Background: Nutrition is an important component of metabolic disease prevention and treatment, yet eating and perceived control over eating (PCOE) are complex behaviors. Most people who attempt lifestyle changes have setbacks that can interfere with confidence and motivation for sustained change. The Virta Health virtual clinic provides medically-supervised nutrition therapy for metabolic disease focused on carbohydrate restriction and provides education and tools to: (1) understand how foods impact metabolic health; (2) facilitate autonomy for food choices; and (3) disentangle physiological and emotional food cues, to foster patients’ eating confidence even if they struggle with adherence. This analysis explored whether Virta patients’ PCOE improved during early treatment as these concepts were taught.

Methods: As part of standard clinical care, Virta patients (N=5940, Mean (M) age = 54 years, 72% white, 61% female, 73% T2D, M BMI = 36) responded to 4 items (total score range 4-20) assessing PCOE before the dietary intervention and at follow-up (M days = 60, SD = 15) . Paired t-tests were conducted to assess changes in PCOE over time among all patients and separately within subgroups based on dietary adherence (M ketones during treatment ≥ or < 0.5 mM) .

Results: PCOE improved from pre-treatment (M=13.3, “slightly” in control) to the first follow-up (M=15.7, “somewhat” in control) in all patients (p<0.0001) and within both subgroups of dietary adherence (more-adherent group: +3.0 from 13.3, p<0.0001; less-adherent group: +1.7 from 13.3, p<0.0001) .

Conclusions: Consistent with treatment aims, patients’ PCOE improved. Importantly, patients who did not meet dietary adherence targets still gained confidence for controlling eating, though to a lesser extent. We predict that a healthier relationship with food, which includes greater PCOE, will help patients maintain motivation and get back on track following a setback; future research should investigate whether greater PCOE is associated with long-term adherence and metabolic health outcomes.


R. N. Adams: Employee; Virta Health Corp. M. Vantieghem: Employee; Virta Health Corp., Stock/Shareholder; Virta Health Corp. B. M. Volk: Employee; Virta Health Corp., Stock/Shareholder; Virta Health Corp. S. J. Athinarayanan: Employee; Virta Health Corp. A. L. Mckenzie: Employee; Virta Health Corp., Stock/Shareholder; Virta Health Corp.

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