Appetitive Trait Weight Loss Programs May Be Successful in Adults with Obesity

Kerri N. Boutelle, PhD

New findings from a recent randomized clinical trial suggest that the regulation of cues (ROC) intervention and ROC combined with behavioral weight loss [BWL] (ROC+) were successful in weight loss among adults with overweight and obesity.

These findings support the use of these interventions as an alternative method for the treatment of overweight and obesity due to specifically targeting appetitive traits and may be used among adults with high levels of food responsiveness, investigators found.

“There were no significant differences between ROC, BWL, and ROC+ for weight loss at posttreatment or 12-month follow-up, which is notable given that the ROC group did not include any energy restriction recommendations,” wrote study author Kerri N. Boutelle, PhD, Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego.

Both food responsiveness and eating offset driven by satiety responsiveness are key aspects of appetite explained in the behavioral susceptibility theory (BST), according to the study authors. The BST theorized that genetically determined appetitive traits interact with the individual's food environment and lead to overeating and weight gain.

The current trial evaluated where ROC or ROC+ would improve weight loss across 12 months of treatment and 12 months of follow-up, compared to an active comparator (AC) and BWL only. The Providing Adult Collaborative Interventions for Ideal Changes (PACIFIC) study was conducted at UC San Diego from December 2015 - December 2019.

It included adults of any sex and race or ethnicity if they had a body mass index (BMI) of 25 to 45, were aged 18 to 65 years, and did not meet exclusion criteria, including type 2 diabetes, recent stroke or angina, and pregnancy.

A total of 4 intervention groups were included and patients were randomized to each:

• ROC targeted food responsiveness and satiety responsiveness
• BWL included energy restriction, increased physical activity, and behavior therapy techniques
• ROC+ combined ROC with BWL
• AC consisted of mindfulness, social support, and nutrition education

From 1488 volunteers from the community who inquired about the study, a total of 271 adults were assessed at baseline, mid treatment, posttreatment, and 6- and 12-month follow-up. They had a mean age of 47 years, 81.6% were female, 61.9% were White, and they had a mean BMI of 34.59. This population was then randomized to AC (n = 66), ROC (n = 69), ROC+ (n = 67), and BWL (n = 69), according to investigators.

Their findings showed that the ROC, ROC+, and BWL intervention led to significantly lower BMI at the end of treatment (BMI ROC, -1.18, 95% CI, -2.10 to -0.35; BMI ROC+, -1.56, 95% CI, -2.43 to -0.67; BMI BWL, -1.58; 95% CI, -2.45 to -0.71). They saw no significant difference in rate of change in BMI after treatment ended for ROC or ROC+ compared with AC.

Then, compared with BWL, they additionally observed BMI at end of treatment was not significantly different from ROC or ROC+ (BMI ROC, 0.40, 95% CI, -0.55 to 1.36; BMI ROC+, 0.03, 95% CI, -0.88 to 0.93). Meanwhile, the BMI of AC was found to be substantially higher (BMI AC, 1.58, 95% CI, 0.72 to 2.45).

Investigators additionally observed reduction in BMI at 24-months following randomization saw similar findings in ROC, ROC+, and BWL. Food responsiveness was a moderator of treatment effects with increased weight loss for individuals who scored higher in the marker in the ROC and ROC+ groups, according to the authors.

The study, “Effect of a Novel Intervention Targeting Appetitive Traits on Body Mass Index Among Adults With Overweight or Obesity: A Randomized Clinical Trial,” was published in JAMA Network Open.