Neil A. King

The use of visual analogue scales to assess motivation to eat in human subjects: a review of their reliability and validity with an evaluation of new hand-held computerized systems for temporal tracking of appetite ratings

This present paper reviews the reliability and validity of visual analogue scales (VAS) in terms of (1) their ability to predict feeding behaviour, (2) their sensitivity to experimental manipulations, and (3) their reproducibility. VAS correlate with, but do not reliably predict, energy intake to the extent that they could be used as a proxy of energy intake. They do predict meal initiation in subjects eating their normal diets in their normal environment. Under laboratory conditions, subjectively rated motivation to eat using VAS is sensitive to experimental manipulations and has been found to be reproducible in relation to those experimental regimens. Other work has found them not to be reproducible in relation to repeated protocols. On balance, it would appear, in as much as it is possible to quantify, that VAS exhibit a good degree of within-subject reliability and validity in that they predict with reasonable certainty, meal initiation and amount eaten, and are sensitive to experimental manipulations. This reliability and validity appears more pronounced under the controlled (but more artificial) conditions of the laboratory where the signal:noise ratio in experiments appears to be elevated relative to real life. It appears that VAS are best used in within-subject, repeated-measures designs where the effect of different treatments can be compared under similar circumstances. They are best used in conjunction with other measures (e.g. feeding behaviour, changes in plasma metabolites) rather than as proxies for these variables. New hand-held electronic appetite rating systems (EARS) have been developed to increase reliability of data capture and decrease investigator workload. Recent studies have compared these with traditional pen and paper (P&P) VAS. The EARS have been found to be sensitive to experimental manipulations and reproducible relative to P&P. However, subjects appear to exhibit a significantly more constrained use of the scale when using the EARS relative to the P&P. For this reason it is recommended that the two techniques are not used interchangeably.

Energy intake and appetite are suppressed by glucagon-like peptide-1 (GLP-1) in obese men

BACKGROUND: Peripheral administration of glucagon-like peptide-1 (GLP-1) for four hours, to normal weight and obese humans, decreases food intake and suppresses appetite.OBJECTIVE: The aim of this study was to assess the effect of an eight hour infusion of GLP-1 on appetite and energy intake at lunch and dinner in obese subjects.DESIGN: Randomised, blinded cross-over design with intravenous infusion of GLP-1 (0.75 pmol·kg−1·min−1) or saline.SUBJECTS: Eight obese (body mass index, BMI, 45.5±2.3 kg/m2) male subjects.MEASUREMENTS: Ad libitum energy intake at lunch (12.00 h) and dinner (16.00 h) after an energy fixed breakfast (2.4 MJ) at 08.00 h. Appetite sensations using visual analogue scales, (VAS) immediately before and after meals and hourly in-between. Blood samples for the analysis of glucose, insulin, C-peptide, GLP-1 and peptide YY. Gastric emptying after breakfast and lunch using a paracetamol absorption technique.RESULTS: Hunger ratings were significantly lower with GLP-1 infusion. The summed ad libitum energy intake at lunch and dinner was reduced by 1.7±0.5 MJ (21±6%) by GLP-1 infusion (P=0.01). Gastric emptying was delayed by GLP-1 infusion, and plasma glucose concentrations decreased (baseline: 6.6±0.35 mmol/L; nadir: 5.3±0.15 mmol/L). No nausea was recorded during GLP-1 infusion.CONCLUSIONS: Our results demonstrate that GLP-1 decreases feelings of hunger and reduces energy intake in obese humans. One possible mechanism for this finding might be an increased satiety primarily mediated by gastric vagal afferent signals.

The contribution of physical activity and sedentary behaviours to the growth and development of children and adolescents: Implications for overweight and obesity

The obesity epidemic is a global trend and is of particular concern in children. Recent reports have highlighted the severity of obesity in children by suggesting: “today’s generation of children will be the first for over a century for whom life expectancy falls.” This review assesses the evidence that identifies the important role of physical activity in the growth, development and physical health of young people, owing to its numerous physical and psychological health benefits. Key issues, such as “does a sedentary lifestyle automatically lead to obesity” and “are levels of physical activity in today’s children less than physical activity levels in children from previous generations?”, are also discussed.Today’s environment enforces an inactive lifestyle that is likely to contribute to a positive energy balance and childhood obesity. Whether a child or adolescent, the evidence is conclusive that physical activity is conducive to a healthy lifestyle and prevention of disease. Habitual physical activity established during the early years may provide the greatest likelihood of impact on mortality and longevity. It is evident that environmental factors need to change if physical activity strategies are to have a significant impact on increasing habitual physical activity levels in children and adolescents. There is also a need for more evidence-based physical activity guidelines for children of all ages. Efforts should be concentrated on facilitating an active lifestyle for children in an attempt to put a stop to the increasing prevalence of obese children.

Liking vs. wanting food: importance for human appetite control and weight regulation.

Current train of thought in appetite research is favouring an interest in non-homeostatic or hedonic (reward) mechanisms in relation to overconsumption and energy balance. This tendency is supported by advances in neurobiology that precede the emergence of a new conceptual approach to reward where affect and motivation (liking and wanting) can be seen as the major force in guiding human eating behaviour. In this review, current progress in applying processes of liking and wanting to the study of human appetite are examined by discussing the following issues: How can these concepts be operationalised for use in human research to reflect the neural mechanisms by which they may be influenced? Do liking and wanting operate independently to produce functionally significant changes in behaviour? Can liking and wanting be truly experimentally separated or will an expression of one inevitably contain elements of the other? The review contains a re-examination of selected human appetite research before exploring more recent methodological approaches to the study of liking and wanting in appetite control. In addition, some theoretical developments are described in four diverse models that may enhance current understanding of the role of these processes in guiding ingestive behaviour. Finally, the implications of a dual process modulation of food reward for weight gain and obesity are discussed. The review concludes that processes of liking and wanting are likely to have independent roles in characterising susceptibility to weight gain. Further research into the dissociation of liking and wanting through implicit and explicit levels of processing would help to disclose the relative importance of these components of reward for appetite control and weight regulation.

Disinhibition: its effects on appetite and weight regulation

Over the past 30 years, the understanding of eating behaviour has been dominated by the concept of dietary restraint. However, the development of the Three Factor Eating Questionnaire introduced two other factors, Disinhibition and Hunger, which have not received as much recognition in the literature. The objective of this review was to explore the relationship of the Disinhibition factor with weight regulation, food choice and eating disorders, and to consider its aetiology. The review indicates that Disinhibition is an important eating behaviour trait. It is associated not only with a higher body mass index and obesity, but also with mediating variables, such as less healthful food choices, which contribute to overweight/obesity and poorer health. Disinhibition is also implicated in eating disorders and contributes to eating disorder severity. It has been demonstrated that Disinhibition is predictive of poorer success at weight loss, and of weight regain after weight loss regimes and is associated with lower self‐esteem, low physical activity and poor psychological health. Disinhibition therefore emerges as an important and dynamic trait, with influences that go beyond eating behaviour and incorporate other behaviours which contribute to weight regulation and obesity. The characteristics of Disinhibition itself therefore reflect many components representative of a thrifty type of physiology. We propose that the trait of Disinhibition be more appropriately renamed as ‘opportunistic eating’ or ‘thrifty behaviour’.

Metabolic and behavioral compensatory responses to exercise interventions: barriers to weight loss.

An activity‐induced increase in energy expenditure theoretically disturbs energy balance (EB) by creating an acute energy deficit. Compensatory responses could influence the weight loss associated with the energy deficit. Individual variability in compensation for perturbations in EB could partly explain why some individuals fail to lose weight with exercise. It is accepted that the regulatory system will readily defend impositions that promote a negative EB. Therefore, a criticism of exercise interventions is that they will be ineffective and futile methods of weight control because the acute energy deficit is counteracted. Compensation for exercise‐induced energy deficits can be categorized into behavioral or metabolic responses and automatic or volitional. An automatic compensatory response is a biological inevitability and considered to be obligatory. An automatic compensatory response is typically a metabolic consequence (e.g., reduced resting metabolic rate) of a negative EB. In contrast, a volitional compensatory response tends to be deliberate and behavioral, which the individual intentionally performs (e.g., increased snack intake). The purpose of this review is to highlight the various metabolic and behavioral compensatory responses that could reduce the effectiveness of exercise and explain why some individuals experience a lower than expected weight loss. We propose that the extent and degree of compensation will vary between individuals. That is, some individuals will be predisposed to compensatory responses that render them resistant to the weight loss benefits theoretically associated with an exercise‐induced increase in energy expenditure. Therefore, given the inter‐individual variability in behavioral and metabolic compensatory responses, exercise prescriptions might be more effective if tailored to suit individuals.

The role of implicit wanting in relation to explicit liking and wanting for food: Implications for appetite control

Eating is an action open to awareness by the individual; however, it cannot be claimed that processes that control the expression of eating habits are necessarily explicit. This distinction between implicit and explicit processes may enhance understanding of the expression of food reward (particularly the concepts of liking and wanting [Berridge, K. C., & Robinson, T. E. (2003). Parsing reward. Trends in Neurosciences, 26, 507–513] and its importance for human appetite control [Finlayson, G. S., King, N. A., & Blundell, J. E. (2007b). Liking vs. wanting food: Importance for human appetite control and weight regulation. Neuroscience and Biobehavioural Reviews, in press]. The present study investigated the effect of meal-induced satiation on implicit and explicit processes of liking (L) and wanting (W) by developing a computer-based procedure to measure L and W in hungry and satiated states. Explicit measures were derived from analogue ratings whilst an implicit W measure was derived from reaction time in a forced-choice procedure, which also identified food preferences. Seventy subjects (21.8±0.9 years, BMI: 22.2±0.5 kg/m2) completed the procedure before and immediately following consumption of a savoury test meal. Satiation caused explicit ratings of L and W to decrease in all food categories (p<0.01); but with a more marked decrease for savoury foods compared with sweet foods (p<0.01). Implicit W was increased for sweet categories (p<0.01), but not for savoury. Implicit and explicit measures of L and W independently correlated with preference for sweet foods. This study provides support that implicit and explicit processes of food reward can be simultaneously measured and dissociated using a test meal. Adjustments in hunger were linked to changes in explicit L and W in a manner consistent with sensory specific satiety, while a relationship between hunger and implicit W was absent. We suggest that implicit W is not systematically downregulated by the physiological consequences of food consumption in the same way as hunger and therefore may be largely independent of homoeostatic processes influencing intake.

High dose exercise does not increase hunger or energy intake in free living males

Objective: To examine the effects of a high dose (two high-intensity exercise sessions) of exercise on energy intake (EI) and subjective states (hunger and mood). Design: Using a within subjects design, there were two treatment conditions, each of two consecutive days. Setting: The Human Appetite Research Unit at Leeds University Psychology Department. Subjects: Eight lean males who were regular exercisers were recruited from the student/staff population of Leeds University. Interventions: The effects of the high dose of exercise on Ex1 were compared with the effects on the day immediately after exercise (Ex2) and two consecutive days of no exercise (R1 and R2). EI was monitored using self-record food diaries and subjective states were tracked using a new Electronic Appetite Rating System (EARS). Heart rate and physical activity were also measured. Results: Feelings of hunger were not elevated by the high dose of exercise on Ex1 or on the day after exercise (Ex2). In fact, average daily feeling of hunger on Ex1 was significantly lower compared with the average daily feeling of hunger on Ex2 (t=3.15, d.f.=7, P<0.05), but not when compared with R1 or R2. EI and macronutrient intakes were not different on Ex1, Ex2, R1 or R2. Therefore, there was no increase in EI on Ex1 or Ex2 to account for the measured increase in exercise-induced energy expenditure (1200 kcal). Continuously monitored heart rate and activity profiles indicated that there was no difference in activity during the non-exercise periods between the four days. Conclusions: This study indicates that a high dose of exercise in one day failed to have any effect on EI within the same day or on the day immediately after exercise, compared with days of no exercise. These results demonstrate that an acute but substantial increase in energy expenditure (EE) due to intense exercise does not automatically increase hunger or EI within 48 h. This indicates the absence of any strong coupling between EE and EI in the short-term, probably as a result of food intake being held in place by environmental contingencies and short-term pre-absorptive physiological responses arising from eating itself. Sponsorship: This experiment was supported by the Biotechnology and Biological Science Research Council (BBSRC) F02501.

Effects of exercise on appetite control: implications for energy balance.

At a time of increased obesity, decreased physical activity, and high food consumption, the relationship between physical activity and appetite control needs to be examined. Many people believe that the energy expended as a result of physical activity generates a drive to eat. However, a counterintuitive conclusion arises since there is no compelling evidence that increased physical activity increases energy intake. A suppression of hunger occurs following intense exercise; however, this effect is brief and has no influence on energy intake. Indeed, there does not appear to be any within-day effect of exercise on energy intake. Day-to-day effects of exercise on energy intake could occur, but only a few provocative data exist showing a delayed effect of exercise on energy intake 2 d later. Therefore, there appears to be only a weak short-term coupling between energy expenditure and energy intake. What about the effects of increased physical activity on food selection? The natural hypothesis would be that the energy reserves used during exercise would estimate a drive for a particular nutrient. There is no clear consistent evidence to indicate that in the short-term, exercise induces changes in food or nutrient preferences. In the long-term there is some evidence that physical activity is associated with an increase in carbohydrate intake, but it is uncertain whether these changes are biologically driven for a result of changes of a psychological nature. Contrary to a popularly held view, food selection and nutrient intake constitute patterns of behavior held in place by environmental contingencies and short-acting post-ingestive physiological responses; these patterns of behavior are relatively immune to modulation by the metabolic effects of exercise.

Appetite sensations and satiety quotient: predictors of energy intake and weight loss.

PURPOSE The aim of this study was to further evaluate the validity and clinical meaningfulness of appetite sensations to predict overall energy intake as well as body weight loss. METHODS Men (n = 176) and women (n = 139) involved in six weight loss studies were selected to participate in this study. Visual analogue scales were used to measure appetite sensations before and after a fixed test meal. Fasting appetite sensations, 1 h post-prandial area under the curve (AUC) and the satiety quotient (SQ) were used as predictors of energy intake and body weight loss. Two separate measures of energy intake were used: a buffet style ad libitum test lunch and a three-day self-report dietary record. RESULTS One-hour post-prandial AUC for all appetite sensations represented the strongest predictors of ad libitum test lunch energy intake (p < or = 0.001). These associations were more consistent and pronounced for women than men. Only SQ for fullness was associated with ad libitum test lunch energy intake in women. Similar but weaker relationships were found between appetite sensations and the 3-day self-reported energy intake. Weight loss was associated with changes in appetite sensations (p < or = 0.01) and the best predictors of body weight loss were fasting desire to eat; hunger; and PFC (p < or = 0.01). CONCLUSIONS These results demonstrate that appetite sensations are relatively useful predictors of spontaneous energy intake, free-living total energy intake and body weight loss. They also confirm that SQ for fullness predicts energy intake, at least in women.