title: Managing temptation in obesity treatment: A neurobehavioral model of intervention strategies.
abstract: Weight loss outcomes in lifestyle interventions for obesity are primarily a function of sustained adherence to a reduced-energy diet, and most lapses in diet adherence are precipitated by temptation from palatable food. The high nonresponse and relapse rates of lifestyle interventions suggest that current temptation management approaches may be insufficient for most participants. In this conceptual review, we discuss three neurobehavioral processes (attentional bias, temporal discounting, and the cold-hot empathy gap) that emerge during temptation and contribute to lapses in diet adherence. Characterizing the neurobehavioral profile of temptation highlights an important distinction between temptation resistance strategies aimed at overcoming temptation while it is experienced, and temptation prevention strategies that seek to avoid or minimize exposure to tempting stimuli. Many temptation resistance and temptation prevention strategies heavily rely on executive functions mediated by prefrontal systems that are prone to disruption by common occurrences such as stress, insufficient sleep, and even exposure to tempting stimuli. In contrast, commitment strategies are a set of devices that enable individuals to manage temptation by constraining their future choices, without placing heavy demands on executive functions. These concepts are synthesized in a conceptual model that categorizes temptation management approaches based on their intended effects on reward processing and degree of reliance on executive functions. We conclude by discussing the implications of our model for strengthening temptation management approaches in future lifestyle interventions, tailoring these approaches based on key individual difference variables, and suggesting high-priority topics for future research.
authors.affiliation: Department of Preventive Medicine, Rush University Medical Center, 1700 W Van Buren St, Suite 470, Chicago, IL 60612, USA; Department of Behavioral Sciences, Rush University Medical Center, 1645 W Jackson Blvd Suite 400, Chicago, IL 60612, USA. Electronic address: brad_appelhans@rush.edu.
authors.forename: Bradley M
authors.initials: BM
authors.lastname: Appelhans
authors.affiliation: Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S 2nd Street, Suite 300, Minneapolis, MN 55454, USA. Electronic address: frenc001@umn.edu.
authors.forename: Simone A
authors.initials: SA
authors.lastname: French
authors.affiliation: Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA. Electronic address: sherry.pagoto@umassmed.edu.
authors.forename: Sherry L
authors.initials: SL
authors.lastname: Pagoto
authors.affiliation: HealthPartners Institute for Education and Research, 8170 33rd Ave S, Mail Stop 23301A, Bloomington, MN 55425, USA. Electronic address: nancy.e.sherwood@healthpartners.com.
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Sherwood
mesh_terms: D065786:Delay Discounting; D019468:Disease Management; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D009042:Motivation; D009765:Obesity / Q000523:psychology* / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D012201:Reward
keywords: Commitment; Diet adherence; Executive function; Food reward; Lifestyle intervention; Obesity; Temporal discounting