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. Author manuscript; available in PMC: 2023 Dec 1.
Published in final edited form as: Eat Behav. 2023 May 20;50:101754. doi: 10.1016/j.eatbeh.2023.101754

Hunger, Temptation, and Dietary Adherence During Weight Management

Umelo A Ugwoaba 1, Chelsea A Carpenter 1, Kelsey M Arroyo 1, Charlayne A Scarlett 1, Kathryn M Ross 1
PMCID: PMC10690492  NIHMSID: NIHMS1945978  PMID: 37263142

Introduction

Reductions in dietary intake represent a key component of behavioral treatments for obesity (Hall et al., 2011; Jensen et al., 2014). Greater adherence to dietary intake goals has been associated with greater initial weight loss and weight loss maintenance (MacLean et al., 2015; Sacks et al., 2009). Thus, interventions aiming to improve weight loss outcomes in adults with obesity may benefit from greater focus on addressing risk factors for nonadherence to dietary intake goals.

At an individual level, hunger and temptation may be important predictors of dietary adherence. Cleobury and Tapper (2014) asked adults with overweight and obesity to keep detailed food diaries for five days and to rate, at each eating occasion, the extent to which they endorsed 13 reasons for eating. Around half of eating episodes consisting of unhealthy snacks were associated with hunger or external temptation (i.e., “because the food looked/smelt so tempting”). Forman and colleagues (2017) also demonstrated that hunger and temptation were significant triggers of dietary lapses by using ecological momentary assessment (EMA) methods (for which participants completed a survey after each lapse and during six other semi-random times each day) at baseline, mid-point, and at the end of a 12-month behavioral weight loss program. In contrast, an EMA study by Carels and colleagues (2004) did not find an association between hunger and dietary lapses in women with obesity during the final week of a behavioral weight loss program; however, it is possible that this timing may have impacted outcomes, such that participants experienced fewer lapses or that hunger had less impact on dietary adherence toward the end of the program.

Although these studies provide evidence of associations between hunger, temptation, and dietary adherence, measurement windows were brief (5–14 days) given use of high-burden data collection methods (Carels et al., 2004; Cleobury & Tapper, 2014; Forman et al., 2017) and none investigated whether hunger and temptation may interact to affect dietary adherence. Furthermore, despite the continued challenge of long-term maintenance after the end of intervention (MacLean et al., 2015), no studies have investigated whether these associations change during a weight maintenance period. Thus, the current study explored associations between hunger, temptation, and dietary adherence each week during a 12-week, Internet-based weight loss program followed by a 40-week post-intervention maintenance period. It was hypothesized that higher ratings of hunger and temptation would be associated with lower ratings of dietary adherence during the same week, and that there would be a significant interaction between hunger and temptation, such that the association between temptation and dietary adherence would be stronger at higher levels of hunger. As an exploratory aim, differences in associations between the intervention and the maintenance period were examined.

Methods

Participants

The current study conducted secondary analyses of data from an Internet-based weight loss program; parent study protocol and intervention outcomes have been published previously (Ross & Wing, 2016). Briefly, participants in the parent study were 75 adults (age 18–70 years) with overweight or obesity (body mass index [BMI] ≥ 25 kg/m2). One participant never logged into the study website to begin the intervention; therefore, data from the 74 participants who participated in the intervention were included in the current study. At baseline, participants were (mean±SD) 50.7±10.4 years old and had BMIs of 31.2±4.5 kg/m2; a majority identified as female (n=51, 68.9%) and, in terms of race/ethnicity, 86.5% (n=64) identified as White, 9.5% (n=7) as Black/African American, 2.7% (n=2) as Asian, 2.7% (n=2) as Hispanic/Latino, 1.4% (n=1) as American Indian or Alaskan Native, and 5.4% (n=4) selected “other” (totals exceed 100% as participants could select more than one race/ethnicity category; Ross, Eastman, et al., 2019). The Miriam Hospital Institutional Review Board (IRB) approved the parent study, and the University of Florida IRB approved current analyses.

Intervention and Maintenance Period

Participants were provided with a 12-week, Internet-based weight loss program (see Ross & Wing, 2016) based on the Diabetes Prevention Program lifestyle intervention (Diabetes Prevention Program Research Group, 2002). During this program, participants were encouraged to consume a reduced calorie diet (1,200–1,800 kcal/day, based on baseline weight, with less than 30% of kcal intake from fat) and to gradually increase engagement in moderate-intensity physical activity (e.g., brisk walking) to 200 minutes/week. To track progress toward these goals, participants were asked to self-monitor weight, dietary intake, and physical activity daily using study-provided tools (body weight scale, calorie reference book, and paper self-monitoring logs). At the end of each week, participants were asked to log into the study website to self-report their daily weight, caloric intake, and minutes of physical activity, and to complete a questionnaire with 11 single-item measures of constructs hypothesized to be associated with weight loss and regain. The following morning (or at their next login), participants received an automated, tailored feedback message based on their self-monitoring data.

During the 40-week observational maintenance period, no additional intervention was provided (past intervention lessons could not be accessed via the study website, participants no longer received weekly feedback messages, and no specific goals were provided related to dietary intake and physical activity), although participants were encouraged to continue to self-monitor daily and maintain the changes they’d made in their eating/activity habits during the program in order to maintain their weight losses long-term. Participants were asked to continue to log into the website each week to report self-monitoring habits (i.e., number of days they self-monitored their weight and dietary intake, and total minutes of physical activity over the past week) and complete the questionnaire (participants received small financial incentives for reporting these data; see Ross, Qiu, et al., 2019).

Measures

The current study included data from three of the single-item measures included on the weekly questionnaire assessing hunger (“How hungry were you during the past week?”; 1 = Not Hungry At All, 7 = Very Hungry), temptation (“How tempted were you during the past week to eat foods not on your plan?”; 1 = Not Tempted At All, 7 = Very Tempted), and dietary adherence (“To what degree were your eating choices during the past week consistent with your weight loss goals?”; 1 = Not Consistent At All, 7 = 100% Consistent). Participants were not trained on how to interpret questionnaire items and weekly feedback messages during the initial intervention were not tailored in response to item ratings (feedback only pertained to self-monitoring data). Construct validity for the dietary adherence question was assessed using self-reported caloric intake data collected during the 12-week program; a multilevel mixed effects model (similar to those described in the analyses section) demonstrated that caloric intake was lower during weeks when ratings of dietary adherence were higher, B=−40.92, SE=4.93, t(704)=−8.29, p<.0001, such that each 1 point higher rating of dietary adherence was associated with 41 fewer calories consumed each day, on average, the same week (or ~286 fewer calories consumed over the week).

Analyses

Analyses were conducted using SAS version 9.4 (SAS Institute, 2013). Multilevel mixed effects models, with repeated observations nested within individuals, were used to examine associations between hunger, temptation, and the interaction between hunger and temptation and dietary adherence each week. Models used all available data, using maximum likelihood estimation to handle missing data, with Satterthwaite approximation used to estimate degrees of freedom.

Results

Intervention outcomes and change over time on the 11 items have been published previously (Ross, Qiu, et al., 2019). On average (mean±SD), participants lost −5.8±4.9 kg during the initial weight loss program and regained 2.4±3.6 kg during the maintenance period. Participants completed 84% of the weekly questionnaire items during the initial intervention and 71% during the maintenance period. Over the 52-week study period, participants reported average ratings of 4.1±1.5 for hunger, 4.9±1.6 for temptation, and 4.1±1.5 for dietary adherence. Ratings did not significantly differ between the initial intervention and the maintenance period for hunger (4.1±1.1 versus 4.2±1.0 points, p=.338) or temptation (4.8±1.3 versus 4.9±1.0 points, p=.146); however, ratings of dietary adherence were significantly higher during the intervention compared to the maintenance period (4.3±1.1 versus 3.8±0.9 points, p<.001).

Within a given week, greater hunger was significantly associated with greater temptation, B=0.34, SE=0.02, t(2704)=21.39, p<.0001. Further, greater hunger was significantly associated with lower dietary adherence, B=−0.20, SE=0.02, t(2648)=−9.28, p<.0001, such that that a 1-point higher rating of hunger was associated with a 0.2-point lower rating for adherence (extrapolating this out, if each additional point of adherence ≈286 fewer calories consumed/week, each 1 point higher rating of hunger would be associated with consumption of an additional 57 calories the same week). Greater temptation was also associated with lower dietary adherence, B=−0.50, SE=0.02, t(2685)=−29.03, p<.0001, such that that a 1-point higher rating of temptation was associated with a 0.5-point lower rating for adherence (with similar extrapolation, each 1 point higher rating of temptation would be associated with consumption of an additional 143 calories the same week). Finally, there was a significant interaction between hunger and temptation, B=0.02, SE=0.01, t(2672)=2.20, p=.028, such that the association between ratings of temptation and dietary adherence was stronger during weeks when ratings of hunger were lower, compared to weeks when ratings of hunger were higher (see Figure 1).

Figure 1.

Figure 1.

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Interaction between ratings of temptation and hunger on dietary adherence within the same week.

NOTE: All ratings were analyzed as continuous variables. For visual purposes in this figure: Low Hunger and Temptation = a rating of “1”, High Hunger and Temptation = a rating of “7”

The association between hunger and temptation was significantly greater in magnitude during the maintenance period (B=0.35, SE=0.02, t(1970)=19.13, p<.0001) compared to during the initial intervention (B=0.28, SE=0.03, t(735)=9.50, p<.0001), t(2668)=2.21, p=.027. There were no significant differences between the initial weight loss program and the post-intervention maintenance period in associations between hunger, temptation, or the interaction between hunger and temptation, and dietary adherence, all ps>.05.

Discussion

The current study examined associations between hunger, temptation, and dietary adherence during and after a 12-week, Internet-based weight loss program. Consistent with Cleobury and Tapper (2014) and Forman and colleagues (2017), higher ratings of hunger and temptation within a given week were significantly associated with lower ratings of dietary adherence that same week. Further, hunger was found to moderate the association between temptation and dietary nonadherence, albeit not in the hypothesized direction. Rather than hunger strengthening the association between temptation and dietary nonadherence, the association between temptation and dietary nonadherence was stronger when ratings of hunger were low. There were no differences in these associations between the initial weight loss intervention and the maintenance period, suggesting that the intervention may not have provided individuals with sufficient strategies for managing hunger and temptation. Similarly, there were not changes in mean ratings of hunger and temptation between the initial intervention and maintenance period; however, participants demonstrated lower ratings of dietary adherence during the maintenance period. Finally, there was a significant positive association between ratings of hunger and temptation that became stronger during the maintenance period.

Combined with results demonstrating that the magnitude of the association between temptation and dietary nonadherence was over twice that of hunger and dietary nonadherence, this pattern of results suggests that temptation, particularly in low-hunger contexts, may serve as an important treatment target for interventions aiming to further improve dietary adherence. For example, participants might benefit from additional training in temptation-management skills such as stimulus control (Butryn et al., 2017), setting of specific implementation intentions (Dombrowski et al., 2016), and/or acceptance-based strategies such as urge surfing (Forman et al., 2009), or the provision of tailored support at times when temptation is high and hunger is low (e.g., within a just-in-time adaptive intervention framework; see Nahum-Shani et al., 2014). The observation of a stronger association between hunger and temptation during the maintenance period versus the initial intervention suggests that additional strategies focused on how to distinguish these sensations may also be helpful during this time (e.g., use of acceptance-based processes focused specifically on increasing mindfulness of bodily sensations versus thoughts). Future studies should investigate whether intervention components specifically targeting temptation and hunger can improve dietary adherence and longer-term weight loss outcomes.

Strengths of the current study included the longitudinal design, weekly data collection for a full year, and concurrent assessment of temptation and hunger, allowing for the investigation of potential interactions. The current study also had several important limitations. First, ratings of hunger, temptation, and dietary adherence were collected only once each week, precluding assessment of causality or validation of temporal precedence. Future studies should use more frequent assessment (e.g., assessing hunger and temptation throughout the day, similar to methods used in the broader EMA literature; see Trull & Ebner-Priemer, 2009) to limit bias due to recall (e.g., recency effects), and items should be delivered independently to minimize risk of priming effects. Second, the items used to assess hunger, temptation, and dietary adherence were developed for use in the parent study to reduce burden related to weekly assessment of these (and other) constructs over a full year (Ross & Wing, 2016). Although single-item measures have demonstrated utility for measuring psychological and behavioral constructs (Allen et al., 2022), the reliability and validity of these specific items are unknown as no psychometric assessments have been conducted. The current study assessed criterion validity of the dietary adherence ratings by comparing them to caloric intake during the initial intervention; however, data were not available to assess validity of the items used to assess hunger and temptation. Previous research using similar single-item measures of hunger have demonstrated good validity and reliability in adults with normal weight (Flint et al., 2000; Stratton et al., 1998), however these measures have not been validated in samples of adults with overweight or obesity. As these constructs likely vary over time, data from the parent study could also not be used to meaningfully assess test-retest reliability. Future studies should replicate these results using validated and reliable measures. Finally, generalizability of results is limited as participants were predominantly female and White; future studies should aim to replicate results in samples including more men and individuals from historically-minoritized backgrounds.

Conclusion

The current study examined within-week associations between hunger, temptation, and adherence to dietary recommendations during and after a weight loss program. Results demonstrated that greater hunger and temptation were associated with lower dietary adherence and that the association between temptation and dietary nonadherence was stronger when ratings of hunger were low. Future research should investigate what specific intervention strategies may best help participants successfully manage temptation and hunger (and to specifically manage temptation in low-hunger contexts), and whether offering these strategies at targeted, high-risk times can improve weight outcomes.

Acknowledgements

Support for this study was provided by the Lifespan Corporation and by the National Institute of Diabetes and Digestive and Kidney Diseases (National Institutes of Health) under awards F32DK100069, R21DK109205, and R01DK119244 awarded to Kathryn M. Ross, PhD MPH. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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