Marion Hetherington - Faculty of Health and Life Sciences

Institute of Psychological SciencesFACULTY OF MEDICINE AND HEALTHBenefits of satiety enhancement– do functional foods deliver?Professor Marion Hetherington

Benefits of satiety to theconsumerAim:To consider and evaluate research on possible benefits ofenhanced satiety and appetite control to the consumerMain questions:1. How is functionality defined?2. How do we describe and measure satiety?3. What foods or ingredients promote satiety?4. What do consumers understand by “satiety” claims?5. What are the benefits?6. Do functional foods deliver ?

How is functionalitydefined?

Defining functionality

Defining functionalityAshwell (2001) PHN a food is functional ifa) provides a benefit beyond nutritional content by improving health and wellbeing or reducing risk of disease e.g. lowering cholesterolb) not pills nor capsules but part of a normal food pattern e.g. whole foods orenhanced foods

Food products with hungercontrol or satiety claims

Defining functionality: EUEC Concerted Action on Functional Food Science (FUFOSE) proposed aworking definitionhttp://www.ilsi.org/Europe/Pages/FUFOSE.aspxthose foods which are intended to be consumed as part ofthe normal diet and that contain biologically activecomponents which offer the potential of enhanced healthor reduced risk of disease.e.g. foods that contain specific minerals, vitamins, fatty acids ordietary fibre, foods with added biologically active substances such asphytochemicals or other antioxidants and probiotics…..

EFSA consultation document(26 April 2011 to 31 August 2011)• changes in appetite ratings after consumption of a“test” food should also be observed after chronicconsumption of the food (e.g. after one month)• tests performed on a single occasion insufficient forsubstantiation• changes in energy intake must be shown over time;after chronic consumption of the food (e.g. after onemonth),•tests performed on a single occasion insufficient forsubstantiation.

www.hc-sc.gc.ca

“Satiety” claimsFood productNutrition shakeVanilla milkshakeOatmeal, cereal, milkshakesYoghurt, ready-to-eat mealsEgg proteinProtein shakeClaim“freedom from hunger”“re-programs appetite to reducehunger and cravings”“helps satisfy your hunger”“Fuller for longer”“helps you want to eat less”“keep me going to preventhunger”

How do we describe andmeasure satiety?

Satiety cascadeBlundell (1991)SensoryCognitivePost-ingestivePost-absorptiveFOODearlyLateSatiationSatiety

Defining satietySatiationthe process by which food intake is terminated; measuredby within meal ratings of appetite and ad libitum intakeof single food or mealSatiety (post-prandial)inhibition of further eating, modulation of hunger in postingestiveperiodMeasured by magnitude or duration of changes insubjective ratings of appetite-related sensations usuallyby visual analogue scales (VAS)

Hunger precedes meal intake+HungerSatietySatietySatiety_Breakfast Lunch DinnerSatiation Satiation Satiation

What foods or ingredientspromote satiety?

Properties of foods which couldpromote satietyMacronutrient content (e.g. protein > fat)Fibre content (high fibre > low fibre)Glycaemic index (low GI > high GI)Energy density (low kcal/g > high kcal/g)Structure (solid food / viscous food > liquids)

Evidence from consumersHealth benefits are important to consumerse.g. cholesterol lowering ingredientsPreventing disease and concerns about body weight arecommonly cited health considerationsManaging hunger is also mentioned in relation to weightcontrolHowever, satiety effects are experienced immediately andare easily discernible

What do consumersunderstand about satiety?Consumers describe fullness as• “a feeling of food in the stomach”• “stomach stretch”• “satisfaction• “lack of the desire to eat”• The term « satiety » is not typically usedMurray & Vickers Appetite (2009)

What do consumersunderstand about satiety?Bilman et al (2012) assessed understanding in 1504respondents in UK, Italy, France and GermanyMost correctly interpreted satiety claimsMajority did not extend satiety claim to include weightloss (no magic bullet) identifying personal efforts toachieve weight lossBut restrained eaters more likely to over-interpretsatiety claims for weight loss benefits

CaveatsWeight loss can only be achieved by sustained, goaldirectedchanges in lifestyle including diet andactivity.Satiety enhancement per se cannot produce weight loss

What are the benefits?

Potential benefits of satietyReduced opportunistic eating (some consumers)Strengthen weak internal cues of satietyPleasure associated with lower energy food productswithout feeling “deprived”Reduced hunger dysphoriaImproved hunger managementImproved compliance with goal directed behavioursAdjunct to achieving weight loss and reducing the risk ofweight gain

Goal directed behaviourSatiety enhancement may increase compliance with ahealthier dietLower ED foods/liquids may promote weaker satiety thanhigh ED foods/liquidsHunger management increases eating self-efficacy sohealthy eating goals may be more easily achievedSatiety enhancement may increase compliance with a weightloss diet (hunger and food cravings may impaircompliance)

Goal directed behaviourTargeting appetite using specific foods or meals can be ameans of managing hunger arising from periods ofenergy restrictionHunger management may help individuals resist the strongenvironmental and situational cues to overconsumeSuccess of pharmacological agents to manage hunger – canfoods provide a similar if more subtle effect on satiety(e.g. d-fenfluramine)

Benefits of hungermanagementPerceived hunger predicts failure to lose weight in clinicaltrials (Womble et al., 2001)Higher fasting state ratings of appetite associated withlower weight loss (Drapeau et al., 2007)Hunger is associated with weight regain (Pasman et al, 1999)Market research reasons for non-compliance to weight lossdiets:“Cravings for foods I love”“Always being hungry” (Unilever Strategic Segmentation Study, 2007, US)

Reduced hunger with highprotein low CHO dietsHPMCN = 17HPLCMean (SEM) daily hunger (mm), HPLC (ketogenic) diet and HPMC (nonketogenic) diet .Over the 4-wk period, hunger was significantly lower with the LC diet than with the MC diet .Johnstone et al (2008) AJCN

Weight loss maintenanceOverweight adults (n = 773) from 8 EUcountrieslost at least 8% of their body weight on an 800kcal low-calorie diet (LCD) then randomised toone of 5 ad libitum diets to prevent weightregain over a 26-week period.Maintenance diets were either high or low inprotein and GI according to a two-by-twofactorial design or a control dietCompletion rate and maintenance of weight losswere highest with the high-protein low GI diet;(Larsen et al., 2010).

High protein and low GI promoteweight loss maintenance

Model to understandbenefitsHetherington et al (2012) NRRsubmitted

SummarySatiety enhancement may be desirable to some consumersMay strengthen internal cues of satietyOffers pleasure without feeling deprivedPotential for improved dietary compliance (healthy diet orweight loss) since perceived hunger is a barrier todietary complianceFunctional foods for satiety may confer consumer benefitsincluding those related to weight managementDo functional foods deliver? Good short term evidencenbut long term studies as yet insufficient

AcknowledgementsILSI expert panelLouise Dye, University of LeedsLeigh Gibson, Roehampton UniversityNikolaj Gregersen, University ofCopenhagenJason Halford, University of LiverpoolClare Lawton, University of LeedsHans van Trijp, Wageningen UniversityKaren Cunningham (Coca Cola)Anne Lluch (Danone)David Mela (Unilever)Athanasia BakaILSI staffFrederic Timmermans