (McGuire, Jeffery, French, & Hannan, 2001;Teixeira et al., 2010) or binge eating abstinence (Downe, Goldfein, & Devlin, 2009). ...
Both food cravings and rigid dietary control strategies have been implicated in low dieting success while flexible control often is associated with successful weight loss. An online survey was conducted (N=616) to test the mediational role of food cravings between dietary control strategies and self-perceived dieting success. Food cravings fully mediated the inverse relationship between rigid control and dieting success. Contrarily, flexible control predicted dieting success independently of food cravings, which were negatively associated with dieting success. Differential mechanisms underlie the relationship between rigid and flexible control of eating behavior and dieting success.
... It also appears that restraint can help patients to maintain the weight that they have lost. Timko (2003) found that greater increases in restraint during 14 weeks of a weight loss program predicted better weight loss maintenance during the latter half of treatment. Consistent with this, McGuire, Wing, Klem et al. (1999) found that individuals who had regained weight over the year following a behavioral obesity treatment program reported greater decreases in restraint and increases in hunger and dietary disinhibition. ...
An estimated 64.5% of the United States population is currently overweight, and 30.5% are obese. These individuals are at risk for numerous medical conditions, including hypertension, dyslipidemia, and type II diabetes. Behavioral treatment produces medically meaningful weight losses that are maintained, with continued treatment, for up to one year. Unfortunately, the mean rate of attrition from behavioral treatment is approximately 22% within six months of treatment. It would therefore be useful for clinicians to be able to identify patient characteristics that are associated with weight loss success. However, reliable predictors of attrition and weight loss have proven elusive to date. The proposed study investigated the ability of pre-treatment levels of self-efficacy, binge eating, depression, emotional eating, stress, hunger, disinhibition, and dietary restraint to predict attrition and weight loss in a sample of 179 males and females undergoing 40 weeks of group behavioral weight loss treatment. Cross-v alidation regression analyses revealed dietary restraint as a significant predictor of weight loss, in both derivation (n = 92) and confirmation (n = 87) samples. Analyses of the full sample revealed the consistent ability of restraint to predict both attrition and weight loss. Logistic regression analyses revealed that individuals who reported higher levels of restraint at baseline were 17% less likely to drop out of treatment. Those who were less depressed at pre-treatment were 11% less likely to drop out than those who were more depressed. We also discuss the potential utility of enhancing certain psychological variables (e.g., restraint, self-efficacy) during treatment in an effort to decrease attrition and increase weight loss in obese individuals.
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