Sensitization of the reinforcing value of high energy density foods is associated with increased zBMI gain in adolescents

BACKGROUND/OBJECTIVES: Characterizing behavioral phenotypes that predict increased zBMI gain during adolescence could identify novel intervention targets and prevent the development of obesity. The purpose of this study was to determine if sensitization of the relative reinforcing value (RRV) of high (HED) or low energy density (LED) foods predicts adolescent weight gain trajectories. A secondary aim was to test the hypothesis that relationships between sensitization of the RRV of food and weight change are moderated by delay discounting (DD). SUBJECTS/METHODS: We conducted a prospective, longitudinal cohort study in 201 boys and girls with an average zBMI of 0.4, who began the study between the ages of 12 and 14 years and completed the study 2 years later. Participants completed five laboratory visits where the RRV of HED and LED, and DD were assessed at a baseline (visits 1, 2, and 4) and then RRV was measured again after participants consumed a portion of the same HED and LED food for 2 weeks (visits 3 and 5; order counterbalanced). Increases (>1) in the RRV from baseline to post-daily intake were categorized as "sensitization" and decreases (≤1) were categorized as "satiation." Participants returned to the laboratory for follow-up visits at 6, 15, and 24 months to have height and weight taken and to complete additional assessments. RESULTS: Sensitization to HED food was associated with a greater zBMI change over time (β = 0.0070; p = 0.035). There was no impact of sensitization to LED food or interaction between sensitization to HED and LED food on zBMI change and no moderation of DD on the relationship between HED sensitization and zBMI change (all p > 0.05). CONCLUSION: Our prior work showed that sensitization to HED food is cross-sectionally associated with greater zBMI. This study extends this work by demonstrating that sensitization to HED food prospectively predicts increased zBMI gain over time in adolescents without obesity. Future studies should determine if sensitization can be modified or reduced through behavioral intervention. TRIAL REGISTRATION: Clinicaltrials.gov: NCT04027608.