(PS13-A12) Effect of a Novel Treatment Incorporating Exposure to Highly Craved Foods on Cravings Among Adults with Overweight and Obesity

Food cue reactivity (FCR) is an appetitive trait associated with overeating, weight gain and treatment non-response in behavioral weight loss (BWL) programs. The Regulation of Cues (ROC) treatment targets FCR through exposure to highly craved foods. A 4-arm randomized control trial designed to evaluate the efficacy of ROC, BWL, ROC+BWL (ROC+) and an active comparator (AC) over 24 months demonstrated weight loss and maintenance over time in ROC treatment, and FCR was a moderator of treatment effects with more weight loss for participants who scored higher in FCR at baseline and received food exposure treatment (ROC or ROC+). However, it has yet to be evaluated whether FCR contributed to differential changes in craving regulation between the treatment arms. Participants completed a food exposure paradigm, during which they provided craving ratings (1=no craving at all, 5=strongest craving) every 30 seconds for 5 minutes while alternating holding (6 trials) and smelling (6 trials) a highly craved food (12 total trials). 271 treatment-seeking adults with overweight or obesity (m BMI=34.6[5.2]; m age=46.5[11.8]; 81.2% female; 19.9% Latinx, 61.6% non-Latinx White) attended 26 treatment sessions over 12-months, and completed the paradigm at baseline, post-treatment (12 months), and follow-up (24 months). Demographics and FCR (measured via Food Cue Responsivity Scale) were assessed via questionnaire. Linear mixed-effects models assessed associations between type of trial (i.e., holding vs. smelling the food), trial number, baseline FCR, treatment arm, assessment time point, and craving rating, adjusting for gender, age, race, ethnicity, and body mass index (BMI). Smelling the food, trial number, baseline FCR, assessment time point, and BMI were all significantly associated with craving ratings (all p’s < 0.05). Additionally, significant FCR by assessment, treatment arm by assessment, and FCR by treatment arm by assessment interaction effects were observed (all p’s < 0.001). At post-treatment, individuals who received ROC (b=-0.19, p< 0.001), ROC+ (b=-0.29, p< 0.001) and BWL (b=-0.23, p< 0.001) demonstrated attenuated relationships between FCR and cravings compared to individuals who received AC. This relationship between FCR and cravings relative to AC was further attenuated at follow-up in individuals who received ROC (b=-0.14, p< 0.001) and BWL(b=-0.14, p< 0.001), and returned towards baseline in individuals who received ROC+ (b=0.15, p< 0.001). For those with high baseline FCR, greater reduction in craving responsiveness was observed during the paradigm at post-treatment for individuals who received ROC, ROC+, and BWL relative to AC. The hypothesized differential improvement in craving regulation for those high in FCR in ROC/ROC+ compared to BWL was not observed. While ROC, ROC+ and BWL produced improved craving regulation for those with high FCR, the combined treatment (ROC+) was not as effective at sustaining improvements in craving regulation over follow-up. Future research should explore whether treatment-related changes in physiological responsiveness to food exposures can also be observed in parallel with cognitive reflections of cravings.