“There are individuals who are very food cue responsive. That is, they cannot resist food and/or cannot stop thinking about food. Behavioral weight-loss skills are not sufficient for these individuals, so we designed an alternative approach to address this clinical need,” said first author Kerri N. Boutelle, Ph.D., UC San Diego professor in the Herbert Wertheim School of Public Health and Human Longevity Science and in the School of Medicine Department of Pediatrics.

Approximately 74% of adults in the United States are living with overweight or obese. Behavioral weight loss programs, that include calorie counting, have been the go-to treatment. However not everyone responds, and most people regain the lost weight.

For those who find it difficult to resist food, weight loss can be particularly challenging. This food responsiveness is both hereditary and shaped by the environment and individual factors.

In the Providing Adult Collaborative Interventions for Ideal Changes (PACIFIC) randomized clinical trial, the researchers compared their intervention, called Regulation of Cues, against a behavioral weight loss program, a control group, and a cohort that combined Regulation of Cues with the behavioral program.

Weight loss was comparable after 24 months among individuals in both the Regulation of Cues and the behavioral weight loss program.

However, participants in the Regulation of Cues arm stabilized their weight and kept it off while participants in the other groups regained weight at mid-treatment when clinic visits were reduced to monthly.

“Our findings suggest that the appetitive mechanisms targeted by Regulation of Cues may be especially critical for weight loss among individuals who have trouble resisting food and could be used in a personalized medicine approach,” said Boutelle.

According to the Centers of Disease Control and Prevention, overweight and obesity are risk factors for heart disease, stroke, Type 2 diabetes, and some cancers, all of which are among the leading causes of preventable death.

Over a 12-month period, 271 adults aged 18 to 65 attended 26 group treatments. They were all asked to engage in at least 150 minutes of moderate or vigorous-intensity physical activity per week.

The Regulation of Cues intervention did not prescribe participants a diet. Instead, it trained the use of natural cues of when to eat rather than focusing on calories, it reinforced tolerance of cravings and focused on inhibiting urges to eat palatable foods when not physically hungry.

Palatable foods — usually food that contain high amounts of sugar or fat with the addition of salt and flavorings — stimulate the reward system in the brain and can be particularly challenging to resist.

The control arm provided nutrition education, social support, and mindfulness training. The behavior weight loss program prescribed a diet, restricted calorie-dense foods, reinforced avoidance of cues to overeat, and focused on restricting calories. The combined program integrated the focus on diet and energy intake from the behavioral weight loss program with Regulation of Cues, including management of hunger cues.

“Individuals who need help losing weight can seek out the Regulation of Cues program if behavioral weight loss did not work for them if they feel they have trouble resisting eating, or if they never feel full,” said Boutelle.

Regulation of Cues is being offered in another randomized clinical trial called Solutions for Hunger and Regulating Eating and at the UC San Diego Center for Healthy Eating and Activity Research of which, Boutelle is the director.

Co-authors include Dawn M. Eichen, David R. Strong, Dong-Jin Eastern Kang-Sim, and Cheryl L. Rock, all with UC San Diego; Carol B, Peterson, University of Minnesota; and Bess Marcus, Brown University.