title: Normalizing eating behavior reduces body weight and improves gastrointestinal hormonal secretion in obese adolescents.
abstract: OBJECTIVE
  Retraining obese adolescents to eat more slowly will lead to beneficial changes in circulating concentrations of gastrointestinal satiety hormones.
  
  
  METHODS
  Ghrelin and peptide tyrosine-tyrosine were measured during an oral glucose tolerance test, at baseline and at 12 months during a randomized trial assessing the clinical effectiveness of a device (Mandometer) designed to retrain eating behavior. This computerized scale provided real-time feedback during meals in the intervention arm (n = 14) to slow down the speed of eating. The control group (n = 13) received only standard care aimed at improving lifestyle behavior. The Mandometer elicited greater improvements in weight loss than standard care.
  
  
  RESULTS
  Compared with baseline, only those using the Mandometer exhibited lower mean levels of fasting ghrelin (48.14 ± 18.47 vs. 68.45 ± 17.78 pg/ml; P = 0.002) and mean ghrelin area under the curve (72.08 ± 24.11 vs. 125.50 ± 29.72 pg/ml × min; P < 0.001) at 12 months. Absolute mean suppression in ghrelin at 60 min was enhanced (-40.50 ± 21.06 vs. -12.14 ± 19.74 pg/ml × min; P = 0.001). Peptide tyrosine-tyrosine response at 90 min remained unaltered in the standard care arm, whereas those in the Mandometer arm increased (P < 0.001): the mean 90-min response increased by 72 pg/ml [95% confidence interval (CI) 52-92 pg/ml] between baseline and 12 months. In a partial correlation analysis adjusting for change (Δ) in body mass index sd scores, Δ meal duration correlated negatively with Δ absolute suppression in ghrelin at 60 min (r = -0.58; P = 0.037; 95% CI -0.79 to -0.27) and Δ ghrelin area under the curve (r = -0.62; P = 0.025; 95% CI -0.81 to -0.31).
  
  
  CONCLUSIONS
  Retraining obese adolescents to eat more slowly has a significant impact on the gastrointestinal hormone response to a carbohydrate load, suggesting that externally modifiable eating behaviors actually regulate the hormonal response to food.
authors.affiliation: Department of Paediatric Endocrinology, Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology, University of Bristol, Bristol BS2 8AE, UK.
authors.forename: J
authors.initials: J
authors.lastname: Galhardo
authors.forename: L P
authors.initials: LP
authors.lastname: Hunt
authors.forename: S L
authors.initials: SL
authors.lastname: Lightman
authors.forename: M A
authors.initials: MA
authors.lastname: Sabin
authors.forename: C
authors.initials: C
authors.lastname: Bergh
authors.forename: P
authors.initials: P
authors.lastname: Sodersten
authors.forename: J P H
authors.initials: JP
authors.lastname: Shield
mesh_terms: D000293:Adolescent; D001835:Body Weight / Q000502:physiology; D002648:Child; D004864:Equipment and Supplies; D005247:Feeding Behavior / Q000502:physiology*; D005260:Female; D005768:Gastrointestinal Hormones / Q000097:blood / Q000378:metabolism*; D054439:Ghrelin / Q000097:blood / Q000378:metabolism; D006262:Health; D006801:Humans; D008019:Life Style; D008297:Male; D009765:Obesity / Q000097:blood / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D019894:Peptide YY / Q000097:blood / Q000378:metabolism; D016896:Treatment Outcome; D061217:Weight Reduction Programs / Q000379:methods*
chemical_list: D005768:Gastrointestinal Hormones; D054439:Ghrelin; D019894:Peptide YY