Olivia Grace Wooliver Owoolive@utk.

edu University of Tennessee at Knoxville Senior in the Department of Nutrition Healthy Eating and Activity Laboratory: Research Assistant Faculty mentor: Dr. Hollie Raynor, PhD, RD, LDN 2013 Summer Research Internship: Results

The Effects of Chewing Gum on a Computer Task and Liking Ratings of Ice Cream I. PROJECT OBJECTIVES Background and Specific Aims Approximately two-thirds of U.S. adults are overweight or obese14, thus placing obesity first as a public health concern in the U.S.17 At the heart of weight management is the ability to appropriately regulate energy intake. A key factor in regulation of consumption is satiation, the process by which an eating bout ends. Quicker onset of satiation may result in decreased consumption2, which is important in achieving an adequate energy balance. Negative energy balance, in which energy intake is less than energy expenditure, is required for weight loss; however, there are challenges with increased hunger and decreased satiation as energy intake is decreased.4 One of the factors believed to influence satiation is the ability to increase the rate of habituation occurring during an eating bout.7 Habituation is a basic form of learning that can be measured by the rate of decrease in consummatory response to repeated presentations of food orosensory cues.6 Following this decreased response rate to a particular food, presentation of new orosensory cues may result in dishabituation to both the previously habituated food as well as the new orosensory cue, thus causing an increase in consummatory response. Dishabituation during an eating bout, i.e. exposure to a variety of orosensory cues, may be related to recovery of appetite and decreased satiation, leading the calorie-replete individual to overconsume.7 Alternatively, with repeated presentations of the same orosensory cue, one becomes accustomed to the taste faster, giving rise to habituation, which should increase satiation. A more rapid rate of habituation would mean that less energy is consumed within an eating bout. Research indicates increased weight status in relation to slower habituation rates3 as well as an inverse relationship between the extent of orosensory variety and habituation rates. Additionally, research shows a positive association between amount of orosensory cues and amount consumed within an eating bout.7 One way to provide a single orosensory cue and initiate enhanced habituation with a minimal amount of additional energy intake is by chewing sugar-free, flavored gum. Therefore, the purpose of this proof-of-concept study was to examine if chewing gum before an eating bout would increase the rate of habituation and subsequently reduce energy intake within the eating bout. Participants came in for 4 sessions total. The first session was a screening session to ensure eligibility. During the remaining 3 sessions, participants engaged in one of three gum-chewing conditions, in which they chewed a specified flavor or gum for 20 minutes. The flavors were Extra Dessert Delights Mint Chocolate Chip and Trident Cinnamon. In the third condition, the participant did not chew gum but instead sat quietly for 20 minutes. Each participant engaged in each condition. After the gum-chewing interval, participants played a computer game for up to 24 minutes. To measure habituation, we recorded responses over the course of this computer game in which the participant was

rewarded a portion of ice cream after each point earned. The primary dependent variable was number of responses during the computer task. Consumption of ice cream was also measured. As of August 16, 2013, 6 participants have completed the study. Recruitment will continue until 10 men and 10 women have completed the study. II. DESCRIPTION AND SOURCE OF RESEARCH PARTICIPANTS Proposed Methods Eligibility Criteria and Recruitment Following IRB approval on June 13, 2013, participants were recruited from the University of Tennessee, Knoxville campus via flyers posted around campus. Eligible participants were to be twenty males and females meeting the following criteria: 1) age between 18 and 40 years; 2) of normal weight (body mass index [BMI] between 18.5 and 24.9 kg/m2); 3) unrestrained eater (scoring less than/equal to 12 on the restraint scale of the Three Factor Eating Questionnaire year or more); and 5) like and are willing to eat (greater than/equal to 50mm on a [TFEQ15]); 4) non-smoker (not having smoked or used tobacco products for a 100mm visual analogue scale [VAS]) MCC ice cream. Participants were excluded if they: 1) have any health condition that requires a specific dietary prescription (i.e., diabetes); 2) are unable to chew the gum for the time required in the investigation; 3) do not like the flavors of gum used in the investigation; 4) are allergic to any ingredients in the foods used in the investigation; 5) are lactose-intolerant; 6) plan to make any changes in dietary intake or physical activity over the course of the study; 7) score >20 on the Eating Attitudes Test (EAT8); 8) score >16 on the Binge Eating Scale (BES10); 9) are not able to stay within the metropolitan area within the time frame of the investigation; 10) are pregnant, lactating, or plan to become pregnant during the investigation; or 11) are taking any type of medication that influences appetite. III. METHODS AND PROCEDURES Study Design Participants were randomized into one of three conditions using the following table. Each participant completed each session. Order 1 2 3 Session 1 Screening Screening Screening Session 2 NO GUM MCC C Session 3 MCC C NO GUM Session 4 C NO GUM MCC

Procedures Participants came to HEAL for a 30-minute screening session and, if eligible, were asked to come to 3, 60-minute experimental sessions. All four sessions were completed within a 4-week period, with at least three days occurring between each session. Appointments were scheduled between the hours of 12:00pm and 5:00pm Monday through Friday.

During the first screening session, informed consent was obtained, and anthropometrics were measured. Participants then completed the EAT and BES questionnaires. Next, participants were given a sample of MCC ice cream and were asked to rate their liking and willingness to eat this food on a 100mm VAS. If still eligible, the participant completed a demographics questionnaire and scheduled the remaining three experimental sessions. Participants were instructed to eat and engage in moderate- to vigorous-intensity physical activity (MVPA) in their usual manner during the 24 hours prior to each experimental session and to keep both dietary intake and MVPA consistent in the 24-hour period prior to each experimental session. Participants were asked not to chew gum, consume food or energy-containing beverages, or engage in MVPA in the two hours prior to each experimental session. In the three experimental sessions, participants were asked to write down everything they had consumed in the previous 24-hrs and the minutes of MVPA engaged in during the previous 24-hrs. Instructions regarding gum chewing were also assessed. If participants had not followed instructions regarding eating, MVPA, or gum chewing, the session was to be rescheduled. Participants then rated their feelings of hunger and fullness using a 100mm VAS, placing an x on the line with Extremely not at one end and Extremely at the other. Similarly, participants rated their liking of MCC ice cream on a 100mm VAS with Extremely Dislike at one end and Extremely Like at the other. Participants then chewed gum (or sat quietly) for 20 minutes. After the 20-minute gum-chewing interval, participants were asked to rate their feelings of hunger, fullness, and liking of MCC ice cream again. Next, participants completed a computer generated task to measure habituation of responding for food, programmed at a variable interval 120 42 seconds (VI-120) reinforcement schedule, so that participants were rewarded one point for the first response made after approximately 120s had passed.5 The computer task consisted of two squares, one that flashed red every time a mouse button was pressed and another square that flashed green when a point was earned. The habituation phase lasted 24 minutes, divided into 12, 2-minute trials, during which participants earned points towards access to 75-kcal portions of ice cream. Participants received the food immediately after each point earned and could continue to play the computer task while consuming the earned ice cream. Water was provided ad libitum throughout the duration of the experiment. Participants were instructed that when they no longer wanted to earn access to the ice cream they could go to another table and engage in the activities provided, such as the daily newspaper, Sudoku, crosswords, and magazines. Availability of alternative activities ensured that participants are not working for food out of boredom. After the computer task, participants rated feelings of hunger, fullness, and liking of MCC ice cream again. Upon completion of the final experimental session, participants were compensated with a $25 gift card. Measures Demographics: Basic demographic information (age, race, gender, education) was obtained during the screening session.

Anthropometrics: During the screening session, height and weight were measured using a stadiometer and an electronic scale, respectively. These measurements were taken with the participant wearing light clothing and no shoes. BMI was calculated using the formula weight in kg/height in m 2.12 Dietary Restraint: Dietary restraint, or the degree of conscious control one exerts over eating behaviors, was measured during the phone screen using the Three Factor Eating Questionnaire (TFEQ15). Scores range from 0-21, with a score greater than 12 indicating that the individual is a restrained eater. Eating Disorder Symptomatology: The Eating Attitudes Test (EAT8) is a series of 26 items assessing symptoms of anorexia nervosa, with scores ranging from 0 to 26. A score of 20 or greater indicates risk of anorexia nervosa9; in this case, the participant was ineligible. Binge Eating: The Binge Eating Scale is a 16-item questionnaire that assesses symptoms associated with binge eating, including behavioral, emotional, and cognitive.10 Scores range from 0 to 46, with a score of less than 17 indicating no association with binge eating. With a score of 17 or higher, the participant was ineligible. Dietary Recall and Activity Log: Participants completed a food record for what they had consumed during the previous 24 hrs. Participants were given 2-D portion size estimation aids to assist with quantifying servings consumed. Nutrition data will be analyzed using the Nutrition Data System Software for Research (NDSR) developed by the Nutrition Coordinating Center, University of Minnesota, Minneapolis, Minnesota. Participants were also asked to record minutes of MVPA engaged in during the 24 hours prior to the session. Liking of Ice Cream: Liking of foods was measured via a 100mm VAS (Visual Analog Scale). This scale consisted of two anchors at either end of a liking scale with Extremely Dislike at one end and Extremely Like at the other. Participants placed an x on the line to indicate how much/little they like the food. A rating of greater 50mm indicated liking the ice cream and was required for the participant to continue with the study during the screening session. Hunger and Fullness: Participants rated their feelings of hunger and fullness using a 100mm VAS, as described above. This scale consisted of two anchors at either end of a hunger or fullness scale (line) with Extremely not at one end and Extremely at the other. Participants placed an x on the line to indicate feelings of hunger and fullness. Consumption: In the course of each experimental session, the ice cream was weighed in a bowl on an electronic food scale (to the nearest 0.1g) before and after consumption for each 90-s trial completed in the computer task. Amount of ice cream consumed was measured using the following formula: amount of ice cream before consumption (first weight) amount of ice cream following consumption (second weight). Energy consumption was calculated using the following formula: total grams consumed x energy per gram of ice cream. Habituation of Operant Behavior: During the computer task the number of consecutive two-minute time blocks before responding ceases, as well as the overall pattern of responding, was measured.

IV. RESULTS As of August 14, 2013, 17 potential participants have been phonescreened for the study; of these recruits, 7 were eligible. Of the 7 eligible participants, 6 have completed the study. Recruitment will continue until 20 participants, 10 males and 10 females, have completed the study. References 1. Anderson JW, Konz EC. Obesity and disease management: Effect of weight loss on comorbid conditions. Obesity Research 2001;4:326S-34S. 2. Blundell JE, Finlayson G. Is susceptibility to weight gain characterized by homeostatic or hedonic risk factors for overconsumption? Physiology & Behavior 2004;82:21-5. 3. Bond DS, Raynor HA, McCaffery JM, Wing RR. Salivary habituation to food stimuli in successful weight loss maintainers, obese and normal-weight adults. International Journal of Obesity 2010;34:593-6. 4. CDC. Low-energy-dense foods and weight management: cutting calories while controlling hunger. PDF. http://www.cdc.gov/nccdphp/dnpa/nutrition/pdf/r2p_energy_density.pdf. 5. Epstein LH, Robinson JL, Temple JL, Roemmich JN, Marusewski AL, Nadbrzuch RL. Sensitization and habituation of motivated behavior in overweight and non-overweight children. National Institute of Health 2008; 39(3): 243-255. 6. Epstein LH, Temple JL, Roemmich JN, Bouton ME. Habituation as a determinant of food intake. Psychological Reviews 2009;116:384-407. 7. Epstein LH, Temple JL, Roemmich JN, Marusewski AL, Nadbrzuch RL. Variety influences habituation of motivated behavior for food and energy intake in children. American Journal of Clinical Nutrition 2009; 89(3): 746 754. 8. Garner DM, Olmsted MP, Bohr Y, Garfinkel PE. The eating attitudes test: Psychometric features and clinical correlates. Psychological Medicine 1982;12:871-8. 9. Garner DM, Garfinkel PE. The Eating Attitudes Test: An index of the symptoms of anorexia nervosa. Psychological Medicine 1979;9:273-9.3 10. Gormally J, Black S, Daston S, Rardin D. The assessment of binge eating severity among obese persons. Addictive Behaviors 1982;7:47-55. 11. Harris MI, Flegal KM, Cowie CC, et al. Prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance in U.S. adults. The Third National Health and Nutrition Examination Survey, 1988-1994. Diabetes Care 1998;21:518-24. 12. Lohman TR, Roche AF, Martorell R. Anthropometric Standardization Reference Manual. Champaign,Illinois: Human Kinetics Books; 1988. 13. NHLBI. Clinical guidelines on the identification, evaluation, and treatment of

overweight and obesity in adults: The evidence report. Obesity Research 1998;6:51S-210S. 14. Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999-2004. Journal of the American Medical Association 2006;295:1549-55. 15. Stunkard AJ, Messick S. The Three-Factor Eating Questionnaire to measure dietary restraint, disinhibition and hunger. Journal of Psychosomatic Research 1985;29:71-83. 16. Wannamethee SG, Shaper AG, Walker M. Overweight and obesity and weight change in middle aged men: Impact on cardiovascular disease and diabetes. Journal of Epidemiology and Community Health 2005;59:134-9. 17. Wyatt SB, Winters KP, Dubbert PM. Overweight and obesity: Prevalence, consequences, and causes of a growing public health problem. American Journal of Medical Science 2006;331:166-74.