Eating behavior dimensions and 9-year weight loss maintenance: a sub-study of the Finnish Diabetes prevention study

BACKGROUND: Behavioral processes through which lifestyle interventions influence risk factors for type 2 diabetes (T2DM), such as body weight, are not well understood. We examined whether changes in psychological dimensions of eating behavior during the first year of lifestyle intervention mediate the effects of intervention on body weight over 9 years. METHODS: Middle-aged participants with overweight and impaired glucose tolerance (IGT) were randomized to an intensive, individualized lifestyle intervention group (n = 51) or a control group (n = 47). Body weight and the Three Factor Eating Questionnaire (cognitive restraint of eating with flexible and rigid components, disinhibition, susceptibility to hunger) were assessed at baseline and annually for nine years in this Kuopio center sub-study of the Finnish Diabetes Prevention Study. RESULTS: During the first year, increases in total cognitive restraint (4.6 vs. 1.7 points; p < 0.001), flexible restraint (1.7 vs. 0.9; p = 0.018) and rigid restraint (1.6 vs. 0.5; p = 0.001), and greater weight loss (−5.2 vs. −1.2 kg; p < 0.001) were observed in the intervention versus control group. Differences up to nine years remained significant for total restraint (2.6 vs. 0.1; p = 0.002), rigid restraint (1.0 vs. 0.4; p = 0.004), and weight loss (−3.0 vs. +0.1 kg; p = 0.046). First-year increases in total, flexible and rigid restraint statistically mediated the intervention’s impact on 9-year weight loss. CONCLUSIONS: Intensive, individually tailored professional lifestyle counselling produced long-lasting increases in cognitive restraint of eating and reductions in body weight among middle-aged adults with overweight and IGT. Early increases in cognitive restraint may contribute to long-term weight loss maintenance, supporting T2DM risk reduction.

Jutta Salmela, Hanna Konttinen, Raimo Lappalainen, Joona Muotka, Anne Antikainen, Jaana Lindström, Jaakko Tuomilehto, Matti Uusitupa, Leila Karhunen