UNDERSTANDING THE RELATIONSHIP BETWEEN WEIGHT MANAGEMENT SUCCESS AND FOOD CRAVINGS: INVESTIGATING STRATEGIES

Abstract

Introduction: Obesity and its related comorbidities have become one of the significant threats to public health. While sustained weight loss can mitigate these comorbidities, achieving and maintaining weight loss remains challenging. One of the significant challenges in sustaining weight loss is managing food cravings, as uncontrolled cravings are associated with increased intake of calorie-dense foods and subsequent weight regain. The goals were to determine the impact of weight loss and maintenance on food cravings and identify effective strategies for managing food cravings that could prevent weight regain. The objective of study 1 was to determine the associations of factors such as food cravings and eating habits with large variations in weight loss and maintenance outcomes. The objective of study 2 was to evaluate the long-term change in food cravings, whether food cravings changes persist during weight maintenance, and explore the relationship between food cravings changes and weight loss outcomes. The objective of the final study was to determine whether an avoidance strategy or an inclusion strategy is more effective in reducing food cravings and achieving a greater magnitude of weight loss. Methods: Study 1 was a one-year follow-up study conducted after completing a one-year dietary weight loss program. Twenty-two participants entered the follow-up phase and weighed themselves daily using Wi-Fi scales. Self-reported questionnaires assessing food cravings and eating habits were collected at 12 and 24 months. In study 2, thirty participants with a BMI of  25 kg/m² enrolled in a one-year weight loss dietary program, EMPOWER, followed by one year of weight maintenance. Self-reported food craving questionnaires were completed at baseline, 6, 12, 18, and 24 months. At 12 months, participants reported their experience using the "inclusion strategy" for managing food cravings and rated its frequency and effectiveness in supporting weight loss goals and controlling food cravings. Daily self-weighing was recorded using Wi-Fi scales. In the final study, sixty-three adults with a BMI of  28 kg/m², who reported moderate food cravings and the consumption of craved foods a few times a week, participated in a 3-month EMPOWER program. Participants were randomized into one of two food craving management strategies: avoidance or inclusion. The avoidance strategy involves completely avoiding craved foods by reducing their availability and accessibility, while the inclusion strategy incorporates small portions of craved foods within well-balanced meals and avoids their consumption between meals. Self-reported food craving questionnaires were completed at baseline and 3 months, along with bi-weekly self-reported treatment adherence. Daily self-weighing was reported using Wi-Fi scales. Body composition and anthropometric measurements were taken at baseline and 3 months. Monthly self-reported dietary intake was assessed, and weekly feedback messages from nutrition coaches were provided to monitor progress in weight loss and food craving management. Results: In study 1, 19 out of 22 (86.3%) completed the questionnaires at 12 and 24 months. Control food cravings at 12 and 24 months was significantly associated with weight loss outcomes; those in the >5% weight loss group had higher food craving control compared to the <5% group (3.23 vs. 2.72, p = 0.03; 3.48 vs. 2.72, p = 0.01, respectively). Self-perceived implementation of maintaining consistent portion sizes significantly correlates with weight loss outcomes at 24 months (r=0.76, p=0.0001). In study 2, out of 30 participants, 24 (80%) remained in the program at 12 months with an average (SD) weight loss of -7.9 (7.2 %) and 20 (66.7%) completed the program at 24 months with a mean weight loss of -6.7 (7.5 %). The frequency of general food cravings and cravings for specific foods and craving traits decreased significantly at 12 and 24 months from baseline and remained stable from 12 to 24 months. Changes in food cravings at 6 months predict concurrent and subsequent weight changes at 12, 18, and 24 months. Participants who implemented the inclusion strategy (n = 16) experienced significantly greater weight loss (-9.9% vs. -3.7%, p = 0.04), reduced cravings for high-fat foods (-0.50 vs. -0.09, p = 0.02), and sweet foods (-1.02 vs. -0.38, p = 0.028) compared to non-strategy users (n = 8) at 12 months. In the final study, 56 of 63 participants (88.9 %) completed the 3-month EMPOWER program, with a mean weight loss of -3.55(3.21 %). There was no significant difference in weight loss between the groups (p=0.67), with the avoidance group's average weight loss of -3.73 (3.34 %) (n=28) and the inclusion group's average weight loss of -3.36(3.34 %) (n=28). Compared to the avoidance group, the inclusion group showed greater reductions in cravings for carbohydrates (p = 0.01), high-fat foods (p = 0.03), and general food cravings (p = 0.05). The inclusion group also had significant improvements in global trait scores (p = 0.04) and specific traits such as "anticipation of relief from the negative state" (p = 0.03), "craving as a physiological state" (p = 0.04), and "guilt from cravings" (p = 0.04). In the inclusion group, craving frequency and strength steadily decreased from Week 2 to Week 12, whereas in the avoidance group, cravings initially decreased from Week 2 to Week 4 but then increased. Conclusion: In study 1, reduced food cravings were correlated with successful weight maintenance. In study 2, food cravings and cravings for specific foods decreased during weight loss, and remained stable during weight maintenance, with craving reduction demonstrating a strong correlation to successful weight loss and maintenance. In the final study, the inclusion strategies resulted in a greater reduction in food cravings and cravings for specific foods compared to the avoidance strategy.