Obesity counseling should focus on neurobehavioral processes, not personal choice, researchers say

August 01, 2011

(CHICAGO) - Current approaches to dietary counseling for obesity are heavily rooted in the notion of personal choice and will power - the ability to choose healthy foods and portion sizes consistent with weight loss while foregoing sweets and comfort foods.

According to preventive medicine and behavioral experts at Rush University Medical Center, research supports a new counseling approach that views obesity as a result of neurobehavioral processes - ways in which the brain controls eating behavior in response to cues in the environment.

The new, proposed neurobehavioral model is highlighted in an article in the August issue of the Journal of the American Dietetic Association.

"Typically, overweight and obese patients receive education about dietary contributions to weight gain, and they are simply encouraged to fight the powerful urge to eat the delicious foods that are available almost everywhere in the environment, and instead, make dietary choices consistent with weight loss," said Brad Appelhans, PhD, clinical psychologist and obesity researcher in the Rush University Prevention Center and lead author of the article. "Yet, we know this approach rarely works. Even highly motivated and nutritionally informed patients struggle to refrain from highly palatable foods that are high in sugar, salt and unhealthy fats."

The suggestion that individuals become or remain obese due to their unhealthy personal choices or a lack of willpower to make healthy choices is also stigmatizing to patients and unlikely to motivate them to lose weight.

The new model adopts a scientifically informed framework that clarifies how personal choice is affected by biological and environmental factors.

The three neurobehavioral processes consistently implicated in obesity and overeating are food reward, inhibitory control and time discounting. "Most of us would rather receive $200 today rather than $300 a year from now," said Appelhans.

Similarly, the immediate pleasure from eating has a greater effect on decision making than the more delayed health benefits of weight loss.

The link between time discounting and body weight is reflected neuroanatomically because it is governed by the same brain regions associated with food reward and inhibitory control - the mesolimbic dopamine system and the prefrontal cortex.

"Obesity is heavily influenced by genetic vulnerabilities and a toxic food environment," said Appelhans. "However, counselors can help patients control their weight through strategies focused on the interaction between the brain and the environment, rather than the traditional approach of encouraging patients to simply ignore or fight food cravings and eat fewer calories than they expend."

A few strategies recommended by the researchers include: Dr. Appelhans is affiliated with the Rush University Prevention Center, which specializes in the behavioral, medical, and nutritional management of obesity and other risk factors for heart disease and diabetes.
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Rush is a not-for-profit academic medical center comprising Rush University Medical Center, Rush University, Rush Oak Park Hospital and Rush Health. Rush is currently constructing a 14-floor, 806,000-square-foot hospital building near the corner of Ashland Avenue and the Eisenhower Expressway. The new hospital, scheduled to open in 2012, is the centerpiece of a ten-year campus redevelopment plan called the Rush Transformation, which also includes completion of a new orthopedics building, a new parking garage and central power plant, renovations of selected existing buildings and demolition of obsolete buildings. The new hospital is designed and built to conserve energy and water, reduce waste and use sustainable building materials. Rush is seeking Leadership in Energy and Environmental Design (LEED) gold certification from the U.S. Green Building Council. It will be the first full-service, "green" hospital in Chicago.

Rush's mission is to provide the best possible care for its patients. Educating tomorrow's health care professional, researching new and more advanced treatment options, transforming its facilities and investing in new technologies--all are undertaken with the drive to improve patient care now, and for the future.

Rush University Medical Center

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