Executive function in weight loss and weight loss maintenance: a conceptual review and novel neuropsychological model of weight control

Executive function in childhood obesity: Promising intervention strategies to optimize treatment outcomes

Executive functions (EFs) are hypothesized to play a role in the development and maintenance of obesity due to their role in self-regulatory processes that manage energy-balance behaviors. Children with obesity have well-documented deficits in EF, which may impede effectiveness of current, evidence-based treatments. This review examines top-down EF processes (e.g., inhibitory control, working memory, cognitive flexibility), as well as bottom-up automatic processes that interact with EFs (e.g., attentional bias, delay discounting) and their relation to weight-loss treatment success in children. It then evaluates EF-related interventions that may improve treatment response. Empirical studies that included an intervention purported to affect EF processes as well as pre-post measurements of EF and/or relative weight in populations ages 19 or younger with overweight/obesity were reviewed. Findings indicate that poorer EF may hinder treatment response. Moreover, there is preliminary evidence that behavioral weight loss intervention and physical activity may positively affect EF and that improvements in EF are related to enhanced weight loss. Finally, novel intervention strategies, such as computer training of core EFs, attention modification programs, and episodic future thinking, show promise in influencing both EFs and EF-related skills and weight. Further research is needed to provide more conclusive evidence of the efficacy of these interventions and additional applications and settings should be considered.

Cognitive control functions in individuals with obesity with and without binge-eating disorder

OBJECTIVE

Deficits in cognitive control are thought to contribute to the maintenance of obesity (OB). Cognitive control is referred to as impulsivity and binge-eating disorder (BED) is characterized by high levels of impulsivity. The present study sought to elucidate which cognitive control functions differentiate between severe OB with and without BED also taking into account hunger as a moderating factor.

METHOD

The study included 48 individuals with OB and BED (OB + BED), 48 individuals with OB and no BED (OB - BED) and 48 normal-weight controls (NWC). Hunger was systematically manipulated: participants were instructed to refrain from eating before testing and received either a liquid meal or flavored water. Then, a comprehensive test battery was administered including a food-related go/no-go task and several subtests from the CANTAB.

RESULTS

There were no differences between the groups with regard to food-related response inhibition. However, while manipulating hunger had no impact on performance in the go/no-go task, self-reported hunger significantly influenced task performance by increasing inhibition deficits to high-caloric stimuli in OB + BED. With regard to general cognitive control functions, we found that deficits in attention and impulse control in decision-making distinguished OB from NWC, while reversal learning and risk taking in decision-making appeared to be relevant factors when distinguishing OB + BED from OB - BED.

DISCUSSION

Our results indicate that self-reported hunger differentially affected food-related response inhibition. Group differences in general cognitive control functions were limited to attention, reversal learning, and decision-making. Future research needs to account for other possible moderating factors, such as mood, food craving, or stress.