Abstract

Background The present study aimed to examine motivations for food choice among long-term weight loss maintainers (WLM) in a widely used commercial weight management program. Methods A cross-sectional study was employed where determinants of food choice were measured in the USA using validated scales: Food Choice Questionnaire, Consideration of Future Consequences, and Eating in the Absence of Hunger. Participants were 3806 WLM following a commercial weight management program (WW International, Inc.) who had maintained a weight loss >= 9.1 kg (mean 24.7 kg) for 3.3 years and had a body mass index (BMI) of 27.6 kg m(2). A control group of weight stable individuals with obesity (controls; n = 519) had a BMI of 38.9 kg m(2) and a weight change < 2.3 kg over the previous 5 years. Results WLM vs. controls made food decisions more based on health (18.9 vs. 16.3; eta(2)(p) = 0.052) and weight control (9.9 vs. 7.5; eta(2)(p) = 0.16) and less based on price (8.4 vs. 9.1; eta(2)(p) = 0.10). WLM also scored higher than controls with respect to considering future consequences of behaviours (44.3 vs. 38.4; eta(2)(p) = 0.060) and reported less external eating in the absence of hunger (7.1 vs. 7.5; eta(2)(p) = 0.058). Standard canonical coefficients indicated that making food choices based on weight (0.717) with less value placed on price (-0.33) and greater consideration of future consequences (0.262) contributed independently and most (overall r = 0.593; p = 0.0001) to discriminating WLM from controls. Conclusions In a widely used commercial weight management program, successful WLM reported food decisions based more on weight and less on price and considered future consequences of current behaviours.


Authors

Young, Jacob;  Phelan, Suzanne;  Alarcon, Noemi;  Roake, James;  Rethorst, Chad D.;  Foster, Gary D.

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    2021/12/06

    06-Dec-2021

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  • pre-publication peer review (ROUND 2)
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    2021/11/22

    22-Nov-2021

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    2021/10/28

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  • pre-publication peer review (ROUND 1)
    Decision Letter
    2021/07/26

    26-Jul-2021

    Dear Dr Phelan

    Manuscript JHND-21-06-0295-OA entitled "Determinants of Food Choice among Long-Term Weight Loss Maintainers", which you submitted to the Journal of Human Nutrition and Dietetics has now been reviewed. The comments of the reviewer(s) are included at the bottom of this letter.

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    Many thanks for submitting this manuscript which provides some interesting data. It would be of interest if you could provide more data with respect to dietary intake.

    Please could you also consider and respond to the specific comments of the reviewers.

    Comments from Reviewer 1:
    This is an interesting paper that presents some novel data on food choice, future thinking and eating in the absence of hunger in successful weight losers vs. weight stable controls. The greatest limitation is that the authors fail to remember that this is cross-sectional investigation and no assumptions should be made about causality. So assuming, for example, that instituting concepts of future thinking into interventions might help with weight loss maintenance , are not supported by these data or the study design. Perhaps future thinkers do better long-term in treatment because they are future thinkers. Is it a trait or a state?
    The following are also critiques that may should be addressed to strengthen the paper:
    There is no discussion of the fact that all the weight loss maintainers had been through - or are still enrolled - in a commercial weight loss program. What might they have learned while in the program that would have influenced their answers to the questions? Or their opinions about food choice, etc.?
    There is inconsistency with the sample size between the text and the tables. Text says that 4319 people completed the FCQ. Is this supposed to be the final sample size? Because the tables list 3806+519; 3327+517 neither of which adds us to 4319. What was the completion rates of each questionnaire?
    *The paragraph on page nine starting at line 6 "Interestingly, weight loss maintainers..." should be moved up page 8 where future orientation begins to be discussed.

    Comments from Reviewer 2:
    The idea behind this work is interesting; however there important methodological issues that limit the merit of the analysis and the manuscript.
    - Introduction: the authors need to be more specific on the research gaps in the existing literature. A new study should be justified based on the currently available scientific knowledge. What does "novel drivers" mean?
    - Results - analyses: There is an interesting collection of assessment tools in these analyses. However, to my point of view, what is missing is the assessment of "actual food choices", i.e. the food/dietary intake. Otherwise we do have a self-perception of what are the potential drivers of food choices, without a clear of picture of food choices per se. Thus, one may speculate that despite the differences in the determinants between the two groups their food choices are similar.
    - Results-analyses: As the design of the study is based on the comparisons of two groups, the authors are is not justified to run association analyses in the total sample (this is not independent of group, as there are two groups per protocol)
    - To which extent do you think that the observed differences are due to the differences in the basic characteristics between the groups (age, sex, BMI, lifetime maximum weight and most importantly socioeconomic characteristics), other that weight loss maintenance status? This is an important limitation of the study.

    Decision letter by
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    Reviewer report
    2021/07/22

    The idea behind this work is interesting; however there important methodological issues that limit the merit of the analysis and the manuscript.
    - Introduction: the authors need to be more specific on the research gaps in the existing literature. A new study should be justified based on the currently available scientific knowledge. What does "novel drivers" mean?
    - Results - analyses: There is an interesting collection of assessment tools in these analyses. However, to my point of view, what is missing is the assessment of "actual food choices", i.e. the food/dietary intake. Otherwise we do have a self-perception of what are the potential drivers of food choices, without a clear of picture of food choices per se. Thus, one may speculate that despite the differences in the determinants between the two groups their food choices are similar.
    - Results-analyses: As the design of the study is based on the comparisons of two groups, the authors are is not justified to run association analyses in the total sample (this is not independent of group, as there are two groups per protocol)
    - To which extent do you think that the observed differences are due to the differences in the basic characteristics between the groups (age, sex, BMI, lifetime maximum weight and most importantly socioeconomic characteristics), other that weight loss maintenance status? This is an important limitation of the study.

    Reviewed by
    Cite this review
    Reviewer report
    2021/07/20

    This is an interesting paper that presents some novel data on food choice, future thinking and eating in the absence of hunger in successful weight losers vs. weight stable controls. The greatest limitation is that the authors fail to remember that this is cross-sectional investigation and no assumptions should be made about causality. So assuming, for example, that instituting concepts of future thinking into interventions might help with weight loss maintenance , are not supported by these data or the study design. Perhaps future thinkers do better long-term in treatment because they are future thinkers. Is it a trait or a state?
    The following are also critiques that may should be addressed to strengthen the paper:
    There is no discussion of the fact that all the weight loss maintainers had been through - or are still enrolled - in a commercial weight loss program. What might they have learned while in the program that would have influenced their answers to the questions? Or their opinions about food choice, etc.?
    There is inconsistency with the sample size between the text and the tables. Text says that 4319 people completed the FCQ. Is this supposed to be the final sample size? Because the tables list 3806+519; 3327+517 neither of which adds us to 4319. What was the completion rates of each questionnaire?
    *The paragraph on page nine starting at line 6 "Interestingly, weight loss maintainers..." should be moved up page 8 where future orientation begins to be discussed.

    Reviewed by
    Cite this review
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