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Background: The obesogenic environment of Western countries raises questions about its current management. Some clinical studies have explored hypnosis, although the current state of knowledge does not lead to definitive conclusions about its efficacy., Objectives: We assessed the impact of Ericksonian hypnosis and self-hypnosis on disinhibition of eating in adults with obesity and high food impulsivity levels, compared with standard nutritional education., Methods: From September 2014 to July 2015, adults with BMI (in kg/m2) of 30-40 and a high disinhibition score [>8 on the Three Factor Eating Questionnaire (TFEQ-51)] were included in a randomized controlled trial. The control and hypnosis groups received the same standard nutrition education in 8 workshops. In the hypnosis group, subjects had 8 sessions of hypnosis combined with training in self-hypnosis. Disinhibition (primary outcome) and other scores from the TFEQ-51 as well as anthropometric, food intake, cardiometabolic, and physical activity variables were collected at inclusion and at 8 mo., Results: Of 82 randomly assigned adults, 70 participated in all sessions; 80 participated in ≥1 session and were included in the main analysis (hypnosis group, n = 41; control group, n = 39). After 8 mo of follow-up, disinhibition scores adjusted for baseline values were lower in the hypnosis group, with a mean between-group difference of 4.2 (95% CI: 2.8, 5.5; P < 0.001); 67.7% of adults in the hypnosis group had normalized their disinhibition (compared with 11.1% in control; P < 0.0001). Differences for weight (1.8 kg; 95% CI: -0.1, 3.7 kg; P = 0.052), BMI (0.8; 95% CI: 0.1, 1.4; P = 0.028), susceptibility to hunger score (2.2; 95% CI: 1.0, 3.3; P < 0.001), and its 2 subscales also favored the hypnosis group., Conclusions: In the management of adults with obesity and a high disinhibition score, hypnosis and self-hypnosis can significantly improve the deep mechanisms of eating behaviors and seem to have a beneficial effect on weight loss.This trial was registered at clinicaltrials.gov as NCT02292108., (© The Author(s) 2022. Published by Oxford University Press on behalf of the American Society for Nutrition.)

Over the course of a lifetime, the perinatal period plays an outsized role in the function of physiological systems. Here, we discuss how neurons that regulate energy metabolism contribute to the infant's relationship with the mother. We focus our discussion on Agrp neurons, which are located in the arcuate nucleus of the hypothalamus. These neurons heavily regulate energy metabolism. Because offspring transition from a period of dependence on the caregiver to independence, we discuss the importance of the caregiver-offspring relationship for the function of Agrp neurons. We present evidence that in the adult, Agrp neurons motivate the animal to eat, while in the neonate, they motivate the offspring to seek the proximity of the caregiver. We specifically highlight the peculiarities in the development of Agrp neurons and how they relate to the regulation of metabolism and behavior over the course of a lifetime. In sum, this review considers the unique insights that ontogenetic studies can offer toward our understanding of complex biological systems, such as the regulation of energy metabolism and mother-infant attachment., (Copyright © 2022 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.)

Humans are regularly in suboptimal psychophysiological states like stressed or hungry. Previous research has made both claims that such impairments should decrease and that they should increase prosocial behaviour. We describe the overarching theoretical reasoning underlying these opposing predictions. Then we discuss empirical research on the two impairments most frequently studied, acute stress and acute hunger, and we find that neither alters prosocial behaviour clearly in one direction. We argue that this is because even under impairments, humans react flexibly to the incentive structure of the specific social situation they are in. Hence, either prosocial or egoistic tendencies get expressed, depending on which strategy can lead to fulfilment of the need the impairment triggered., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Context: The neural regulation of appetite and energy homeostasis significantly overlaps with the neurobiology of stress. Frequent exposure to repeated acute stressors may cause increased allostatic load and subsequent dysregulation of the cortico-limbic striatal system leading to inefficient integration of postprandial homeostatic and hedonic signals. It is therefore important to understand the neural mechanisms by which stress generates alterations in appetite that may drive weight gain., Objective: To determine glucocorticoid effects on metabolic, neural and behavioral factors that may underlie the association between glucocorticoids, appetite and obesity risk., Methods: A randomized double-blind cross-over design of overnight infusion of hydrocortisone or saline followed by a fasting morning perfusion magnetic resonance imaging to assess regional cerebral blood flow (CBF) was completed. Visual Analog Scale (VAS) hunger, cortisol and metabolic hormones were also measured., Results: Hydrocortisone relative to saline significantly decreased whole brain voxel based CBF responses in the hypothalamus and related cortico-striatal-limbic regions. Hydrocortisone significantly increased hunger VAS pre-scan, insulin, glucose and leptin, but not other metabolic hormones versus saline CBF groups. Hydrocortisone related increases in hunger were predicted by less reduction of CBF (hydrocortisone minus saline) in the medial OFC, medial brainstem and thalamus, left primary sensory cortex and right superior and medial temporal gyrus. Hunger ratings were also positively associated with plasma insulin on hydrocortisone but not saline day., Conclusions: Increased glucocorticoids at levels akin to those experienced during psychological stress, result in increased fasting hunger and decreased regional cerebral blood flow in a distinct brain network of prefrontal, emotional, reward, motivation, sensory and homeostatic regions that underlie control of food intake., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022. Published by Elsevier Inc.)

Background & Aims: The association of quantity and quality of carbohydrate sources with appetite during long-term weight-loss maintenance (WLM) after intentional weight loss (WL) is unclear. We aimed to investigate longitudinal associations of quantity and quality of carbohydrate sources with changes in subjective appetite sensations during WLM., Methods: This secondary analysis evaluated longitudinal data from the 3-year WLM phase of the PREVIEW study, a 2 × 2 factorial (diet-physical activity arms), multi-center, randomized trial. 1279 individuals with overweight or obesity and prediabetes (25-70 years; BMI≥25 kg m -2 ) were included. Individuals were merged into 1 group to assess longitudinal associations of yearly changes in appetite sensations. Quantity and quality of carbohydrate sources including total carbohydrate, glycemic index (GI), glycemic load (GL), and total dietary fiber were assessed via 4-day food diaries at 4 timepoints (26, 52, 104, and 156 weeks) during WLM. Visual analog scales were used to assess appetite sensations in the previous week., Results: During WLM, participants consumed on average 160.6 (25th, 75th percentiles 131.1, 195.8) g·day -1 of total carbohydrate, with GI 53.8 (48.7, 58.8) and GL 85.3 (67.2, 108.9) g day -1 , and 22.3 (17.6, 27.3) g·day -1 of dietary fiber. In the available-case analysis, multivariable-adjusted linear mixed models with repeated measures showed that each 30-g increment in total carbohydrate was associated with increases in hunger (1.36 mm year -1 , 95% CI 0.77, 1.95, P < 0.001), desire to eat (1.10 mm year -1 , 0.59, 1.60, P < 0.001), desire to eat something sweet (0.99 mm year -1 , 0.30, 1.68, P = 0.005), and weight regain (0.20%·year -1 , 0.03, 0.36, P = 0.022). Increasing GI was associated with weight regain, but not associated with increases in appetite sensations. Each 20-unit increment in GL was associated with increases in hunger (0.92 mm year -1 , 0.33, 1.51, P = 0.002), desire to eat (1.12 mm year -1 , 0.62, 1.62, P < 0.001), desire to eat something sweet (1.13 mm year -1 , 0.44, 1.81, P < 0.001), and weight regain (0.35%·year -1 , 0.18, 0.52, P < 0.001). Surprisingly, dietary fiber was also associated with increases in desire to eat, after adjustment for carbohydrate or GL., Conclusions: In participants with moderate carbohydrate and dietary fiber intake, and low to moderate GI, we found that higher total carbohydrate, GL, and total fiber, but not GI, were associated with increases in subjective desire to eat or hunger over 3 years. This study was registered as ClinicalTrials.gov, NCT01777893., Competing Interests: Conflicts of interest AR has received honorariums from the International Sweeteners Association and Unilever. JB-M is President and Director of the Glycemic Index Foundation, oversees of a glycemic index testing service at the University of Sydney and is a co-author of books about diet and diabetes. She is also a member of the Scientific Advisory Board of the Novo Foundation and of ZOE Global. SDP was the Fonterra Chair in Human Nutrition during the PREVIEW intervention. TML is advisor for “Sense” diet programme. TL is employed by NetUnion sarl, who contributed to the data collection process in the absence of commercial or financial conflict of interest with the study analysis. The rest of the authors declare that they have no potential conflicts of interests., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Hedonic hunger occurs in response to a desire to consume food for pleasure. The μ-opioid system regulates the hedonic impact of food and the opioid receptor mu 1 gene (OPRM1) polymorphism has been associated with fat intake., Objectives: The aim of this study was to determine whether the intake of high-fat food is associated with hedonic hunger and the OPRM1 polymorphism and whether these variables are related to BMI., Methods: Participants were 20- to 40-y-old women and men enrolled in Poznań, Poland in 2016-2018. The frequency of consumption of high-fat food was measured using a validated application for mobile devices. Hedonic hunger was assessed with the use of the Power of Food Scale (PFS). PFS1, PFS2, and PFS3 scores were generated for food available, food present, and food tasted, respectively. Genotyping of rs1799971 in the OPRM1 gene was performed using TaqMan probes. The associations were analyzed using linear regression or logistic regression, as appropriate., Results: Hedonic hunger scores were not associated with total high-fat food intake. Total PFS was associated with snack intake (β: 0.16, P = 0.0066). PFS1 was positively associated with healthy high-fat food intake (β: 0.27, P = 0.0001) and PFS2 with sweet high-fat food and fast-food intake (β: 0.27, P = 0.0030). OPRM1 genotype and hedonic hunger interacted on fast-food intake (β: -0.17; P < 0.0154). Total PFS and PFS2 increased the chance of having a BMI ≥ 25 kg/m2 (OR: 1.43; 95% CI: 1.03, 2.01; P = 0.0335 and OR: 1.89; 95% CI: 1.37, 2.61; P = 0.0001, respectively), whereas PFS3 decreased it (OR: 0.61; 95% CI: 0.41, 0.87; P = 0.0082)., Conclusions: Hedonic hunger is associated with the intake of selected types of high-fat food, but not with its total intake, in people aged 20-40 y. Associations between hedonic hunger and fast-food intake can be modified by OPRM1 genotype. Hedonic hunger is associated with BMI., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Society for Nutrition.)

Objective: To explore the motivational transfer between physical activity (PA) and body-related eating cues, through self-determined motivations to exercise (SDM Ex) and regulate eating (SDM Eat)., Design: Cross-sectional., Setting: Participants completed an online inventory on PA and eating behaviors and motivations in 2017-2018., Participants: A convenience sample of 300 adults (71% women; 34.4 ± 10.7 years; 23.2 ± 3.4 kg/m 2 ), recruited through Facebook and cooperating Portuguese gyms., Variables Measured: Moderate-to-vigorous physical activity (independent), SDM Ex and SDM Eat (mediators), and body-related eating cues (dependent) variables assessed through validated self-reported measures., Analysis: Structural equation modeling and serial mediation procedures were used to test the hypothetical model., Results: Physical activity was positively associated with SDM Ex, which was, in turn, associated with SDM Eat, which in turn positively predicted reliance on hunger/satiety cues and (more strongly) body-food choice congruence. The path through exercise and eating motivations was the leading mediating path in the PA and body-food choice congruence association., Conclusions and Implications: This study lends support to the motivational transfer hypothesis between SDM Ex and SDM Eat in normal-weight adults, suggesting that more physically active individuals present higher SDM Ex and SDM Eat, and therefore, greater attentiveness to body-related eating cues and necessities. Encouraging PA might also improve individuals' eating self-regulation, especially if self-determined motivations are targeted in future interventions., (Copyright © 2020 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.)

Background & Aims: The incidence of tube feeding dependency seems to increase worldwide, and these children may remain on prolonged tube feeding for many months to years. The multidisciplinary clinical hunger provocation (CHP) program is an intensive inpatient intervention of usually 2-3 weeks, aimed at weaning children from tube feeding. CHP has been proven highly effective on the short term (80-86%), particularly when applied before the age of two years but long-term data are lacking. The aims of our study were to determine the long-term efficacy of the CHP program and factors associated with success or failure and to assess anthropometrics, feeding behavior, and medical outcomes at long-term follow-up., Methods: All tube-dependent children who underwent CHP at a tertiary hospital in Amsterdam, the Netherlands, between 2001 and 2014, and had a minimum follow-up of 12-months in 2015, were eligible to participate in this retrospective cohort study. During the CHP program, tube feeding is ceased stepwise to create appetite, according to a strict protocol. The program was defined successful if patients achieved oral intake and could be fully weaned from tube feeding following the CHP program. Acute malnourishment was defined as weight for height <2 SD or loss of >1 SD within 3 months, chronic malnourishment as height for age <2 SD and both acute and chronic malnourishment as both a height for age and weight for height <2 SD. Long-term efficacy (tube free at varying follow-up periods), anthropometrics (height for age, weight for height), feeding behavior and medical outcomes were assessed by a structured cross-sectional parental interview., Results: In total, 57 patients were admitted to the CHP program. Fifty-two patients could be contacted of whom 42 participated in the study (response rate 81%) with a median age at admittance of 19 (IQR 13-22) months (62% female). The program was initially successful in 36/42 (86% (Bca CI 95% 75.0-95.2)) patients. A younger age upon initiation of tube feeding was negatively correlated with success (p 0.016). At follow-up, a median period of 67.0 (IQR 37.0-101.5) months after discharge, long-term efficacy was 32/41 (78% (Bca CI 95% 64.1-90.0)) (1 missing data). Patients with a successful CHP had beneficial outcomes compared to those with an unsuccessful CHP, showing less selective eating behavior (p 0.025), nocturnal feeding (p 0.044), forced feeding (p 0.044) and hospital admissions (p 0.028). However, 44% of successfully weaned patients fulfilled the criteria for malnourishment at long-term follow-up (13% acute, 22% chronic, and 9% both acute and chronic (compared to 22% at admittance: 13% acute, 6% chronic, and 3% both)). 59.4% of successfully weaned patients showed signs of developmental delays or were diagnosed with new medical diagnoses (43.8%) at long-term follow-up., Conclusions: The multidisciplinary CHP is a highly effective short-term (86%) and long-term (78%) intervention to wean young children from tube feeding, with beneficial feeding outcomes. However, at long-term follow-up, many successfully weaned patients were malnourished, showed signs of developmental delay, and were diagnosed with new medical diagnoses. For these reasons, patients should be monitored carefully during and after tube weaning, also after successful CHP. Tube dependency might be an early expression of medical diagnoses., (Copyright © 2020 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Insulin, a highly conserved peptide hormone, links nutrient availability to metabolism and growth in animals. In fed states insulin levels remain high and in animals that are food deprived insulin signalling drops. Here, we report that in Drosophila, feeding elicited by short periods of starvation is dependent on insulin signalling. The activity of insulin signalling pathway in the abdominal fatbody aids in feeding during short periods of starvation. A feedback regulatory signalling that involves cells that express the Drosophila hunger hormone short-neuropeptide-F (sNPF) and insulin-producing cells sustain the orexigenic function of insulin. Furthermore, the orexigenic phase of insulin activity aids in the efficient management of nutrient stores and survival of flies during starvation., Competing Interests: Declaration of competing interest None., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: To test the effects of a cooking program on healthy food decisions., Design: An experimental between-subjects design with 3 conditions: healthy, unhealthy, and control., Setting: Class settings in 5 different schools., Participants: One hundred twenty-five children between 10 and 12 years of age., Interventions: Video clips of cooking program containing healthy foods versus cooking program containing unhealthy foods versus control program., Main Outcome Measures: Healthy versus unhealthy food choice., Analysis: Logistic regression analysis, with the control condition as a reference in the first contrast test and the unhealthy food condition as a reference in the second contrast, to examine effects on food choice between conditions., Results: Children who watched the cooking program with healthy foods had a higher probability of selecting healthy food than children who watched the cooking program with unhealthy foods (P = .027), or with the control condition (P = .039)., Conclusions and Implications: These findings indicated a priming effect of the foods the children were exposed to, showing that nutrition education guided by reactivity theory can be promising. Cooking programs may affect the food choices of children and could be an effective method in combination with other methods to improve their dietary intake., (Copyright © 2019 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.)

Objective: We evaluated the specific association between food insecurity and cognitive function among a national sample of the broader U.S. older adult population., Methods: Data from the 1999-2002 National Health and Nutrition Examination Survey (NHANES) were used to identify 1851 adults, between 60 and 85 years, with complete data on selected study variables. The Food Security Survey Module (FSSM) was administered to assess food insecurity. We used the 10-item U.S. Food Security Survey Module. Based on responses to the FSSM, four mutually exclusive categories were determined: fully food secure (0), marginally food secure (1-2), food insecure without hunger (3-5) and food insecure with hunger (6-10). The DSST (Digit Symbol Substitution Test) was used to assess cognitive functioning., Results: Compared to those who were fully food secure, those who were marginally food secure (β = -13.4; 95% CI: -17.6, -9.2; P < 0.001), food insecure without hunger (β = -10.9; 95% CI: -17.6, -4.1; P = 0.003) and food insecure with hunger (β = -22.2; 95% CI: -28.6, -15.8; P < 0.001) had significantly lower cognitive function. After adjustments, results were attenuated, but remained statistically significant. Older adults who were marginally food secure (β adjusted  = -7.7; 95% CI: -11.9, -3.5; P = 0.001), food insecure without hunger (β adjusted  = -7.0; 95% CI: -11.4, -2.6; P = 0.003) and food insecure with hunger (β adjusted  = -14.4; 95% CI: -23.9, -4.5; P = 0.005) had significantly lower cognitive function., Conclusion: In this national sample of older adults, there was an inverse association between food insecurity and cognitive function., (Copyright © 2017 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background & Aims: Rapid weight loss (WL) has been associated with a larger loss of fat free mass and a disproportional reduction in resting metabolic rate (RMR), but the evidence is inconclusive. We aimed to evaluate the impact of WL rate on body composition and compensatory mechanisms activated with WL (reduced RMR, increased exercise efficiency (ExEff) and appetite), both during negative and neutral energy balance (EB)., Methods: Thirty-five participants with obesity were randomized to lose a similar weight rapidly (4 weeks) or gradually (8 weeks), and afterwards to maintain it (4 weeks). Body weight and composition, RMR, ExEff (10, 25 and 50 W), appetite feelings and appetite-regulating hormones (active ghrelin, cholecystokinin, total peptide YY (PYY), active glucagon-like peptide-1 and insulin), in fasting and every 30 min up to 2.5 h, were measured at baseline and after each phase., Results: Changes in body weight (≈9%) and composition were similar in both groups. With WL, RMR decreased and ExEff at 10 W increased significantly in the rapid WL group only. However, fasting hunger increased significantly with gradual WL only, while fasting and postprandial prospective food consumption, and postprandial hunger decreased (and postprandial fullness increased) significantly with rapid WL only. Basal total PYY, and basal and postprandial insulin decreased significantly, and similarly in both groups. After weight stabilization and no ketosis no differences between groups were found., Conclusions: Despite differences while under negative EB, WL rate does not seem to have a significant impact on body composition or on compensatory mechanisms, once EB is reestablished., Clinical Trial Registration Number: NCT01912742 (the study was registered in clinicaltrial.gov)., (Copyright © 2017 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background: Medical treatment of hunger-strike patients, especially those in incarceration facilities, may pose clinical and treatment challenges for the treating physicians., Objective: The aim of our study is to describe the epidemiology and clinical and laboratory characteristics of hunger-strike prisoners presenting to the emergency department (ED) and to describe etiologies of hospitalization and complications among this group., Method: We retrospectively examined clinical and laboratory manifestations of 50 hunger-strike prisoners who were referred for evaluation to the ED after a longstanding fast., Results: After a mean of 38 (28-44) days of a hunger strike, the most common complaints were chest pain and abdominal pain (14/60 [23.3%], 13/60 [21.6%], respectively). Mean weight loss percentage was 18.5%, and most patients were bradycardic (25/40 [62.5%]), and some hypothermic (16/50, [32%]). We describe several laboratory disturbances observed in these patients; leukopenia was the most common hematologic manifestation (31/50 [62%]), and a prolonged international normalized ratio was observed in 12/29 (41.3%) patients. We hospitalized 12% of the patients; the most common hospitalization cause was bradycardia (3/6 [50%])., Conclusions: Our study found that the most common clinical symptom was chest pain, which has not been previously reported among hunger strikers. We observed a substantial number of laboratory disturbances due to muscle wasting and protein loss and due to presumed vitamin and micronutrient deficiencies. We suggest monitoring electrocardiograms for heart rate, blood count, chemistry, coagulation tests, and vitamin levels., (Copyright © 2018 Elsevier Inc. All rights reserved.)

In the fruitfly Drosophila melanogaster, hunger has a significant impact on its sensory systems and brain functions, and consequently modifies related behaviors. However, it remains unclarified whether hunger affects nociceptive behavioral responses to heat stimuli. In this study, we show that food deprivation reduces responses to noxious heat in wild-type flies. We further identified that the neuropeptide Leucokinin (Lk) and its receptor (Lkr) are essential for the reduction of responses to noxious heat. Temporal silencing of Lk-expressing neurons and a knockout mutation of Lkr generated using the CRISPR/Cas9 system inhibited the reduction of responses to noxious heat. Thus, our results reveal that hunger induces reduction of responses to noxious heat through the Lk/Lkr signaling pathway in Drosophila., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: While many people with overweight or obesity can lose weight temporarily, most have difficulty maintaining weight loss over the long term. Studies of dietary composition typically focus on weight loss, rather than weight-loss maintenance, and rely on nutrition education and dietary counseling, rather than controlled feeding protocols. Variation in initial weight loss and insufficient differentiation among treatments confound interpretation of results and compromise conclusions regarding the weight-independent effects of dietary composition. The aim of the present study was to evaluate three test diets differing in carbohydrate-to-fat ratio during weight-loss maintenance., Design and Dietary Interventions: Following weight loss corresponding to 12±2% of baseline body weight on a standard run-in diet, 164 participants aged 18 to 65years were randomly assigned to one of three test diets for weight-loss maintenance through 20weeks (test phase). We fed them high-carbohydrate (60% of energy from carbohydrate, 20% fat), moderate-carbohydrate (40% carbohydrate, 40% fat), and low-carbohydrate (20% carbohydrate, 60% fat) diets, controlled for protein content (20% of energy). During a 2-week ad libitum feeding phase following the test phase, we assessed the effect of the test diets on body weight., Outcomes: The primary outcome was total energy expenditure, assessed by doubly-labeled water methodology. Secondary outcomes included resting energy expenditure and physical activity, chronic disease risk factors, and variables to inform an understanding of physiological mechanisms by which dietary carbohydrate-to-fat ratio might influence metabolism. Weight change during the ad libitum feeding phase was conceptualized as a proxy measure of hunger., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Obesity is associated with reduced activation in the left dorsolateral prefrontal cortex (DLPFC), a region of the brain that plays a key role in the support of self-regulatory aspects of eating behavior and inhibitory control. Transcranial direct current stimulation (tDCS) is a noninvasive technique used to modulate brain activity. Objectives: We tested whether repeated anodal tDCS targeted at the left DLPFC (compared with sham tDCS) has an immediate effect on eating behavior during ad libitum food intake, resulting in weight change, and whether it might influence longer-term food intake-related appetite ratings in individuals with obesity. Design: In a randomized parallel-design study combining inpatient and outpatient assessments over 31 d, 23 individuals with obesity [12 men; mean ± SD body mass index (BMI; in kg/m 2 ): 39.3 ± 8.42] received 15 sessions of anodal (i.e., enhancing cortical activity) or sham tDCS aimed at the left DLPFC. Ad libitum food intake was assessed through the use of a vending machine paradigm and snack food taste tests (SFTTs). Appetite was evaluated with a visual analog scale (VAS). Body weight was measured. We examined the effect of short-term (i.e., 3 sessions) and long-term (i.e., 15 sessions) tDCS on these variables. Results: Relative to sham tDCS, short-term anodal tDCS did not influence ad libitum intake of food from the vending machines. Accordingly, no effect on short-term or 4-wk weight change was observed. In the anodal tDCS group, compared with the sham group, VAS ratings for hunger and the urge to eat declined significantly more ( P = 0.01 and P = 0.05, respectively), and total energy intake during an SFTT was relatively lower in satiated individuals ( P = 0.01), after long-term tDCS. Conclusions: Short-term anodal tDCS of the left DLPFC did not have an immediate effect on ad libitum food intake or thereby weight change, relative to sham tDCS. Hunger and snack food intake were reduced only after a longer period of anodal tDCS in individuals with obesity. This trial was registered at clinicaltrials.gov as NCT00739362., (© 2017 American Society for Nutrition.)

Background: Patients with severe obesity need to adapt to surgically induced changes in their eating behaviors to maintain treatment success., Objectives: This study examined the effects of laparoscopic sleeve gastrectomy (LSG) on weight loss and on 3 dimensions of eating behavior, namely, cognitive restraint, disinhibition, and hunger. Outcomes of the LSG group were compared with a group of conservatively treated (CT) patients, who underwent a 1-year multimodal weight-reduction group program that included dietary advice, physical exercise, psychoeducation, cognitive-behavioral therapy, training in Jacobson's progressive muscle relaxation, and social group support., Setting: The study setting was a multidisciplinary obesity center located in a university hospital., Methods: A sample of 102 patients with obesity were investigated using the Three-Factor Eating Questionnaire before and, on average, 19 (±5) months after weight loss intervention. Of the 102 patients, 62 (age 45.8±10.8 years, 71% females) underwent LSG, and 40 patients (age 50.6±11.3 years, 77.5% females) underwent the CT program. Patients were assigned to either the surgical or the nonsurgical intervention group following clinical guidelines and patient preference., Results: In the LSG group, total weight loss was 25.9±11.0%, excess weight loss was 52.8±24.1%, and body mass index decreased from 51.4±8.1 to 38.0±7.8 kg/m². In the CT group, total weight loss was 5.4±10.6%, excess weight loss was 13.9±27.1%, and body mass index decreased from 40.3±6.7 to 38.0±7.2 kg/m². Significant improvements in self-reported eating behaviors were observed in both groups, that is, an increased cognitive restraint of eating, a decreased disinhibition of eating control, and a reduced degree of perceived hunger. In contrast, whereas Three-Factor Eating Questionnaire scores before weight loss intervention did not differ between groups, LSG patients reported significantly greater reductions in disinhibition and hunger than CT patients did after weight loss intervention. In both groups, greater weight loss was associated with decreased hunger sensations., Conclusion: In the second follow-up year, LSG was associated with greater weight loss and greater improvements in self-reported eating behaviors compared with conservative treatment., (Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Motilin-induced phase III contractions have been identified as a hunger signal. These phase III contractions occur as part of the migrating motor complex (MMC), a contractility pattern of the gastrointestinal tract during fasting. The mechanism involved in this association between subjective hunger feelings and gastrointestinal motility during the MMC is largely unknown, however, as is its ability to stimulate food intake., Objectives: We sought to 1) investigate the occurrence of hunger peaks and their relation to phase III contractions, 2) evaluate whether this relation was cholinergically driven, and 3) assess the ability of the motilin receptor agonist erythromycin to induce food intake., Design: An algorithm was developed to detect hunger peaks. The association with phase III contractions was studied in 14 healthy volunteers [50% men; mean ± SEM age: 25 ± 2 y; mean ± SEM body mass index (BMI; in kg/m(2)): 23 ± 1]. The impact of pharmacologically induced phase III contractions on the occurrence of hunger peaks and the involvement of a cholinergic pathway were assessed in 14 healthy volunteers (43% men; age: 29 ± 3 y; BMI: 23 ± 1). Last, the effect of erythromycin administration on food intake was examined in 15 healthy volunteers (40% men; age: 28 ± 3 y; BMI: 22 ± 1)., Results: The occurrence of hunger peaks and their significant association with phase III contractions was confirmed (P < 0.0001). Pharmacologically induced phase III contractions were also significantly associated with hunger peaks (P < 0.05), and this association involved a cholinergic pathway. Administering erythromycin significantly stimulated food intake compared with placebo (53% ± 13% compared with 10% ± 5%; P < 0.05)., Conclusions: Motilin-induced phase III contractions induced hunger feelings through a cholinergic pathway. Moreover, erythromycin stimulated food intake, suggesting a physiologic role of motilin as an orexigenic signal from the gastrointestinal tract. This trial was registered at www.clinicaltrials.gov as NCT02633579., (© 2016 American Society for Nutrition.)

Background: Compared with nonaerated, isocaloric controls, aerated foods can reduce appetite throughout an entire dieting day. Increased gastric volumes and delayed emptying are possible but unexplored mechanisms., Objective: We tested the hypothesis that aerated drinks (foams) of differing gastric stability would increase gastric distension and reduce appetite compared with a control drink., Design: In a randomized, balanced, crossover trial, 18 healthy male participants consumed the following 3 skimmed-milk-based test products (all 110 kcal): 2 drinks aerated to foams by whipping (to 490 mL), one drink that was stable in the stomach [stable foam (SF)], and one drink that was less stable in the stomach [less-stable foam (LSF)], and a nonaerated drink [liquid control (LC); 140 mL]. Over 4 h, stomach contents (foam, air, and liquid) were imaged using magnetic resonance imaging (MRI), and self-reported appetite ratings were collected and quantified by the area under the curve or time to return to baseline (TTRTB)., Results: Compared with the LC, both foams caused significantly increased gastric volumes and reduced hunger (all P < 0.001). Compared with the LSF, SF further produced a significantly slower decrease in the total gastric content (P < 0.05) and foam volume (P < 0.0001) and a longer TTRTB (197 compared with 248 min, respectively; P < 0.05), although the hunger AUC was not statistically different. Results for other appetite scales were similar., Conclusions: With this MRI trial, we provide novel insights on the gastrointestinal behavior of aerated drinks by measuring separate volumes of foam, liquid, and air layers in the stomach. Appetite suppression induced by foams could largely be explained by effects on gastric volumes and emptying, which may be further enhanced by foam stability. This trial was registered at clinicaltrials.gov as NCT01690182., (© 2015 American Society for Nutrition.)

This article is a summary of the symposium "Modifying Eating Behavior: Novel Approaches for Reducing Body Weight, Preventing Weight Regain, and Reducing Chronic Disease Risk" held 29 April 2014 at the ASN Scientific Sessions and Annual Meeting at Experimental Biology 2014 in San Diego, CA. In this symposium, novel approaches to modifying eating behavior were highlighted, including 1) alteration of meal timing and macronutrient composition and 2) retraining and provision of feedback about eating behavior. Dr. Ciampolini discussed a method for teaching individuals to recognize a decrease in blood glucose concentration, and therefore the need for energy, by learning the associated physical sensations (signifying hunger). Dr. Madar and Sigal Sofer presented their work on reducing hunger during energy reduction by feeding carbohydrate only in the evening. Dr. Hamilton-Shield reviewed studies on the Mandometer (Mikrodidakt), a device for training individuals to slow eating rate. Finally, Dr. Sazonov presented information on a wearable device, the Automatic Ingestion Monitor, which senses jaw motion and/or hand-to-mouth gestures to detect and characterize food intake. His goal is to use the instrument to prevent overeating by providing feedback to the user to stop ingestion at a predetermined limit., (© 2014 American Society for Nutrition.)

Background: Mothers use a range of feeding practices to limit children's intake of palatable snacks (eg, keeping snacks out of reach, not bringing snacks into the home), but less is known about the effects of these practices on children's eating and weight outcomes., Objective: The objective was to identify distinct feeding practice profiles and evaluate the interactive effects of these profiles and girls' temperament (inhibitory control and approach) on girls' eating behaviors and weight outcomes at 5 and 7 y., Design: Participants included 180 mother-daughter dyads; measures were mothers' reports of controlling feeding practices and girls' height and weight, eating in the absence of hunger (EAH) at 5 y, and inhibitory control (a measure of behavioral inhibition) and approach (a measure of appetitive motivation) at 7 y., Results: Latent profile analysis of maternal feeding practices showed 4 feeding profiles based on maternal use of limit-setting practices and keeping snacks out of girls' physical reach, a restrictive practice: Unlimited Access to Snacks, Sets Limits+Does Not Restrict Snacks, Sets Limits+Restricts High Fat/Sugar Snacks, and Sets Limits+Restricts All Snacks. Girls whose mothers used Sets Limits+Restricts All Snacks had a higher approach and EAH at 5 y. Low inhibitory control girls whose mothers used Sets Limits+Restricts All Snacks or Unlimited Access to Snacks had greater increases in EAH and body mass index (BMI) from 5 to 7 y., Conclusions: Effects of maternal control on girls' EAH and BMI may differ by the type of practice used (eg, limit-setting or restrictive practices). Girls with low inhibitory control were more susceptible to the negative effects of low and high control.

Background: Initial outcome studies have reported that Roux-en-Y gastric bypass (RYGB) is safe and efficacious for adolescents with extreme obesity. Although rapid weight loss is seen initially, data also show that modest weight regain typically occurs as early as the second postoperative year. The contribution of various psychological factors, including hedonic hunger, to postoperative weight regain has not previously been studied in adolescents. The objective of this study was to examine the variability in hedonic hunger and body mass index (BMI) over the initial 2-year period of weight loss and modest weight regain in adolescent RYGB recipients., Methods: A total of 16 adolescents completed the Power of Food Scale before surgery and at 3, 6, 12, 18, and 24 months postoperatively. Height and weight were measured at each time point, from which BMI was calculated., Results: Nonlinear trends were observed for time on both overall hedonic hunger and hedonic hunger specifically related to food available in the adolescent's environment. The BMI reduction during the first 18 months postoperatively was paralleled by reduction in hedonic hunger; increases in hedonic hunger also paralleled the modest BMI increase at 24 months. In growth analysis, significant power gains are available to models using 4 or more points of data. However, only large effect sizes that are>.85 were detectable with a sample of 16 patients., Conclusion: These data provide preliminary evidence that hedonic hunger is in need of further study in adolescent patients receiving RYGB both preoperatively and postoperatively., (Copyright © 2014 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Low- and high-fat meals affect homeostatic and gustatory brain areas differentially. In a previous study, we showed that a high-fat meal decreased cerebral blood flow (CBF) in homeostatic brain areas (hypothalamus), whereas a low-fat meal increased CBF in gustatory regions (anterior insula)., Objective: The aim of this study was to investigate the long-lasting effect of fat-free flavor-active compounds of olive oil on the brain and whether those aroma components can trigger fat-associated brain responses in homeostatic and gustatory regions., Design: Eleven healthy male subjects participated in a functional magnetic resonance imaging study. On 2 measurement days, subjects consumed single-blinded a plain low-fat yogurt or low-fat yogurt mixed with a fat-free aroma extract of olive oil. Resting CBF was measured before and 30 and 120 min after yogurt intake. Hunger was rated before each measurement. Blood samples were collected at 6 time points., Results: The extract-containing yogurt elicited higher CBF in the frontal operculum 30 and 120 min after a meal. Furthermore, the activity change in the anterior insula after 30 min correlated positively with the glucose change in the extract condition only. No effects were observed in the hypothalamus., Conclusions: The anterior insula and the frontal operculum are regarded as the primary taste cortex. Modulation of the frontal operculum by the yogurt containing the olive oil extract suggests that it might be possible to simulate fat-triggered sensations in the brain on the gustatory level, possibly by ingredients the body implicitly associates with fat. This trial was registered at clinicaltrials.gov as NCT01716286.

Background: Obesity as a chronic disease has spread worldwide. Conservative treatment, especially with severe obesity, often fails. Obesity surgery has been shown to be an effective treatment. Laparoscopic sleeve gastrectomy (LSG), as a restrictive procedure, has low risks and results in good weight loss outcomes. However, to date, no studies have investigated the changes in psychological dimensions-especially concerning eating behavior and cognitive restraint-after LSG. The present study investigated, for the first time, eating behavior (cognitive restraint, disinhibition, hunger), depression, and perceived stress before and 1 year after LSG. The setting was a university hospital, comprehensive obesity center., Methods: Of 59 patients who had undergone LSG from 2008 to 2010, 40 patients were evaluated using questionnaires on eating behavior, depression, and stress, with measurements made before and 1 year after surgery., Results: The body mass index had decreased, on average, by 15.5 kg/m(2) 1 year after LSG (62.7% excess weight loss). The eating behaviors had changed, with patients experiencing less hunger, fewer food cravings, and decreased disinhibition. Depressive symptoms and perceived stress improved. However, the results showed high levels in the dimension of cognitive restraint of eating 1 year after LSG., Conclusions: Most psychological dimensions improved as expected. The patients were less distracted by food, experienced less hunger, and were less disturbed by emotional distress. However, we found persistent cognitive restraint, reflecting an ongoing need for central eating control. Additional investigations are needed to describe the communication between the gut and brain after surgery., (Copyright © 2013 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Effects of protein intake on appetite-regulating hormones and their dynamics are unclear., Objectives: We investigated the satiating effects of meals with varying protein contents and whether there was an effect of dose on appetite-regulating hormones and appetite ratings., Design: Twenty-five men [mean ± SD age: 30.0 ± 8.7 y; body mass index (BMI; in kg/m(2)): 25.9 ± 4.7] participated in the 3-way, randomized, double-blind crossover study. Test meals were isocaloric with 30% of energy from fat and protein content adjusted at the expense of carbohydrate. Test meals were normal protein (NP; 14% of energy from protein), medium-high protein (MHP; 25% of energy from protein), and high protein (HP, 50% of energy from protein). Appetite ratings and blood samples were assessed every 0.5 h for 4 h. An ad libitum lunch was served 4 h after the meal., Results: Protein increased dose-dependently glucagon-like peptide-1 (GLP-1), peptide YY (PYY) 3-36, and glucagon; MHP produced 10%, 7%, and 47% greater responses, respectively; and HP produced 20%, 14%, and 116% greater responses, respectively, than did NP (P < 0.03). Compared with NP, HP increased insulin and cholecystokinin and decreased ghrelin and glucose-dependent insulinotropic polypeptide (P < 0.05). Satiety and fullness dose-dependently increased by 7% and 6% for MHP and 16% and 19% for HP compared with NP (P < 0.001). Hunger and prospective consumption dose-dependently decreased by 15% and 13% for MHP and by 25% and 26% for HP compared with NP (P < 0.0003). There was a combined effect of GLP-1 and PYY 3-36 (P = 0.03) next to the additive effect of GLP-1 (P = 0.006) on the composite appetite score. No difference was shown in ad libitum energy intake., Conclusion: Protein dose-dependently increased satiety and GLP-1, PYY 3-36, and glucagon, which may, at least in part, be responsible for the satiety-stimulating effect of protein. This trial was registered at clinicaltrials.gov as NCT01561235.

Background: Flexibility of food reward-related brain signaling (FRS) between food and nonfood stimuli may differ between overweight and normal-weight subjects and depend on a fasted or satiated state., Objective: The objective was to assess this flexibility in response to visual food and nonfood cues., Design: Twenty normal-weight [mean ± SEM BMI (in kg/m(2)) = 22.7 ± 0.2; mean ± SEM age = 22.4 ± 0.4 y] and 20 overweight (BMI = 28.1 ± 0.3; age = 24.0 ± 0.7 y) participants completed 2 fMRI scans. Subjects arrived in a fasted state and consumed a breakfast consisting of 20% of subject-specific energy requirements between 2 successive scans. A block paradigm and a food > nonfood contrast was used to determine FRS., Results: An overall stimulus × condition × subject group effect was observed in the anterior cingulate cortex (ACC) (P < 0.006, F((1,38)) = 9.12) and right putamen (P < 0.006, F((1,38)) = 9.27). In all participants, FRS decreased from the fasted to the satiated state in the cingulate (P < 0.005, t((39)) = 3.15) and right prefrontal cortex (PFC) (P < 0.006, t((39)) = 3.00). In the fasted state, they showed FRS in the PFC (P < 0.004, t((39)) = 3.17), left insula (P < 0.009, t((39)) = 2.95), right insula (P < 0.005, t((39)) = 3.12), cingulate cortex (P < 0.004, t((39)) = 3.21), and thalamus (P < 0.006, t((39)) = 2.96). In the satiated state, FRS was limited to the left insula (P < 0.005, t((39)) = 3.21), right insula (P < 0.006, t((39)) = 3.04), and cingulate cortex (P < 0.005, t((39)) = 3.15). Regarding subject group, in the fasted state, FRS in the ACC was more pronounced in overweight than in normal-weight subjects (P < 0.005, F((1,38)) = 9.71), whereas in the satiated state, FRS was less pronounced in overweight than in normal-weight subjects in the ACC (P < 0.006, F((1,38)) = 9.18) and PFC (P < 0.006, F((1,38)) = 8.86), which suggests lower inhibitory control in the overweight., Conclusion: FRS was higher in the overweight in the satiated state; however, when sufficiently satiated, the overweight showed decreased inhibitory control signalling, which facilitates overeating. This trial was registered in the Dutch clinical trial register as NTR2174.

Background: Smoking cessation is often followed by weight gain. Eating behaviors and weight change have been linked to the brain response to food, but it is unknown whether smoking influences this response., Objective: We determined the influence of smoking status (smokers compared with nonsmokers) on the brain response to food in regions associated with weight changes in nonsmokers., Design: In study 1, we used functional MRI (fMRI) to identify regions of the brain associated with weight change in nonsmokers. BMI and the brain response to a milk shake, which is a palatable and energy-dense food, were measured in a group of 27 nonsmokers (5 men). Sixteen subjects (3 men) returned 1 y later for BMI reassessment. The change in BMI was regressed against the brain response to isolate regions associated with weight change. In study 2, to determine whether smokers showed altered responses in regions associated with weight change, we assessed the brain response to a milk shake in 11 smokers. The brain response to a milk shake compared with a tasteless control solution was assessed in 11 smokers (5 men) in comparison with a group of age-, sex- and body weight-matched nonsmokers selected from the pool of nonsmokers who participated in study 1., Results: The response in the midbrain, hypothalamus, thalamus, and ventral striatum was positively associated with weight change at the 1-y follow-up in 16 nonsmokers. Compared with nonsmokers, smokers had a greater response to milk shakes in the hypothalamus., Conclusion: Smokers display an altered brain response to food in the hypothalamus, which is an area associated with long-term weight change in nonsmokers.

Background: There are strong logical reasons why energy expended in metabolism should influence the energy acquired in food-intake behavior. However, the relation has never been established, and it is not known why certain people experience hunger in the presence of large amounts of body energy., Objective: We investigated the effect of the resting metabolic rate (RMR) on objective measures of whole-day food intake and hunger., Design: We carried out a 12-wk intervention that involved 41 overweight and obese men and women [mean ± SD age: 43.1 ± 7.5 y; BMI (in kg/m(2)): 30.7 ± 3.9] who were tested under conditions of physical activity (sedentary or active) and dietary energy density (17 or 10 kJ/g). RMR, daily energy intake, meal size, and hunger were assessed within the same day and across each condition., Results: We obtained evidence that RMR is correlated with meal size and daily energy intake in overweight and obese individuals. Participants with high RMRs showed increased levels of hunger across the day (P < 0.0001) and greater food intake (P < 0.00001) than did individuals with lower RMRs. These effects were independent of sex and food energy density. The change in RMR was also related to energy intake (P < 0.0001)., Conclusions: We propose that RMR (largely determined by fat-free mass) may be a marker of energy intake and could represent a physiologic signal for hunger. These results may have implications for additional research possibilities in appetite, energy homeostasis, and obesity. This trial was registered under international standard identification for controlled trials as ISRCTN47291569.

Background: Prolonged postprandial hypertriglyceridemia is a potential risk factor for cardiovascular diseases. In the context of obesity, this is associated with a chronic imbalance of lipid partitioning oriented toward storage and not toward β-oxidation., Objective: We tested the hypothesis that the physical structure of fat in a meal can modify the absorption, chylomicron transport, and further metabolic handling of dietary fatty acids., Design: Nine normal-weight and 9 obese subjects were fed 40 g milk fat (+[(13)C]triacylglycerols), either emulsified or nonemulsified, in breakfasts of identical composition. We measured the postprandial triacylglycerol content and size of the chylomicron-rich fraction, plasma kinetics of [(13)C]fatty acids, exogenous lipid oxidation with breath-test/indirect calorimetry, and fecal excretion., Results: The emulsified fat resulted in earlier (>1 h) and sharper chylomicron and [(13)C]fatty acid peaks in plasma than in spread fat in both groups (P < 0.0001). After 2 h, the emulsified fat resulted in greater apolipoprotein B-48 concentrations (9.7 ± 0.7 compared with 7.1 ± 0.9 mg/L; P < 0.05) in the normal-weight subjects than did the spread fat. In the obese subjects, emulsified fat resulted in a 3-fold greater chylomicron size (218 ± 24 nm) compared with the spread fat (P < 0.05). The emulsified fat induced higher dietary fatty acid spillover in plasma and a sharper (13)CO(2) appearance, which provoked increased exogenous lipid oxidation in each group: from 45% to 52% in normal-weight subjects (P < 0.05) and from 40% to 57% in obese subjects (P < 0.01)., Conclusion: This study supports a new concept of "slow vs fast fat," whereby intestinal absorption can be modulated by structuring dietary fat to modulate postprandial lipemia and lipid β-oxidation in humans with different BMIs. This trial was registered at clinicaltrials.gov as NCT01249378.

Background: The protein leverage hypothesis requires specific evidence that protein intake is regulated more strongly than energy intake., Objective: The objective was to determine ad libitum energy intake, body weight changes, and appetite profile in response to protein-to-carbohydrate + fat ratio over 12 consecutive days and in relation to age, sex, BMI, and type of protein., Design: A 12-d randomized crossover study was performed in 40 men and 39 women [mean ± SD age: 34.0 ± 17.6 y; BMI (in kg/m(2)): 23.7 ± 3.4] with the use of diets containing 5%, 15%, and 30% of energy from protein from a milk or plant source., Results: Protein-content effects did not differ by age, sex, BMI, or type of protein. Total energy intake was significantly lower in the high-protein (7.21 ± 3.08 MJ/d) condition than in the low-protein (9.33 ± 3.52 MJ/d) and normal-protein (9.62 ± 3.51 MJ/d) conditions (P = 0.001), which was predominantly the result of a lower energy intake from meals (P = 0.001). Protein intake varied directly according to the amount of protein in the diet (P = 0.001). The AUC of visual analog scale appetite ratings did not differ significantly, yet fluctuations in hunger (P = 0.019) and desire to eat (P = 0.026) over the day were attenuated in the high-protein condition compared with the normal-protein condition., Conclusions: We found evidence to support the protein leverage hypothesis in that individuals underate relative to energy balance from diets containing a higher protein-to-carbohydrate + fat ratio. No evidence for protein leverage effects from diets containing a lower ratio of protein to carbohydrate + fat was obtained. It remains to be shown whether a relatively low protein intake would cause overeating or would be the effect of overeating of carbohydrate and fat. The study was registered at clinicaltrials.gov as NCT01320189.

Recent findings suggest that disgust can activate particular aspects of the immune system. In this study we examine whether disgust can also elevate core body temperature (BT), a further feature of an immune response to disease. In addition, we also examined whether food based disgust--a core eliciting stimulus--may be a more potent immune stimulus than non-food based disgust. Healthy males were randomly assigned to view one of four sets of images--food disgust, non-food disgust, food control and negative emotion control. Measures of BT, salivary immune and related markers, and self-report data, were collected before, and at two time points after image viewing. Disgust elevated BT relative to the negative emotion control condition, as did food images. Different mechanisms appeared to account for these effects on BT, with higher initial levels of Tumor Necrosis Factor alpha (TNF-a) and disgust, predictive of BT increases in the disgust conditions. Disgust also increased TNF-a, and albumin levels, relative to the control conditions. Type of disgust exerted little effect. These findings further support the idea that disgust impacts upon immune function, and that disgust serves primarily a disease avoidance function., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Separation of solids and liquids within the stomach allows faster gastric emptying of liquids compared with solids, a phenomenon known as sieving. We tested the hypothesis that blending a solid and water meal would abolish sieving, preventing the early rapid decrease in gastric volume and thereby enhancing satiety. We carried out 2 separate studies. Study 1 was a 2-way, crossover, satiety study of 22 healthy volunteers who consumed roasted chicken and vegetables with a glass of water (1008 kJ) or the same blended to a soup. They completed satiety visual analogue scales at intervals for 3 h. Study 2 was a 2-way, crossover, mechanistic study of 18 volunteers who consumed the same meals and underwent an MRI to assess gastric emptying, gallbladder contraction, and small bowel water content (SBWC) at intervals for 3 h. In Study 1, the soup meal was associated with reduced hunger (P = 0.02). In Study 2, the volume of the gastric contents after the soup meal decreased more slowly than after the solid/liquid meal (P = 0.0003). The soup meal caused greater gallbladder contraction (P < 0.04). SBWC showed a biphasic response with an initial "gastric" phase during which SBWC was greater when the solid/liquid meal was consumed (P < 0.001) and a later "small bowel" phase when SBWC was greater when the soup meal was consumed (P < 0.01). Blending the solid/liquid meal to a soup delayed gastric emptying and increased the hormonal response to feeding, which may contribute to enhanced postprandial satiety.

Background: The hypothalamus is the central homeostatic control region of the brain and, therefore, highly influenced by nutrients such as glucose and fat. Immediate and prolonged homeostatic effects of glucose ingestion have been well characterized. However, studies that used stimulation with fat have mainly investigated immediate perceptional processes. Besides homeostatic processes, the gustatory cortex, including parts of the insular cortex, is crucial for the processing of food items., Objective: The aim of this study was to investigate the effect of high- compared with low-fat meals on the hypothalamus and the insular cortex., Design: Eleven healthy men participated in a single-blinded, functional MRI study of high- and low-fat meals on 2 measurement days. Cerebral blood flow (CBF) was measured before and 30 and 120 min after intake of high- and low-fat yogurts. Hunger was rated and blood samples were taken before each CBF measurement., Results: High-fat yogurt induced a pronounced decrease in CBF in the hypothalamus, and the corresponding CBF change correlated positively with the insulin change. Furthermore, insular activity increased after 120 min in the low-fat condition only. The CBF change in both regions correlated positively in the high-fat condition., Conclusions: The decrease in hypothalamic activity and the interaction with the insular cortex elicited by fat may contribute to an efficient energy homeostasis. Therefore, fat might be a modulator of homeostatic and gustatory brain regions and their interaction. This trial was registered at clinicaltrials.gov as NCT01516021.

Purpose: A hunger strike is a voluntary fast, performed to protest publicly against an issue deemed unfair. In the case of French prisoners, hospitalization in an interregional hospital secured units (UHSI) may be necessary., Methods: A retrospective epidemiological study based on one UHSI medical records was performed on the period of May, 2006 to December, 2008, and focused on symptoms, outcomes and ethical problems encountered., Results: Seven men and one woman with a mean age of 32.6 years were hospitalized in an UHSI, with nine episodes of hunger strike of a median duration of 57 days. Clinical symptoms began after two weeks of voluntary deprivation in the form of dizziness, weakness, muscle pain and headache. Laboratory tests showed hypoglycemia (<0.4g/L) on admission, 16.3% decrease of albumin after 40.5 days, and dehydration in case of thirst strike. The clinical tolerance was good and no patient presented Wernicke's encephalopathy. A diabetic patient developed acidocetosis during two hunger strikes. All hunger strikes were respected by medical staff, and treatment was based upon surveillance of symptoms, vitamin B and sweetened drinks administration and explanations of the clinical hazards on a daily basis., Conclusion: The special problem encountered in the medical management of these strikers was to convince them to accept treatments in order to avoid a coercive life-saving treatment as requested by French law., (Copyright © 2011 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.)

Background: Eating behavior is determined, to a significant extent, by the rewarding value of food (ie, liking and wanting)., Objective: We determined brain regions involved in liking and wanting and related brain signaling to body mass index (BMI; in kg/m(2)) and dietary restraint., Design: Fifteen normal-weight female subjects [mean ± SEM age: 21.5 ± 0.4 y; BMI: 22.2 ± 0.2] completed a food-choice paradigm by using visually displayed food items during functional magnetic resonance imaging scans. Two scans were made as follows: one scan was made in a fasted condition, and one scan was made in a satiated condition. The paradigm discriminated between liking and wanting, and subjects were offered items rated highly for wanting immediately after each scan. Imaging contrasts for high and low liking and wanting were made, and data for regions of interest were extracted. Activation related to liking and wanting, respectively, was determined. Outcomes were correlated to cognitive dietary restraint and BMI., Results: Dietary restraint predicted liking task-related signaling (TRS) in the amygdala, striatum, thalamus, and cingulate cortex (r = -0.5 ± 0.03, P < 0.00001). In the nucleus accumbens, the premeal liking and wanting TRS and premeal to postmeal liking TRS changes correlated positively with dietary restraint [bilateral average r = 0.6 ± 0.02, P < 0.04 (Bonferroni corrected)]. BMI and hunger predicted wanting TRS in the hypothalamus and striatum (P < 0.05). Postmeal liking TRS in the striatum, anterior insula, and cingulate cortex and wanting TRS in the striatum predicted the energy intake (liking: r = -0.3 ± 0.05, P < 0.0001; wanting: r = -0.3 ± 0.03, P < 0.00001)., Conclusions: Successful dietary restraint was supported by liking TRS from premeal to postmeal in the nucleus accumbens. Reward-related signaling was inversely related to BMI and energy intake, indicating reward deficiency.

High-protein preloads have been shown to enhance satiety, but little is known about the satiating effects of protein in more typical situations when meals are consumed ad libitum. To investigate the effects of protein in amounts commonly consumed over a day, a crossover study was conducted in 2008. In this experiment, 18 normal-weight women consumed ad libitum lunch and dinner entrées 1 day a week that were covertly varied in protein content (10%, 15%, 20%, 25%, or 30% energy). Entrées were manipulated by substituting animal protein for starchy ingredients and were matched for energy density, fat content, palatability, and appearance. Unmanipulated breakfasts and evening snacks were consumed ad libitum. Participants rated their hunger and fullness before and after meals as well as the taste and appearance of entrées. Data were analyzed using a mixed linear model. Results showed that mean 24-hour protein intake increased significantly across conditions, from 44±2 g/day in the 10% protein condition to 82±6 g/day in the 30% condition. Daily energy intake did not differ significantly across the 10% to 30% protein conditions (means 1,870±93, 1,887±93, 1,848±111, 1,876±100, and 1,807±98 kcal in the 10%, 15%, 20%, 25%, and 30% energy groups, respectively). There were no significant differences in hunger and fullness ratings across conditions or in taste and appearance ratings of the manipulated entrées. This study showed that varying the protein content of several entrées consumed ad libitum did not differentially influence daily energy intake or affect ratings of satiety., (Copyright © 2011 American Dietetic Association. Published by Elsevier Inc. All rights reserved.)

Using content and interpretative phenomenological analysis, we explored the meaning of food and eating from the perspective of adults receiving home parenteral nutrition (PN). The aim of this research was to obtain a deeper understanding of how issues related to food and eating influence quality of life (QOL). Semistructured telephone interviews were conducted between May 2006 and January 2007 with 24 adults with intestinal failure and home PN dependency. The analysis revealed themes relevant to eating behaviors, hunger and thirst, strategies for dining in restaurants, and a perception of wasting money because of malabsorbed food. Three patterns of eating emerged: eating for survival, eating for health benefits, and eating for socialization. A proposed model illustrates how these eating patterns are linked to QOL. Being able to eat and enjoy food is an important ingredient for good self-reported QOL. Measurements of QOL for this population may be enhanced with inclusion of a food and eating domain. The social and emotional context of food and mealtimes is an important component to address in the nutrition care plan for PN-dependent adults., (Copyright © 2010 American Dietetic Association. Published by Elsevier Inc. All rights reserved.)

Background: Eating in the absence of hunger (EAH) is typically assessed by measuring youths' intake of palatable snack foods after a standard meal designed to reduce hunger. Because energy intake required to reach satiety varies among individuals, a standard meal may not ensure the absence of hunger among participants of all weight strata., Objective: The objective of this study was to compare adolescents' EAH observed after access to a very large food array with EAH observed after a standardized meal., Design: Seventy-eight adolescents participated in a randomized crossover study during which EAH was measured as intake of palatable snacks after ad libitum access to a very large array of lunch-type foods (>10,000 kcal) and after a lunch meal standardized to provide 50% of the daily estimated energy requirements., Results: The adolescents consumed more energy and reported less hunger after the large-array meal than after the standardized meal (P values < 0.001). They consumed ≈70 kcal less EAH after the large-array meal than after the standardized meal (295 ± 18 compared with 365 ± 20 kcal; P < 0.001), but EAH intakes after the large-array meal and after the standardized meal were positively correlated (P values < 0.001). The body mass index z score and overweight were positively associated with EAH in both paradigms after age, sex, race, pubertal stage, and meal intake were controlled for (P values ≤ 0.05)., Conclusion: EAH is observable and positively related to body weight regardless of whether youth eat in the absence of hunger from a very large-array meal or from a standardized meal. This trial was registered at clinicaltrials.gov as NCT00631644.

Background: Overeating as a pathogenetic hallmark of obesity may be promoted by an increase in hedonic hunger, ie, the drive to eat palatable foods in the absence of energy need. Gastric bypass surgery, which effectively reduces severe obesity, might also affect hedonic hunger., Objective: The objective was to assess hedonic hunger in severely obese patients with and without a history of gastric bypass surgery., Design: Severely obese patients who had not undergone gastric bypass surgery (n = 123), gastric bypass patients (n = 136), and nonobese control subjects (n = 110) were examined with the Power of Food Scale (PFS)--a questionnaire that reliably measures an individual's motivation to consume highly palatable foods., Results: Compared with nonobese control subjects, severely obese patients achieved markedly higher aggregated PFS scores and subdomain scores related to generally available as well as physically present foods (all P < 0.001). On the aggregated score as well in those 2 subdomains, gastric bypass patients scored significantly lower than did non-gastric bypass obese patients (all P < 0.001) and did not differ significantly from the nonobese control group (P > 0.2). In contrast, in the PFS domain concerning food tasted, gastric bypass patients had significantly lower scores than did the nonobese control subjects (P = 0.04) and the severely obese patients (P = 0.008), both of whom did not differ significantly in this measure (P = 0.90)., Conclusion: In comparison with nonobese control subjects, severely obese patients display a marked increase in hedonic hunger that is not observed in patients who have undergone gastric bypass surgery, suggesting that the operation normalizes excessive appetite for palatable foods, which may be an important pathophysiologic feature of severe obesity.

The endocannabinoid system (ECS) consists of two receptors (CB(1) and CB(2)), several endogenous ligands (primarily anandamide and 2-AG), and over a dozen ligand-metabolizing enzymes. The ECS regulates many aspects of embryological development and homeostasis, including neuroprotection and neural plasticity, immunity and inflammation, apoptosis and carcinogenesis, pain and emotional memory, and the focus of this review: hunger, feeding, and metabolism. This mini-review summarizes the main findings that supported the clinical use of CB1 antagonists/inverse agonists, the clinical concerns that have emerged, and the possible future of cannabinoid-based therapy of obesity and related diseases. The ECS controls energy balance and lipid metabolism centrally (in the hypothalamus and mesolimbic pathways) and peripherally (in adipocytes, liver, skeletal muscle and pancreatic islet cells), acting through numerous anorexigenic and orexigenic pathways. Obese people seem to display an increased endocannabinoid tone, driving CB(1) receptor in a feed-forward dysfunction. Several CB(1) antagonists/inverse agonists have been developed for the treatment of obesity. Although these drugs were found to be efficacious at reducing food intake as well as abdominal adiposity and cardiometabolic risk factors, they resulted in adverse psychiatric effects that limited their use and finally led to the end of the clinical use of systemic CB(1) ligands with significant inverse agonist activity for complicated obesity. However, the existence of alternatives such as CB(1) partial agonists, neutral antagonists, antagonists restricted to the periphery, allosteric modulators and other potential targets within the ECS indicate that a cannabinoid-based therapy for the management of obesity and its associated cardiometabolic sequelae should remain open for consideration., (Copyright 2010 Elsevier Inc. All rights reserved.)

Background: Acute partial sleep deprivation increases plasma concentrations of ghrelin and decreases those of leptin., Objective: The objective was to observe modifications in energy intake and physical activity after acute partial sleep deprivation in healthy men., Design: Twelve men [age: 22 +/- 3 y; body mass index (in kg/m(2)): 22.30 +/- 1.83] completed a randomized 2-condition crossover study. During the first night of each 48-h session, subjects had either approximately 8 h (from midnight to 0800) or approximately 4 h (from 0200 to 0600) of sleep. All foods consumed subsequently (jam on buttered toast for breakfast, buffet for lunch, and a free menu for dinner) were eaten ad libitum. Physical activity was recorded by an actimeter. Feelings of hunger, perceived pleasantness of the foods, desire to eat some foods, and sensation of sleepiness were also evaluated., Results: In comparison with the 8-h sleep session, subjects consumed 559 +/- 617 kcal (ie, 22%) more energy on the day after sleep restriction (P < 0.01), and preprandial hunger was higher before breakfast (P < 0.001) and dinner (P < 0.05). No change in the perceived pleasantness of the foods or in the desire to eat the foods was observed. Physical activity from 1215 to 2015 was higher after sleep restriction than after 8 h of sleep (P < 0.01), even though the sensation of sleepiness was more marked (P < 0.01)., Conclusions: One night of reduced sleep subsequently increased food intake and, to a lesser extent, estimated physical activity-related energy expenditure in healthy men. These experimental results, if confirmed by long-term energy balance measurements, suggest that sleep restriction could be a factor that promotes obesity. This trial was registered at clinicaltrials.gov as NCT00986492.

Background: The design of dietary, metabolic, and intervention studies should reflect the meal patterning of free-living individuals, but this design has not been systematically reviewed recently., Objective: Our objective was to examine meal-patterning trends [meals and snacks, termed eating occasions (EOs)] in a sample of US children and adults., Design: This was a nationally representative cross-sectional study of US data sets from 1977 to 1978, 1994 to 1998, and 2003 to 2006 in 28,404 children (2-18 y of age) and 36,846 adults (> or = 19 y of age). The main outcomes of interest included the number and size (energy/d) of meal and snack EOs, the composition (food or beverage) of each EO, and the time interval between each EO., Results: The number of EOs increased over the previous 30 y among all ages. For adults and children, the change in the number of EOs from 1977 to 2006 was greatest for those in the 75th and 90th percentiles, although the mean number increased across all percentiles. Energy intake, particularly from snacking, increased for both groups in all percentiles of the distribution. The time between EOs decreased by 1 h for adults and children (to 3.0 and 3.5 h in 2003-2006, respectively). Overwhelmingly, meals consisted of both food and beverages, but the percentage of snacking occasions that consisted of beverages only increased considerably among children., Conclusions: US children and adults are consuming foods more frequently throughout the day than they did 30 y ago. Researchers undertaking future clinical, preload, and related food studies need to consider these marked shifts as they attempt to design their research to fit the reality of the eating patterns of free-living individuals.

Background: In healthy elderly people, reduced appetite and the consequent decrease in food intake has been defined as the "anorexia of aging"; this condition may lead to malnutrition. The aim of this study was to investigate how different compositions of macronutrients affect satiety and hunger signals as well as subjective sensations after meals in healthy elderly subjects., Methods: Experimental controlled study. Ambulatory healthy community-dwelling subjects evaluation in a single center on 12 elderly subjects, (75.2+/-2 years old) and 12 younger controls (28.2+/-2 years old). Using a visual analogical scale, hunger was evaluated under fasting conditions and at 30-minute intervals for up to 4 hours after two 800-kcal meals, where 20% and 40% of the calories were derived from fat. Serum samples were collected at -30, 60, 120, and 240 minutes to determine the concentrations of GLP-1, acylated and desacylated ghrelin, triglycerides, glucose, and insulin., Results: Serum concentrations of GLP-1 were higher after the 40% fat meal than after the 20% fat meal (P < .01) in the elderly but not in the younger subjects. Acylated to desacylated ratio was lower after the 40% fat meal (P < .05) in the elderly. Only in the older group were triglycerides higher (P < .05), whereas hunger was significantly lower (P < .05) after the 40% fat meal., Conclusion: In healthy elderly people relatively large amounts of fat increase the satiety signal from GLP-1 and lower the acylated to desacylated ratio of ghrelin, consequently decreasing hunger. This condition may lead to a reduction in calorie intake., ((c) 2010 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.)

Increasing the protein content of a diet results in increased satiety and energy expenditure (EE). It is not clear whether the magnitude of these effects differs between proteins differing in concentrations of indispensable amino acids (IAA). We hypothesized that a protein lacking IAA may stimulate appetite suppression and EE and may limit positive protein balance. Therefore, we compared appetite, EE, and substrate balances between gelatin (incomplete protein) and casein (complete protein) in single-protein diets with either 25 or 10% of energy (En%) from protein. During a 36-h stay in a respiration chamber, 23 healthy men (n = 11) and women (n = 12) (BMI, 22.2 +/- 2.3 kg/m(2); age, 25 +/- 7 y) consumed 4 isoenergetic diets: 25 En% (25/20/55 En% protein/fat/carbohydrate) and 10 En% (10/35/55 En% protein/fat/carbohydrate) casein or gelatin diet in a randomized crossover design. For 3 d before the study, participants consumed a diet at home with similar macronutrient distribution as the diet they would receive during the subsequent stay in the chamber. Hunger was suppressed 44% more (P < 0.05) and protein balance was more negative when consuming the 10 En% gelatin diet (-0.17 +/- 0.03 MJ/d) compared with the 10 En% casein diet (-0.07 +/- 0.03 MJ/d; P < 0.05); carbohydrate and fat balances did not differ between the treatments. EE did not differ when participants consumed the 25 En% or 10 En% diets. Participants were in higher protein balance (0.56 +/- 0.05 vs. 0.30 +/- 0.04 MJ/d; P < 0.0001), lower carbohydrate balance (0.86 +/- 0.14 vs. 1.37 +/- 0.17 MJ/d; P < 0.01), and similar negative fat balance when they consumed the 25 En% casein compared with the 25 En% gelatin diet. In conclusion, when we compared the effects of an incomplete protein (gelatin) and a complete protein (casein) at 2 concentrations over 36 h, gelatin resulted in a greater appetite suppression; casein caused a greater positive (smaller negative) protein balance, and effects on EE did not differ. In terms of weight loss for people with obesity, the greater hunger-suppressing effect of gelatin may play a role in reducing energy intake if this effect is maintained when consuming a gelatin diet in the long term. In addition, long-term use of casein may contribute to preservation of fat-free mass.

Background: The common rs9939609 single nucleotide polymorphism (SNP) in the fat mass and obesity-associated (FTO) gene is associated with adiposity, possibly by affecting satiety responsiveness., Objective: The objective was to determine whether postprandial responses in hunger and satiety are associated with rs9939609, taking interactions with other relevant candidate genes into account., Design: Sixty-two women and 41 men [age: 31 +/- 14 y; body mass index (in kg/m(2)): 25.0 +/- 3.1] were genotyped for 5 SNPs in FTO, DNMT1, DNMT3B, LEP, and LEPR. Individuals received fixed meals provided in energy balance. Hunger and satiety were determined pre- and postprandially by using visual analog scales., Results: A general association test showed a significant association between postprandial responses in hunger and satiety with rs9939609 (P = 0.036 and P = 0.050, respectively). Individuals with low postprandial responses in hunger and satiety were overrepresented among TA/AA carriers in rs9939609 (FTO) compared with TT carriers (dominant and additive model: P = 0.013 and P = 0.020, respectively). Moreover, multifactor dimensionality reduction showed significant epistatic interactions for the postprandial decrease in hunger involving rs9939609 (FTO), rs992472 (DNMT3B), and rs1137101 (LEPR). Individuals with a low postprandial decrease in hunger were overrepresented among TA/AA (dominant), CC/CA (recessive), and AG/GG (dominant) carriers in rs9939609 (FTO), rs992472 (DNMT3B), and rs1137101 (LEPR), respectively (n = 39), compared with TT, AA, and/or AA carriers in these SNPs, respectively (P = 0.00001). Each SNP had an additional effect., Conclusions: Our results confirm a role for FTO in responsiveness to hunger and satiety cues in adults in an experimental setting. The epistatic interaction suggests that DNA methylation, an epigenetic process, affects appetite.

Background: Poor long-term success observed with current weight-control strategies stresses the relevance to explore new weight management approaches., Objective: To assess the effects of a Health-At-Every-Size (HAES) intervention on eating behaviors, appetite sensations, metabolic and anthropometric variables, and physical activity levels in women at 6-month and 1-year postintervention., Design: Randomized controlled trial; measurements at baseline, at the end of the intervention period (4 months), and at 6-month and 1-year postintervention (10 months and 16 months, respectively). Intervention and testing took place from September 2003 to August 2006., Participants/setting: Premenopausal overweight/obese women (n=144; mean age of 42.3+/-5.6 years), recruited from free-living, general community., Intervention: Women were randomly assigned to: HAES group (n=48), social support group (n=48), or control group (n=48)., Main Outcome Measures: Eating behaviors (restraint, disinhibition, and susceptibility to hunger), appetite ratings (desire to eat, hunger, fullness, and prospective food consumption), anthropometric and metabolic variables (body mass index, waist and hip circumferences, blood lipid levels, and blood pressure), and engagement in moderate to intense physical activity (energy cost > or =1.2 k cal x kg(-1) x 15 minutes(-1) [> or =4.8 metabolic equivalents])., Statistical Analyses Performed: Changes for each dependent variable were assessed by linear mixed models according to a group (HAES vs social support vs control) by time (baseline vs 4 months vs 10 months vs 16 months) split-plot design., Results: Situational susceptibility to disinhibition and susceptibility to hunger significantly decreased over time in both HAES group (-0.9+/-0.2 and -1.3+/-0.5, respectively) and the social support group (-0.4+/- 0.2 and -1.4+/-0.5, respectively). Although eating behavior scores observed at 16 months did not differ between HAES and social support groups (situational susceptibility to disinhibition: 2.5+/-0.2 in HAES group vs 2.7 +/- 0.2 in social support group; susceptibility to hunger: 4.2+/-0.5 in both groups), they were lower in these groups than scores noted in the control group (3.3+/-0.2 for situational susceptibility to disinhibition and 5.9+/-0.5 for susceptibility to hunger)., Conclusions: These results suggest that, when compared to a control group, an HAES approach could have long-term beneficial effects on eating behaviors related to disinhibition and hunger. In addition, our study did not show distinctive effects of the HAES approach in comparison to a social support intervention.