Does intake itself sometimes stimulate more intake? The term "appetizer" would suggest so, and common experience would seem to confirm that appetite can be stimulated by small delicacies. No compelling research has been conducted on this topic in humans, but if strong appetizer effects were confirmed, then the presumptive physiological mediation of such effects (ie, the appetizer triggers an anticipatory digestive reflex, which in turn demands satisfaction in the form of a complete meal) should be distinguished from alternative explanations (eg, the appetizer initiates a behavioral response sequence that is not hunger driven but that perseverates until satiety occurs). The role of behavioral momentum in feeding and other repetitive action patterns has not been adequately explored, although it has been argued that obese subjects overeat because of an inability to terminate repetitive behavior sequences (especially eating) once they have begun (31). This would suggest that appetizer effects might be stronger in the obese.
Preload studies, in which subjects are initially given a fixed amount of food and then permitted to continue ad lib, show a complex pattern. When subjects are classified as dieters (obese or normal weight) or nondieters, opposite reactions are observed, with nondieters eating ad lib in inverse proportion to preload size and dieters eating more following large preloads than following small preloads. The nondieter pattern would seem to contradict expectations based on an appetizer effect, and the data from dieters likewise do not fit in well, because a small preload (appetizer) would be expected to trigger the greatest amount of subsequent eating. Interpretations of these effects in dieters emphasize deliberate cognitive control of intake and its disruption, rather than the sort of analysis ordinarily invoked to explain the hypothetical appetizer effect (32).
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