Managing temptation in obesity treatment: A neurobehavioral model of intervention strategies

Bradley M. Appelhans, Simone A. French, Sherry L. Pagoto, Nancy E. Sherwood

Research output: Contribution to journalReview articlepeer-review

43 Scopus citations

Abstract

Weight loss outcomes in lifestyle interventions for obesity are primarily a function of sustained adherence to a reduced-energy diet, and most lapses in diet adherence are precipitated by temptation from palatable food. The high nonresponse and relapse rates of lifestyle interventions suggest that current temptation management approaches may be insufficient for most participants. In this conceptual review, we discuss three neurobehavioral processes (attentional bias, temporal discounting, and the cold-hot empathy gap) that emerge during temptation and contribute to lapses in diet adherence. Characterizing the neurobehavioral profile of temptation highlights an important distinction between temptation resistance strategies aimed at overcoming temptation while it is experienced, and temptation prevention strategies that seek to avoid or minimize exposure to tempting stimuli. Many temptation resistance and temptation prevention strategies heavily rely on executive functions mediated by prefrontal systems that are prone to disruption by common occurrences such as stress, insufficient sleep, and even exposure to tempting stimuli. In contrast, commitment strategies are a set of devices that enable individuals to manage temptation by constraining their future choices, without placing heavy demands on executive functions. These concepts are synthesized in a conceptual model that categorizes temptation management approaches based on their intended effects on reward processing and degree of reliance on executive functions. We conclude by discussing the implications of our model for strengthening temptation management approaches in future lifestyle interventions, tailoring these approaches based on key individual difference variables, and suggesting high-priority topics for future research.

Original languageEnglish (US)
Pages (from-to)268-279
Number of pages12
JournalAppetite
Volume96
DOIs
StatePublished - Jan 1 2016

Bibliographical note

Funding Information:
BMA has received grant funding from Hillshire Brands Foundation. SP has received speaking funds from Weight Watchers, Int. All authors receive grant funding from the National Institutes of Health. The other authors declare that they have no competing interests.

Funding Information:
The development of this manuscript was supported by grants R01HL117804 and R21HL121861 from the National Institutes of Health (NHLBI) . The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The sponsor had no role in the writing of the manuscript or in the decision to submit the manuscript for publication. We thank Dr. Howard Rachlin for his input on portions of this manuscript.

Publisher Copyright:
© 2015 Elsevier Ltd.

Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.

Keywords

  • Commitment
  • Diet adherence
  • Executive function
  • Food reward
  • Lifestyle intervention
  • Obesity
  • Temporal discounting

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