Normalizing Eating Behavior Reduces Body Weight and Improves Gastrointestinal Hormonal Secretion in Obese Adolescents

Hypothesis: 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 x 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 (Delta) in body mass index SD scores, Delta meal duration correlated negatively with Delta absolute suppression in ghrelin at 60 min (r = -0.58; P = 0.037; 95% CI -0.79 to -0.27) and Delta 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. (J Clin Endocrinol Metab 97: E193-E201, 2012)