DTIC ADA434776: The Impact of a Low-Fat Diet and the Use of Fat Substitutes on Fat Preferences Among Overweight Women Seeking Weight Loss Treatment PDF
Preview DTIC ADA434776: The Impact of a Low-Fat Diet and the Use of Fat Substitutes on Fat Preferences Among Overweight Women Seeking Weight Loss Treatment
Copyright Statement The author hereby certifies that the use of any copyrighted material in the thesis manuscript entitled: “The Impact of a Low-Fat Diet and the Use of Fat Substitutes on Fat Preferences Among Overweight Women Seeking Weight Loss Treatment” is appropriately acknowledged and, beyond brief excerpts, is with the permission of the copyright owner. Kimberly Kalupa, M.S. Department of Medical & Clinical Psychology Uniformed Services University of the Health Sciences ii Report Documentation Page Form Approved OMB No. 0704-0188 Public reporting burden for the collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to a penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. 1. REPORT DATE 3. DATES COVERED 2003 2. REPORT TYPE - 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER The impact of a low-fat diet and the use of fat substitutes on fat 5b. GRANT NUMBER preferences among overweight women seeking weight loss treatment 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) 8. PERFORMING ORGANIZATION Uniformed Servicces universsity of the Health Sciences,F. Edward REPORT NUMBER Herbert School of Medicine,4301 Jones Bridge Road,Bethesda,MD,20814-4799 9. SPONSORING/MONITORING AGENCY NAME(S) AND ADDRESS(ES) 10. SPONSOR/MONITOR’S ACRONYM(S) 11. SPONSOR/MONITOR’S REPORT NUMBER(S) 12. DISTRIBUTION/AVAILABILITY STATEMENT Approved for public release; distribution unlimited 13. SUPPLEMENTARY NOTES 14. ABSTRACT Overweight and obesity form the basis of the second leading cause of preventable death in the United States and are on the rise (NIH, 1998). Traditionally, recommendations for weight loss include a reduction in dietary fat (Drewnowski, 1990). However, adherence to low-fat diets remains a challenge. Hedonic responses to food may be important to understand the adherence problem. When compared to bland-tasting foods, nutritionally-equivalent foods that are flavorful are more satiating (Rolls, 1995; Warwick et al., 1993). Two previous studies that examined the sensory impact of dietary fat modification reported conflicting results (Mattes, 1993; Guinard et al., 1999). The current study evaluated the impact of dietary fat modification on fat preference in three weight loss groups. The impact of changes in fat preference on shortterm adherence to a 6-week weight loss program was assessed. Sixty-one otherwise, healthy overweight women (BMI 25-37 kg/m2) between the ages of 18-60 were randomly assigned to one of three brief, 6-week weight loss programs. All three groups were asked to reduce dietary intake to 1800 kilocalories per day, but one group was asked to maintain fat at 36%, and two additional groups were asked to consume 20-25% of kilocalories in fat. One low-fat group was instructed to use fat substitutes and the other was instructed to avoid substitutes. It was hypothesized that decreased fat intake and sensory exposure to fat would cause a decrease in preference for high fat foods. Excellent adherence was observed with over 91% of participants completing treatment. In addition, guidelines regarding kilocalories, respective fat intake, fat substitute use were followed. Taste changes that occurred were subtle and did not affect on short-term dietary adherence. More time on the prescribed fat levels might be required to induce a change in fat preference. Differential changes in fat preference following dietary fat modification were expected, but not observed in the current investigation. However, results suggest that a modified 6-week Behavior Choice program might be a viable treatment option for women in this age and weight category (BMI < 37 kg/m2). 15. SUBJECT TERMS 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF 18. NUMBER 19a. NAME OF ABSTRACT OF PAGES RESPONSIBLE PERSON a. REPORT b. ABSTRACT c. THIS PAGE 237 unclassified unclassified unclassified Standard Form 298 (Rev. 8-98) Prescribed by ANSI Std Z39-18 ABSTRACT Title of Dissertation: The impact of a low-fat diet and the use of fat substitutes on fat preferences among overweight women seeking weight loss treatment Name, Degree, Year: Kimberly L. Kalupa, Ph.D., 2002 Thesis Directed by: Tracy Sbrocco, Ph.D., Associate Professor, Medical Psychology Overweight and obesity form the basis of the second leading cause of preventable death in the United States and are on the rise (NIH, 1998). Traditionally, recommendations for weight loss include a reduction in dietary fat (Drewnowski, 1990). However, adherence to low-fat diets remains a challenge. Hedonic responses to food may be important to understand the adherence problem. When compared to bland-tasting foods, nutritionally-equivalent foods that are flavorful are more satiating (Rolls, 1995; Warwick et al., 1993). Two previous studies that examined the sensory impact of dietary fat modification reported conflicting results (Mattes, 1993; Guinard et al., 1999). The current study evaluated the impact of dietary fat modification on fat preference in three weight loss groups. The impact of changes in fat preference on short- term adherence to a 6-week weight loss program was assessed. Sixty-one otherwise, healthy overweight women (BMI 25-37 kg/m2) between the ages of 18-60 were randomly assigned to one of three brief, 6-week weight loss programs. All three groups were asked to reduce dietary intake to 1800 kilocalories per day, but one group was asked to maintain fat at 36%, and two additional groups were asked to consume 20-25% of kilocalories in fat. One low-fat group was instructed to use fat substitutes and the other was instructed iii to avoid substitutes. It was hypothesized that decreased fat intake and sensory exposure to fat would cause a decrease in preference for high fat foods. Excellent adherence was observed with over 91% of participants completing treatment. In addition, guidelines regarding kilocalories, respective fat intake, fat substitute use were followed. Taste changes that occurred were subtle and did not affect on short-term dietary adherence. More time on the prescribed fat levels might be required to induce a change in fat preference. Differential changes in fat preference following dietary fat modification were expected, but not observed in the current investigation. However, results suggest that a modified 6-week Behavior Choice program might be a viable treatment option for women in this age and weight category (BMI < 37 kg/m2). iv RUNNING HEAD: DIETARY ADHERENCE AND FAT PREFERENCE The impact of a low-fat diet and the use of fat substitutes on fat preferences among overweight women seeking weight loss treatment by Kimberly L. Kalupa, M.S. Dissertation submitted to the Faculty of the Medical Psychology Graduate Program Uniformed Services University of the Health Sciences in partial fulfillment of the requirements for the degree of Doctor of Philosophy 2003 v Acknowledgements I would like to thank all of the members of my dissertation committee for their involvement on this project. Each and every committee member contributed uniquely to the development, implementation, and analysis of my dissertation. Neil Grunberg, Ph.D. served as my dissertation committee chairman and was an invaluable resource who facilitated the dissertation process. Michael Feuerstein, Ph.D. offered insightful feedback that strengthened both the design and the final written product. Evelyn Lewis, M.D. provided medical advice during the design and implementation of this study and also consistently provided encouragement. Tracy Sbrocco, Ph.D. served as my primary academic, research, and clinical supervisor during my five years at USUHS. I can’t imagine having gone through this process without her honest feedback and guidance. I would also like to thank some of my colleagues and classmates for all that they did to make graduate school a more enlightened, more bearable experience. Robyn Osborn, M.A. was a volunteer research assistant who made the completion of my dissertation possible. Lt. Sandra King Young, M.S. was a respected colleague whose quick wit and directness enriched my education and growth as a clinician. Maj. Mark Bates, Ph.D. is a dear friend who supported me in countless ways during my time at USUHS. Nicole Vaughn, M.S. has been a colleague and close friend through each and every trial and tribulation I have experienced during graduate school. She has been a constant source of encouragement and laughter over the past several years. I feel very fortunate to have been blessed with the presence of so many kind, compassionate, and dedicated individuals over the past five years. My personal and professional education would have been sorely lacking without them. vi This project is dedicated to Lt. Sandra King Young, M.S. She lived with intention and died with grace and will remain in my heart always. It was an honor to have known her. vii Table of Contents Approval Sheet i Copyright Statement ii Abstract iii Title page v Acknowledgments vi Dedication vii Table of Contents viii List of Tables x List of Figures xii Introduction 1 Importance of Taste in Dietary Modification 2 Factors Contributing to Fat Over-consumption and Obesity 3 Health Benefits of a Low Fat Diet 5 Adherence to Low Fat Diets 5 Factors to Improve Adherence to Low Fat Diets: A Summary 23 Taste Preferences 25 Taste Perception 29 Overview of Taste Parameters and Applicability to Obesity 31 Impact of Dietary Fat Modification and Sensory Exposure 40 Current Investigation 42 Description of Treatment Groups 45 Specific Aims 46 viii Table of Contents (continued) Design and Methods 49 Participants 49 Measures 50 Procedure 58 Results 64 Adherence Data 64 Treatment Group Data 66 Treatment Effects 67 Pudding Results 71 Milk Results 80 Discussion 87 Fat Preference 89 Taste Changes 91 Limitations 93 Implications 97 Conclusions 99 References 100 Tables 121 Figures 136 Appendices 146 ix
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