ABSTRACT
24Environmental and genetic factors are important influences on diet and its cardiometabolic effects, but overeating and unhealthy eating are ultimately malleable behaviors. Environmental- and individual-level factors are therefore key targets for intervention. In this chapter, we review current behavioral models of three types of overeating: mindless overeating, stress-induced overeating, and compulsive overeating. We define mindless overeating as overeating that occurs outside of one’s awareness and without attention. We define stress-induced overeating as overeating that can occur with or without awareness in response to stress. We define compulsive overeating as eating that occurs with awareness and that typically involves (1) overeating of highly palatable foods for their hedonic properties, and (2) experiencing a loss of control over such eating. These forms of overeating can increase risk of metabolic syndrome. We review evidence that environmental interventions at both the institutional and individual levels can decrease overeating and improve cardiometabolic health. These interventions target food environments in which people make most of their food purchasing and consumption decisions and include workplaces, supermarkets, restaurants, and schools. Cognitive-behavioral intervention approaches, such as cognitive restructuring and self-monitoring of weight and food consumption, have been demonstrated effective in weight loss in the context of lifestyle interventions, such as the Diabetes Prevention Program, which typically employ a combination of such cognitive-behavioral approaches. Mindfulness-based interventions that target overeating by enhancing nonjudgmental awareness of eating behaviors and eating related to distressing emotions also hold promise, although more data are needed to better assess the effectiveness of these interventions. We conclude that current data support referral of individuals who are overweight or obese to high-quality behavioral intervention programs that include evidence-based components to promote improvements in cardiometabolic risk factors. In settings without high-quality group interventions, referral to a nutritionist with expertise in behavioral weight loss strategies may be helpful.
