Executive functions and the self-regulation of eating behavior: A review

Linking Grazing to Inhibition and Goal-Directed Behaviour in Obesity With and Without Eating Disorder Features

Recent models of obesity and eating behaviour have implicated both automatic responding to food-related cues and executive functioning in driving dietary choice. This study aimed to relate grazing severity to high weight with and without significant eating disorder features via the effects of inhibition and degree of goal-directed behaviour, in persons with obesity with and without significant eating disorder features compared to healthy controls. Forty-four participants with obesity (43.1% endorsing marked eating disorder features), and 43 healthy-weight age- and sex-matched participants (N = 87; 67.8% female, age = 28.57 (8.70; 18.18–58.34) years, BMI = 29.18 (7.80; 18.65–51.95) kg/m2) completed demographic and eating disorder-related questionnaires, a neuropsychological task of inhibition and an instrumental decision-making task. Bootstrapped serial mediation analyses were performed to examine the effect of group on grazing via goal-directed behaviour and inhibition. While significant differences existed between the groups in terms of inhibition, goal-directed behaviour and grazing severity, the effect of group on grazing severity was not found to be mediated by the degree of behavioural goal-directedness and inhibition. Therefore, :in persons with obesity with or without eating disorder symptoms, putative relationships between a reduced inhibitory profile and/or behaviour that is less flexible and goal-directed and eating behaviours such as grazing, remain unclear.

Diet and cognitive function in cancer survivors with cancer-related cognitive impairment: A qualitative study

OBJECTIVE

To identify cancer survivors' perceptions of the role diet plays in their cognitive function, and how their cancer-related cognitive changes influence their diet.

METHODS

Cancer survivors diagnosed with cancer in the past 5 years, not on active treatment, and with self-reported cognitive changes since diagnosis were recruited from the general population. Semi-structured interviews were conducted with 15 Australian breast (n = 13) and colorectal (n = 2) survivors (mean time since diagnosed: 27.0 months ± SD=16.8). Questions related to how their diet and cognitive changes influenced each other. Interviews were recorded, and transcripts were analysed using thematic analysis.

RESULTS

Four themes related to how diet impacted cognition: (a) directly (e.g. healthy diet improves cognition), (b) indirectly (e.g. diet affects tiredness which affects cognition); (c) no impact; and (d) potentially (e.g. poorer diet quality would worsen cognition). Three themes emerged for how cognitive changes were thought to impact survivors' diets: (a) planning meals is harder; (b) cooking is more difficult and complex; and, (c) choosing healthy is more challenging.

CONCLUSIONS

Many cancer survivors perceived a bidirectional influence between diet and cognition that has cognitive and behavioural consequences. Diet could be investigated as a modifiable lifestyle behaviour to improve cancer-related cognitive impairment and fatigue. Survivors may benefit from dietary guidance with meal planning and preparing.

Individual differences in the influence of taste and health impact successful dietary self-control: A mouse tracking food choice study in children

In order to improve dietary quality among children, there is a need to understand how they make decisions about what foods to eat. This study used a mouse tracking food choice task to better understand how attributes such as health and taste contribute to food decisions among 70 children aged 7-to-11 years old. Children rated health, taste, and desire to eat for 76 common foods that varied in energy density and then used a computer mouse to select which of two presented foods they would like to eat. The presented food pairs were based on children's own ratings of taste and health so that some trials required self-control to choose the healthier option (i.e., healthy/not tasty paired with unhealthy/tasty). Children's body mass index (BMI) percentile was not associated with number of healthy choices. To examine mouse trajectories, we replicated previous analytic techniques and applied a novel technique, time-varying effects modeling (TVEM). Results showed that desire to eat impacted food decision-making sooner than taste and health during trials that required self-control, with TVEM showing that early discounting of desire to eat enabled healthier choices. However, these temporal dynamics varied by age, BMI percentile, and overall self-control performance in the task. When the less healthy food was chosen (i.e., self-control failure), older children and children with better overall self-control were more influenced by taste and desire to eat. However, children with higher BMI percentiles showed stronger discounting (i.e., negative influence) of taste when choosing the healthier food. Together this highlights how the influence of hedonic food attributes on food decision-making varies by individual child-level characteristics. Understanding individual differences in the cognitive processes that support healthy food choices in children may help identify targets for interventions aimed at improving child nutrition.

The Clinical Obesity Maintenance Model: A Theoretical Framework for Bariatric Psychology

Ranked highly in its association with serious medical comorbidities, obesity, a rapidly growing epidemic worldwide, poses a significant socio-economic burden. While bariatric procedures offer the most efficacious treatment for weight loss, a subset of patients risk weight recidivism. Due to the heterogeneity of obesity, it is likely that there are phenotypes or sub-groups of patients that require evidence-based psychological support to produce more sustainable outcomes. So far, however, characteristics of patients have not led to a personalized treatment algorithm for bariatric surgery. Maintenance of weight loss following bariatric surgery requires long-term modification of eating behaviors and physical activity. A recent Clinical Obesity Maintenance Model (COMM) proposed a conceptual framework of salient constructs, including the role of habit, behavioral clusters, emotion dysregulation, mood, health literacy, and executive function as interconnected drivers of obesity maintaining behaviors relevant to the field of bariatric psychology. The primary aim of this concise review is to bring together emerging findings from experimental and epidemiological studies relating to the COMM constructs that may inform the assessment and follow up of bariatric surgery. We also aim to explain the phenotypes that need to be understood and screened prior to bariatric surgery to enable better pre-surgery intervention and optimum post-surgery response.

Modification of food preferences by posthypnotic suggestions: An event-related brain potential study

The preference for high-over low-calorie food and difficulties in inhibiting the desire for high-calorie food are important factors involved in unhealthy food choices. Here, we explored posthypnotic suggestions (PHS), aiming to increase the desire for vegetables and fruits, as a possible new tool to induce a preference for low-calorie food. Following the termination of hypnosis, PHS was activated and deactivated in counterbalanced order, while event-related brain-potentials were recorded. Two tasks were administered, a food-face classification measuring implicit food preferences, where stimuli were categorized as showing food items or faces, and a Go-NoGo task measuring inhibition, where food items were selected as being appropriate for making a salad or not. In the food-face classification task without PHS, the early visual P1 component, a marker of stimulus reward-associations, was larger in response to high-than low-calorie food pictures; PHS eliminated this difference. PHS also yielded faster RTs and larger amplitudes of a late positive component in low-versus high-calorie items. Hence, PHS appeared to neutralize the positive perceptual bias toward high-calorie food items and enhance the effective processing of low-calorie items by increasing motivated attention. In the Go-NoGo task, PHS decreased the NoGo-N2; PHS increased the early Go- and NoGo-P3, possibly by turning low- and high-calorie items more pleasant and unpleasant, respectively, requiring more proactive control to inhibit task-irrelevant food-related emotions. Further, in the Go condition, PHS quickened the rejection of salad-inappropriate high-calorie items and increased the amplitude of late-P3, indicating facilitated classification of high-calorie items and increased response monitoring. Together, PHS effectively increased the preference for low-calorie food and the inhibition of impulses toward high-calorie food; therefore, PHS may be a promising tool for supporting healthy and sustainable food choices.

What is Needed for Evidence-Based Dietary Recommendations for Migraine: A Call to Action for Nutrition and Microbiome Research

BACKGROUND

The gastrointestinal symptoms of migraine attacks have invited numerous dietary hypotheses for migraine etiology through the centuries. Substantial efforts have been dedicated to identifying dietary interventions for migraine attack prevention, with limited success. Meanwhile, mounting evidence suggests that the reverse relationship may also exist - that the biological mechanisms of migraine may influence dietary intake. More likely, the truth involves some combination of both, where the disease influences food intake, and the foods eaten impact the manifestations of the disease. In addition, the gut's microbiota is increasingly suspected to influence the migraine brain via the gut-brain axis, though these hypotheses remain largely unsubstantiated.

OBJECTIVE

This paper presents an overview of the strength of existing evidence for food-based dietary interventions for migraine, noting that there is frequently evidence to suggest that a dietary risk factor for migraine exists but no evidence for how to best intervene; in fact, our intuitive assumptions on interventions are being challenged with new evidence. We then look to the future for promising avenues of research, notably the gut microbiome.

CONCLUSION

The evidence supports a call to action for high-quality dietary and microbiome research in migraine, both to substantiate hypothesized relationships and build the evidence base regarding nutrition's potential impact on migraine attack prevention and treatment.

Go/no-go for food: Attention bias and intention to eat unhealthy food

OBJECTIVE

The current research evaluated whether Go/No-go training for highly palatable (HP) food affected attention bias for HP food (an automatic/implicit outcome) and intention to eat unhealthy food (a controlled/explicit outcome).

METHOD

A sample of Australian adults representative for age, gender and Body Mass Index (BMI) (N = 561, M_age = 46.31 years, SD = 16.75, 52.3% women, M_BMI = 27.11, SD = 6.34) completed self-report measures of dietary psychological constructs and food image modified Stroop tasks as measures of pre- and post-test attention bias for HP food. After random assignment of participants to two conditions, a Go/No-go intervention was used to train HP food targeted inhibitory control in the experimental group, or general inhibitory control in the control group. All research tasks were delivered online.

RESULTS

The experimental, HP food inhibitory control training group reported intention to eat less unhealthy food than the control group, F (1, 637) = 4.81, R² = 0.09, p = .029. Counter to expectations, the experimental group exhibited a heightened attention bias to HP food images after the training, F (1, 637) = 9.48, R² = 0.39, p = .002.

CONCLUSION

Go/No-go training for food may improve both top-down and bottom-up inhibitory control, using both automatic and controlled processes. Further, it may not be effective in lowering attention bias for HP food, but may be effective in lowering unhealthy food intake despite raising attention bias for HP food. Further research that tests these effects using varied reaction time tasks is needed to confirm these results and to explore possible alternative explanations.

Using confidence interval-based estimation of relevance to explore bottom-up and top-down determinants of problematic eating behavior in children and adolescents with obesity from a dual pathway perspective

Prevalence of overweight and obesity in children and adolescents is high, not only in Western countries but also in developing countries. Efforts to improve prevention and treatment programs are needed. Given their essential role in weight problems, knowledge of determinants of problematic eating behavior ('External Eating' and 'Emotional Eating') is crucial for intervention development. Inspired by Appelhans' Dual Process Theory of Eating Behavior, the present study evaluated the importance of top-down regulative capacities and bottom-up reactivity, using the CIBER approach. CIBER is an innovative statistical approach to test the importance of behavior determinants, based on confidence intervals, instead of significance testing of point estimates. Survey data on different aspects of executive functioning (as indices of regulative capacities: Inhibition, Cognitive Flexibility, Emotional Control, Initiation, Working Memory, Planning/Organizing, Organization of materials, and Monitoring) and reward sensitivity (as an index of reactivity) were collected in a large sample of children and adolescents (n = 572) with severe obesity (adjBMI > 180%). Results showed that Emotional Eating is determined by Emotional Control, while External Eating is determined by Reward Sensitivity. The finding that differential mechanisms underlie different aspects of problematic eating suggests the need for using tailored intervention techniques to address altered reactivity and weak regulative capacities.

Is cognitive training an effective tool for improving cognitive function and real-life behaviour in healthy children and adolescents? A systematic review

Computerised cognitive training (CCT) has been applied to improve cognitive function in pathological conditions and in healthy populations. Studies suggest that CCT produces near-transfer effects to cognitive functions, with less evidence for far-transfer. Newer applications of CTT in adults seem to produce certain far-transfer effects by influencing eating behaviour and weight loss. However, this is more unexplored in children and adolescents. We conducted a systematic review of 16 studies with randomised controlled design to assess the impact of CCT on cognitive functioning and real-life outcomes, including eating behaviour, in children and adolescents with typical development (PROSPERO registration number: CRD42019123889). Results show near-transfer effects to working memory, with inconsistent results regarding far-transfer effects to other cognitive functions and real-life measures. Long-term effects show the same trend. Far-transfer effects occurred after cue-related inhibitory control and attentional training, although effects seem not to last. CCT may be a potential weight-loss treatment option but more research is needed to determine the specific characteristics to enhance treatment outcomes.

Decreased inhibitory control after partial sleep deprivation in individuals reporting binge eating: preliminary findings

Background

Poor executive functions are associated with dysregulated eating and greater caloric intake in healthy samples. In parallel, findings suggested that sleep deprivation impairs executive functions.

Methods

We investigated whether partial sleep deprivation impairs executive functions in individuals reporting binge eating (BE, N = 14) and healthy controls (C, N = 13). Switch cost and backward inhibition were measured using the Task Switching Paradigm after a habitual night of sleep and after a night of partial sleep deprivation.

Results

Results showed a Night by Group interaction on the backward inhibition. The two groups differed in the habitual night, evidencing higher inhibitory control in BE compared to C. Additionally, after partial sleep deprivation, compared to the habitual night, backward inhibition decreased in BE group. This preliminary study was the first to explore the impact of sleep deprivation on executive functions in participants reporting binge eating and healthy controls, thus highlighting their potential role in influencing eating behavior.

Implicit food odour priming effects on reactivity and inhibitory control towards foods

The food environment can interact with cognitive processing and influence eating behaviour. Our objective was to characterize the impact of implicit olfactory priming on inhibitory control towards food, in groups with different weight status. Ninety-one adults completed a modified Affective Shifting Task: they had to detect target stimuli and ignore distractor stimuli while being primed with non-attentively perceived odours. We measured reactivity and inhibitory control towards food pictures. Priming effects were observed on reactivity: participants with overweight and obesity were slower when primed with pear and pound cake odour respectively. Common inhibitory control patterns toward foods were observed between groups. We suggest that non-attentively perceived food cues influence bottom-up processing by activating distinguished mental representations according to weight status. Also, our data show that cognitive load influences inhibitory control toward foods. Those results contribute to understanding how the environment can influence eating behaviour in individuals with obesity.

Executive functioning and disinhibited eating in children and adolescents

BACKGROUND

Executive functioning (EF) difficulties may be associated with problems regulating eating behaviours. Few studies have evaluated this question in youth using diverse measures of EF or objective measures of energy intake.

METHODS

The current study used neuropsychological tasks and a laboratory test meal to evaluate the links between EF and youth's disinhibited eating patterns. Two-hundred-five nontreatment seeking youth (M age = 13.1 ± 2.8 years; M BMIz = 0.6 ± 1.0; 33.2% overweight; 54.1% female) completed tasks measuring decision making, general and food-specific behavioural disinhibition, willingness to delay gratification for food and money, cognitive flexibility, and working memory. Age (children vs adolescents) was examined as a moderator. All analyses adjusted for demographic factors, pubertal status, lean mass (kg), fat mass (%), height, general intellectual functioning, and depressive symptoms.

RESULTS

After adjusting for multiple comparisons, more general behavioural disinhibition was associated with greater total energy intake (P = .02), and poorer cognitive flexibility was associated with more fat intake (P = .03) across all ages. Poorer decision making in children (P = .04), but not adolescents (P = .24), was associated with greater fat intake. Food-specific behavioural disinhibition, the ability to delay gratification for both food and monetary rewards, and working memory were not significantly associated with youth's disinhibited eating patterns during a single meal.

CONCLUSIONS

Most domains of EF were not associated with youth's disinhibited eating. Significant associations may highlight the need to target specific cognitive processes, particularly behavioural disinhibition, decision making, and cognitive flexibility, in potential intervention strategies for children's disinhibited eating.

Examining core self-management skills among adolescents with celiac disease

A strict gluten-free diet is the only treatment for celiac disease, and it is especially challenging among adolescents. Participation in food-related activities and self-managing the chronic health condition involve use of cognitive skills. This cross-sectional study examined how executive functions might be associated with participation in food-related activities. Adolescents aged 12-18 years (N = 65; M_age = 14.67) with celiac were interviewed about participation, and their parents completed an executive function questionnaire. Poorer participation significantly correlated with poorer executive abilities. Identifying executive function profiles may contribute to understanding and advancing resourceful daily functioning and participation in daily food-related activities.

Maladaptive Eating in Children and Adolescents With Obesity: Scrutinizing Differences in Inhibition

INTRODUCTION

In order to grasp the complex etiology of childhood obesity, we aim to clarify the relationship between external eating and weight. Based on theory and empirical evidence, we claim that inhibition is an important moderator in this association. In our first research question we expected that high external eating would be related to a higher weight status, especially for those with high inhibition problems. Secondly, we explored the moderating role of inhibition in the association between external eating and weight change after a multidisciplinary obesity treatment.

METHOD

We investigated n=572 participants (51% boys, aged 7-19) with moderate to extreme obesity recruited in a Belgian inpatient treatment center. At intake, parents reported on inhibition (BRIEF), while the children and adolescents reported on their eating behavior (DEBQ). Weight and length were objectively measured pre and post treatment (ADJUSTED BMI). Two hierarchical linear regression models were built to scrutinize the influence of inhibition on the association between external eating and both baseline weight and weight change.

RESULTS

First, predicting baseline weight, we found no significant moderating effect of inhibition problems. Second, predicting weight loss, inhibition turned out to be a substantial moderator, specifically in adolescents. Some unexpected gender differences occurred in favor of adolescent boys, in a way that those with high external eating and low inhibition problems lost most weight.

CONCLUSION

Inhibition problems act as a moderator explaining weight loss, but this only holds for adolescents. This suggests that external eating and inhibition play a complex role in weight loss in certain age and gender categories, and stresses the importance of identifying subgroups for tailoring interventions. For those with high inhibition problems, interventions aimed at increasing inhibition skills might be needed to optimize treatment outcomes.

Automatic and Controlled Processing: Implications for Eating Behavior

It is a widely held view that humans have control over their food choices and consumption. However, research also suggests that eating behavior is often triggered by contextual cues and guided by automaticities and habits. Interestingly, the dichotomy between automatic and controlled processing has recently been challenged, suggesting that they may be intertwined. In a large female sample (n = 567), we investigated the hypothesis that task-based and self-reported measures of automatic and controlled processing would interact and impact self-reported eating behavior. Results analyzed via structural equation modeling suggest that automatic, but not controlled processing, during a modified flanker task, including a context-specific proportion congruent (CSPC) manipulation, was inversely associated with self-reported self-control. The influence of self-control on unhealthy eating behavior (i.e., uncontrolled and emotional eating, heightened consumption of fat and sugar) was only indirect via habitual behavior, which itself had a strong direct impact. Unhealthy eating was further associated with real-life outcomes (e.g., body mass index (BMI)). Our findings suggest that eating behavior may indeed be guided primarily by automaticities and habits, whereas self-control might facilitate this association. Having self-control over eating might therefore be most effective by avoiding contextual cues eliciting undesired automatic behavior and establishing habits that serve long-term goals.

Prefrontal Cortex Neuromodulation Enhances Frontal Asymmetry and Reduces Caloric Intake in Patients with Morbid Obesity

OBJECTIVE

The objective of this study was to test the feasibility of a combined intervention involving transcranial direct current stimulation (tDCS) on the dorsolateral prefrontal cortex (dlPFC) and cognitive training (CT). Short-term effects on food consumption, cognition, endocannabinoid (eCB) levels, and electroencephalogram (EEG) markers of future weight loss were explored.

METHODS

Eighteen healthy volunteers with morbid obesity were randomized in a double-blind, placebo-controlled, parallel trial. Participants received sham or active tDCS plus CT for four consecutive days. Cognitive performance, daily food intake, and eCB blood samples were collected before and after the intervention; EEG data were gathered before and after daily training.

RESULTS

The active tDCS + CT group reversed left-dominant frontal asymmetry and increased frontal coherence (FC) in the γ-band (30-45 Hz) after the intervention. The strength of the latter predicted BMI reduction. Additionally, a large intervention effect on food intake was shown in the active tDCS + CT group at follow-up (-339.6 ± 639 kcal on average), and there was a decrease of plasma eCB concentrations.

CONCLUSIONS

dlPFC modulation through tDCS + CT is an effective tool to restore right dominance of the dlPFC and enhance FC in patients with morbid obesity. Moreover, the effect of the strength of FC on BMI suggests that the interhemispheric FC at the dlPFC is functionally relevant for the efficient regulation of food choice.

"Food" and "non-food" self-regulation in childhood: a review and reciprocal analysis

BACKGROUND

In developmental science, there is an extensive literature on non-food related self-regulation in childhood, where several domains relating to emotions, actions and cognitions have been identified. There is now growing attention to food related self-regulation in childhood, especially difficulties with ASR, and the consequences for weight gain and adiposity. The aim of this narrative review was to conduct a reciprocal analysis of self-regulation in the food and non-food domains in childhood (referred to as appetite self-regulation (ASR) and general self-regulation (GSR) respectively). The focus was on commonalities and differences in key concepts and underpinning processes.

METHODS

Databases and major journals were searched using terms such as self-regulation, appetite self-regulation, or self-regulation of energy intake, together with associated constructs (e.g., Executive Function, Effortful Control, delay-of-gratification). This was followed by backward and forward snowballing.

RESULTS AND DISCUSSION

The scholarship on GSR in childhood has had a focus on the role of the cognitively-oriented Executive Function (EF), the temperamentally-based Effortful Control (EC) and the recursive interplay between bottom-up (reactive, emotion driven, approach or avoidance) and top-down (cognitive, conscious decision-making) processes. "Hot" and "cool/cold" EF and self-regulation situations have been distinguished. There were some parallels between GSR and ASR in these areas, but uncertainty about the contribution of EF and EC to ASR in young children. Possible differences between the contribution to ASR-related outcomes of delay-of-gratification in food and non-food tasks were apparent. Unique elements of ASR were identified; associated with psychological, biological and neurological responses to food and bottom-up processes. A diverse number of situations or elements connected to ASR exist: for example, energy balance homeostasis, caloric compensation, hunger regulation, satiation, satiety, energy density of food, eating in the absence of hunger, emotional eating, etc. CONCLUSIONS: Self-regulation in food and non-food domains are amenable to a reciprocal analysis. We argue that self-regulation of appetite should be added as a domain under the umbrella of self-regulation in childhood along with the other non-food related domains. This could lead to a broader understanding of self-regulation in childhood, and generate novel lines of enquiry.

Altered regional gray matter volume in Chinese female patients with bulimia nervosa

BACKGROUND

Bulimia nervosa (BN) is a psychiatric disorder with unclear pathophysiology. Several studies have associated BN with structural and functional changes in the brain, but findings have been inconsistent. Here we explored this potential association in a small group of Chinese women with BN.

METHODS

This retrospective study examined 34 women with BN and 34 age-matched healthy controls, all of whom underwent T1-weighted magnetic resonance imaging (MRI). Voxel-based morphometry was carried out to explore alterations in regional grey matter volume (GMV) that may be associated with BN.

RESULTS

The BN group showed smaller GMV in the left medial superior frontal gyrus (SFGmed.L), right superior temporal gyrus (STG.R), right median cingulate and paracingulate gyri (DCG.R), left median cingulate and paracingulate gyri (DCG.L) and left dorsolateral superior frontal gyrus (SFGdor.L). No regions showing GMV increases in BN were identified. The GMV reduction did not correlate with body mass index, duration of illness, or patients' self-esteem or overall self-evaluation. GMV reduction correlated negatively with age in the SFGmed. L (r = - 0.516, P < 0.005), DCG. R (r = - 0.556, P < 0.005), DCG. L (r = - 0.576, P < 0.05) and SFGdor. L (r = - 0.576, P < 0.005).

CONCLUSIONS

Women with BN show reduced GMV in several brain regions, but it is difficult to know whether these changes are the result of BN pathology or of binge-eating and compensatory behavior. These changes may be associated with impaired inhibitory control, body dissatisfaction and emotion dysregulation.

Personalised eHealth interventions in adults with overweight and obesity: A systematic review and meta-analysis of randomised controlled trials

Given that many existing electronic health (eHealth) interventions with a general approach have limited effects, a personalised approach is necessary. We aimed to evaluate the effectiveness of personalised eHealth interventions in reducing body weight and identify the effective key features of such interventions. We searched seven databases for randomised controlled trials (RCTs) from inception until September 6, 2018. Of the 26,733 records identified, 15 RCTs were included. Meta-analysis revealed a significant reduction (-2.77 kg, 95% confidence interval - 3.54 to -2.00 kg) in the personalised eHealth intervention group compared with that in the control group (Z = -7.04, p < .001). The duration of the interventions ranged from 14 weeks and three trials had follow-up assessments at 6 and 12 months. Our subgroup analyses highlighted several crucial design elements of future personalised eHealth interventions by utilising a combination of tailored content and customised feedback with human feedback, usage of theoretical basis, short message service, device, reminder, self-monitoring, goal setting and synchronous communication for 12 to 14 weeks. Egger's regression asymmetry test suggested no evidence of publication bias (p = .458). Using meta-regression we found evidence that a statistically significant impact of age and year of publication on the effectiveness of intervention. The overall evidence grade of outcomes ranged from very low to low, hence future trials should use well-designed RCTs.

Motivation: key to a healthy lifestyle in people with diabetes? Current and emerging knowledge and applications

AIM

Motivation to take up and maintain a healthy lifestyle is key to diabetes prevention and management. Motivations are driven by factors on the psychological, biological and environmental levels, which have each been studied extensively in various lines of research over the past 25 years. Here, we analyse and reflect on current and emerging knowledge on motivation in relation to lifestyle behaviours, with a focus on people with diabetes or obesity. Structured according to psychological, (neuro-)biological and broader environmental levels, we provide a scoping review of the literature and highlight frameworks used to structure motivational concepts. Results are then put in perspective of applicability in (clinical) practice.

RESULTS

Over the past 25 years, research focusing on motivation has grown exponentially. Social-cognitive and self-determination theories have driven research on the key motivational concepts 'self-efficacy' and 'self-determination'. Neuro-cognitive research has provided insights in the processes that are involved across various layers of a complex cortical network of motivation, reward and cognitive control. On an environmental - more upstream - level, motivations are influenced by characteristics in the built, social, economic and policy environments at various scales, which have provided entry points for environmental approaches influencing behaviour.

CONCLUSIONS

Current evidence shows that motivation is strongly related to a person's self-efficacy and capability to initiate and maintain healthy choices, and to a health climate that supports autonomous choices. Some approaches targeting motivations have been shown to be promising, but more research is warranted to sustainably reduce the burden of diabetes in individuals and populations.

The association between obesity and lower working memory is mediated by inflammation: Findings from a nationally representative dataset of U.S. adults

Obesity is often accompanied by lower working memory (e.g., a lower ability to keep goal-relevant information in mind) relative to healthy weight individuals. Understanding this relative working memory impairment has important clinical implications, as working memory is thought to facilitate adherence to weight management programs. Theoretical models of obesity, self-regulation, and inflammation suggest that inflammation plays a role in obesity-related working memory impairments, but to date no study has tested this prediction. Therefore, the current study examined whether inflammation statistically mediated the relationship between obesity and working memory in a nationally representative dataset of U.S. adults from Wave IV of The National Longitudinal Study of Adolescent to Adult Health (N = 11,546, age range 25-34). Inflammation was quantified via C-reactive protein (CRP) level, and working memory was assessed using a modified digit span backward task. As expected, cross-sectional analyses showed that a body mass index (BMI) indicative of obesity-as well as greater BMI when BMI was analyzed continuously-and greater CRP were each related to lower working memory. Critically, we found that CRP levels statistically mediated the relationships between obesity/greater BMI and working memory, with CRP accounting for 44.1% of the variance explained in working memory by BMI. Moreover, these findings held both with and without controlling for relevant covariates, including demographic characteristics (e.g., age), socioeconomic status, and behavioral factors (e.g., smoking). Our results therefore point to inflammation as playing an important role in the relationship between obesity and working memory, and suggest that interventions aimed at reducing inflammation may help lessen the cognitive burden of obesity.

Scrutinizing Domains of Executive Function in Binge Eating Disorder: A Systematic Review and Meta-Analysis

BACKGROUND

Cognitive deficits are implicated in theoretical explanatory models for binge eating disorder (BED). Furthermore, evidence suggest that alterations in executive function may underlie symptoms in BED. The current systematic review and meta-analysis provides an update on executive functioning in individuals with BED.

METHODS

Literature searches (up to November 2019) were conducted in electronic databases combining binge eating or BED with executive functions. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines was used. Studies of any design comparing adults with BED with those without BED in executive function domains were selected. Methodological quality of studies was based on the Newcastle-Ottawa scale.

RESULTS

Of 1,983 citations identified, 28 case-control studies met inclusion criteria for this review. Six meta-analyses that examined four domains (decision-making, cognitive flexibility, inhibitory control, and working memory) were conducted. The only meta-analysis to show a significant difference in executive functioning between BED and obese controls was working memory (SMD = 0.32, 95% IC: -0.60, -0.03; p = 0.028), with an effect size of small magnitude. Qualitative inspection of the literature indicated mixed findings for control inhibition, decision making and cognitive flexibility in individuals with BED compared to controls (obese or normal weight). In addition, people with BED showed poorer problem solving performance, but similar planning abilities to obese controls.

CONCLUSIONS

Individuals with BED were found to show worse performance on working memory tasks compared to obese individuals without the disorder. The findings did not provide definitive evidence of alterations in other aspects of executive functioning. Interest in executive functioning in people with BED is increasing but is limited by insufficient data from small studies with varied methodology. Future studies should focus on using similar tests and outcome measures, in order to enable more pertinent comparisons across studies.

Eating behavior and weight gain during pregnancy

OBJECTIVES

Little is known about the relationship between eating behavior and weight gain during pregnancy.

PURPOSE

Our objective was to assess the relationship among self-reported cognitive restraint, disinhibition, and hunger, and excessive gestational weight gain (GWG) as defined by the Institute of Medicine's (IOM) 2009 guidelines. Based on previous research examining eating behaviors and weight gain in non-pregnant women, we hypothesized that excessive GWG would be related to higher cognitive restraint, higher disinhibition, and higher perception of hunger.

METHODS

190 pregnant women from the Glowing study completed the Three-Factor Eating Questionnaire (TFEQ) at the enrollment visit, which included subscales assessing restraint, disinhibition, and hunger. Participants' height and weight from <10 weeks through 36 weeks gestation were measured, allowing classification within or in excess of the IOM guidelines adjusted for the week of the final measurement.

RESULTS

The odds that a participant would gain weight above IOM recommendations was 1.2 times higher (OR = 1.17, 95% CI = 1.05-1.29) for each one-unit increase in the disinhibition subscale in the unadjusted logistic regression. However, after controlling for sociodemographic characteristics and baseline BMI categories, participants' TFEQ scores were not associated with the likelihood of having GWG above IOM guidelines. Eating behaviors subscales were modestly correlated with baseline BMI categories (all rs < 0.50 with p-values ranging from <0.001 to 0.619).

CONCLUSIONS

Although disinhibition scores had a significant relationship with excessive GWG, the significance of this relationship was not sustained after adjusting for sociodemographic characteristics and baseline BMI categories.

Obesity is associated with poor working memory in women, not men: Findings from a nationally representative dataset of U.S. adults

A growing body of research has linked obesity to lower working memory performance. However, sex differences are often found in associations between obesity and cognition, and little work has examined potential sex differences in the association between obesity and working memory. To address this issue, the present research uses data from Wave IV of The National Longitudinal Study of Adolescent to Adult Health (N = 4,769, mean age = 29) to examine whether sex moderated the association between excess weight and working memory. As expected, we found that obesity was associated with poorer working memory, but-importantly-this association was exclusively seen in women, not men. These results held when treating BMI as a continuous or categorical variable (e.g., normal weight, obese), as well as with and without controlling for covariates. The present results therefore indicate that the association between obesity and poorer working memory performance may be sex-dependent. These results suggest that interventions targeted at reducing obesity should be tailored to an individual's sex, as adherence to these interventions often requires working memory.

Disordered eating after bariatric surgery: clinical aspects, impact on outcomes, and intervention strategies

PURPOSE OF REVIEW

Disordered eating behaviors (DEBs) are associated with poor weight outcomes following bariatric surgery. We describe DEBs most relevant to this population, their associations with weight outcomes, and emerging data on interventions for DEBs.

RECENT FINDINGS

Loss of control eating episodes and grazing have been the most well studied DEBs in bariatric samples. Although DEBs often remit after surgery even without targeted intervention, a subgroup of patients have persistent or newly developed DEBs postoperatively. Preoperative DEBs have little effect on weight outcomes, whereas preoperative impulse control-related features commonly associated with DEBs (e.g., inhibitory control) may have stronger predictive value. Postoperatively, DEBs appear to exert robust effects on concurrently measured weight. Postoperative interventions hold promise for optimizing treatment outcomes.

SUMMARY

We recommend the following to improve clinical care and move research forward: a common language for DEB constructs is needed to improve cross-talk among researchers and care providers; diagnostic schemes and assessment tools may require tailoring for the bariatric population; mechanisms underlying improvements in DEBs following surgery should be clarified; ongoing monitoring of DEBs in the postoperative period is warranted; and a stepped-care approach may improve weight outcomes in a cost-effective manner.

The interplay between self-regulation and affectivity in binge eating among adolescents

Binge eating among adolescents is associated with negative developmental outcomes. From a cognitive perspective, the role of impaired self-regulation is increasingly emphasized as an underlying factor in binge eating, whereas the affect regulation model proposes that affectivity is a key factor in explaining binge eating. Studies combining both perspectives are scarce, but necessary to add to the understanding of this pathological eating behavior. Therefore, the aim of the current study was to investigate unique and joint contributions of both factors in understanding binge eating among adolescents. Participants were 301 adolescents (10-17 years; 67.2% girls; M_age = 13.46 years; SD = 1.99) from the general community. Adolescents self-reported on different types of binge eating episodes (loss of control over eating in general, objective and subjective binge eating in particular), self-regulation (general self-regulation and inhibitory control) and affectivity (positive and negative). The parents were questioned about their children's self-regulatory capacities. Results revealed main effects of self-regulatory capacities (adolescent report) and negative affectivity in predicting objective binge eating. In addition, negative affectivity interacted with self-regulation (parent report) to predict objective binge eating, whereas positive affectivity interacted with self-regulation (adolescent report) to predict subjective binge eating. No significant effects were found for loss of control over eating specifically. Both self-regulation and affectivity each make unique as well as joint contributions to binge eating among adolescents, with results differing across types of binge eating episodes and informants. Theoretical and practical implications are discussed.

The Relationship Between Housing Instability and Poor Diet Quality Among Urban Families

OBJECTIVE

To examine associations between housing instability and poor diet quality in a sample of urban parents and children.

METHODS

Cross-sectional study of 340 parent/guardian-child dyads visiting a pediatric primary care center in Boston, Massachusetts. The parent/guardian (hereafter, parent) completed 2 Harvard Service Food Frequency Questionnaires, one regarding their own dietary intake and one regarding their child's intake, and an assessment of health-related social needs. Diet quality was measured using the Healthy Eating Index-2010 (HEI-2010; score range 0-100). Housing instability was defined as: 1) homeless or in sheltered housing, 2) doubled up with another family, 3) utilities threatened or shut off, or 4) concerned about eviction. Multivariable logistic regression was used to measure associations between unstable housing and lowest-quartile HEI-2010 scores, adjusting for parent age, race/ethnicity, education, income, and child age.

RESULTS

Median (interquartile range) parent and child HEI-2010 scores were 63.8 (56.3-70.8) and 59.0 (54.2-64.7), respectively. Housing instability was found in 136 dyads (40%). In multivariable analysis, it was associated with increased odds of lowest-quartile total parent HEI-2010 scores (adjusted odds ratio [aOR], 1.9; 95% confidence interval [95% CI], 1.1-3.5) but not child scores (aOR, 1.4; 95% CI, 0.8-2.5). It also was associated with increased odds of lowest-quartile parent HEI-2010 dietary component scores for Total vegetables and Greens and beans (aOR, 2.0; 95% CI, 1.1-3.7 and aOR, 2.5; 95% CI, 1.3-4.8, respectively).

CONCLUSIONS

In this urban primary care population, housing instability is associated with lower diet quality scores for parents but not children. Lower vegetable consumption appears to drive this association.

Bidirectional Associations between Obesity and Cognitive Function in Midlife Adults: A Longitudinal Study

The links between obesity and cognition remain equivocal due to a variety of methodological limitations with current research, such as an overreliance on body mass index (BMI) as a measure of obesity, the use of cross-sectional designs, and inadequate specification over the domains of cognitive function to be examined. To address these issues, we used data from the Cognitive Project of the National Survey of Midlife Development in the United States, a large-scale, longitudinal dataset on non-institutionalized midlife adults (N = 2652), which enabled us to examine the long-term bidirectional relations between obesity and two latent factors of cognition-executive function and episodic memory-while controlling for potential confounds. Results showed that, over a span of nine years, an increase in obesity in Time 1 is associated with a decline in episodic memory in Time 2 (but not executive function), while an increase in executive function in Time 1 (but not episodic memory) is associated with a reduction in obesity in Time 2. These results were elucidated when obesity was indexed with waist-to-hip ratio but not with BMI. Our findings highlight important directions for further research, in particular the use of more valid obesity indices and a greater focus on the bidirectional effects between obesity and cognition.

The Executive Functions in Overweight and Obesity: A Systematic Review of Neuropsychological Cross-Sectional and Longitudinal Studies

Background: The increasing incidence of people affected by overweight or obesity is a significant health problem. The knowledge of the factors which influences the inappropriate eating behaviors causing excessive body fat is an essential goal for the research. Overweight and obesity are significant risk factors for many health diseases, such as cardiovascular problems, diabetes. Recently, many studies have focused on the relationship between body weight and cognitive processes. Objectives: This systematic review is aimed to investigate the existence and the nature of the relationship between excessive body weight (overweight/obesity) and executive functions, analyzing cross-sectional, and longitudinal studies in order to verify the evidence of a possible causality between these variables. Methods: The review was carried out according to the PRISMA-Statement, through systematic searches in the scientific databases PubMed, Medline, PsychInfo, and PsycArticles. The studies selected examined performance on executive tasks by participants with overweight or obesity, aged between 5 and 70 years. Studies examining eating disorders or obesity resulting from other medical problems were excluded. Furthermore, the results of studies using a cross-sectional design and those using a longitudinal one were separately investigated. Results: Sixty-three cross-sectional studies and twenty-eight longitudinal studies that met our inclusion and exclusion criteria were analyzed. The results confirmed the presence of a relation between executive functions and overweight/obesity, although the directionality of this relation was not clear; nor did any single executive function emerge as being more involved than others in this relation. Despite this, there was evidence of a reciprocal influence between executive functions and overweight/obesity. Conclusions: This systematic review underlines the presence of a relationship between executive functions and overweight/obesity. Moreover, it seems to suggest a bidirectional trend in this relationship that could be the cause of the failure of interventions for weight reduction. The results of this review highlight the importance of a theoretical model able to consider all the main variables of interest, with the aim to structuring integrated approaches to solve the overweight/obesity problems.

Emotion regulation difficulties and impaired working memory interact to predict boredom emotional eating

Emotional eating (EE), or eating in response to emotions, is related to depression, binge eating, and weight gain. Emotion regulation difficulties are a risk factor for EE. Working memory deficits may also be a risk factor for EE, as working memory is an important cognitive factor in emotion regulation. The current study is a secondary analysis that examined whether working memory moderated the relationship between emotion regulation and emotional eating. A college student sample completed measures of EE in response to depression, boredom, and anxiety/anger (Emotional Eating Scale), emotion regulation (Difficulties in Emotion Regulation Scale) and a working memory task (AOSPAN). Moderated regression analyses were conducted. Conditional moderation was observed, such that greater emotion regulation difficulties were associated with boredom EE, when working memory was one standard deviation (SD) below average. Moderation analyses were not significant when examining associations between working memory, emotion regulation difficulties, and depression and anxiety EE. Findings suggest that the correlates of boredom EE may be different than depression and anxiety/anger EE. Although the current study was cross-sectional, it is possible that individuals with poorer working memory and emotion regulation difficulties, especially in tandem, may be at increased risk for boredom EE.

Allostatic load and executive functions in overweight adults

BACKGROUND/OBJECTIVE

Overweight is linked to inflammatory and neuroendocrine responses potentially prompting deregulations in biological systems harmful to the brain, particularly to the prefrontal cortex. This structure is crucial for executive performance, ultimately supervising behaviour. Thus, in the present work, we aimed to test the relationship between allostatic load increase, a surrogate of chronic physiological stress, and core executive functions, such as cognitive flexibility, inhibitory control, and working memory.

METHOD

Forty-seven healthy-weight and 56 overweight volunteers aged from 21 to 40 underwent medical and neuropsychological examination.

RESULTS

Overweight subjects exhibited a greater allostatic load index than healthy-weight individuals. Moreover, the allostatic load index was negatively related to inhibitory control. When separated, the link between allostatic load index and cognitive flexibility was more marked in the overweight group.

CONCLUSIONS

An overweight status was linked to chronic physiological stress. The inverse relationship between the allostatic load index and cognitive flexibility proved stronger in this group. Set-shifting alterations could sustain rigid-like behaviours and attitudes towards food.

Lack of conflict during food choice is associated with the failure of restrained eating

Restrained eaters tend to sustain a restriction in caloric intake to lose or maintain body weight; however, only a few restrained eaters can achieve the goal of restricting their caloric intake to lose or maintain body weight. Those who are effective restrained eaters habitually adhere to their intentions to avoid eating certain palatable foods, whereas those who are ineffective restrained eaters are generally unable to translate their intentions into behavior. To restrain eating regardless of temptation, an individual must first identify potential conflicts between achieving restrained eating and temptation to eat. Regarding food selections, the association between a lack of conflict between temptation, eating enjoyment, and weight loss or maintenance goals and the failure of restriction of caloric intake remains unknown. The present study used an eye-tracking technique to assess the degree of conflict experienced by effective and ineffective restrained eaters during food choice. Participants were required to choose between pairs of high- and low-calorie foods. The results showed that choosing the low-calorie food was associated with the experience of more conflict, measured by longer response times and more gaze switches, than choosing the high-calorie food. Ineffective restrained eaters experienced less conflict, exhibiting shorter response times and fewer gaze switches, than did effective restrained eaters, which suggests that a failure to restrain eating might be associated with a lack of experience of conflict.

Associations Between Cool and Hot Executive Functions and Children's Eating Behavior

PURPOSE OF REVIEW

Studies on obesogenic eating behaviors in young children have mainly focused on the roles of family environment and parental behaviors. However, intrapersonal characteristics, particularly executive functions, have recently gained more attention in the literature. Therefore, herein we review work on children's executive functions (EFs), particularly the roles of cold and hot executive functions on children's obesogenic eating behaviors.

RECENT FINDINGS

Most work examining the associations between EF and obesogenic eating among children has focused on the cool EF, particularly inhibitory control/impulsivity. Findings have consistently showed that deficits in inhibitory control/impulsivity are associated with overeating and food responsiveness. The roles of the other two cool EFs (attention control/shifting and working memory) and hot EF (delay of gratification and affective decision-making) in contributing to child obesogenic eating are less clear. For instance, the association between children's performance on delay of gratification tasks and obesogenic eating varies depending on whether food or non-food rewards were used; children with poorer delay of gratification in non-food tasks had more obesogenic eating, although children with poorer delay of gratification in food tasks had less obesogenic eating. Deficits in inhibitory control/impulsivity are associated with more obesogenic eating, suggesting that improving children's inhibition may reduce overeating and childhood obesity. The roles of other cool and hot components of EFs in contributing to obesogenic eating require further study.

The Role of Self-Control and the Presence of Enactment Models on Sugar-Sweetened Beverage Consumption: A Pilot Study

The objective of the present research was to investigate associations of dispositional and momentary self-control and the presence of other individuals consuming SSBs with the consumption frequency of sugar-sweetened beverages (SSBs) in a multi-country pilot study. We conducted an Ambulatory Assessment in which 75 university students (52 females) from four study sites carried smartphones and received prompts six times a day in their everyday environments to capture information regarding momentary self-control and the presence of other individuals consuming SSBs. Multilevel models revealed a statistically significant negative association between dispositional self-control and SSB consumption. Moreover, having more self-control than usual was only beneficial in regard to lower SSB consumption frequency, when other individuals consuming SSBs were not present but not when they were present. The findings support the hypothesis that self-control is an important factor regarding SSB consumption. This early evidence highlights self-control as a candidate to design interventions to promote healthier drinking through improved self-control.

A systematic review and meta-analysis of the executive function-health behaviour relationship

Objective

This study provides the first comprehensive meta-analysis of the relationship between executive function (EF) and performance of health behaviours in healthy populations.

Method

Electronic databases (MEDLINE, Embase, PsycINFO, Web of Science) were searched, and forward and backward citation tracking was undertaken to identify articles investigating the relationship between EF and health behaviour. Studies were eligible if they examined the direct correlational relationship between EF and health behaviour in healthy populations, were available in English and published in peer-reviewed journals in any year.

Results

Sixty-one articles covering 65 tests were included in a random effects meta-analysis. Several moderators were assessed, including: the type, and addictiveness of the health behaviour; the type of EF measure; study design, and sample characteristics. Overall EF had a significant, but small correlation with health behaviour; EF was significantly positively associated with health-protective behaviours and significantly negatively associated with health-damaging behaviours. There was considerable heterogeneity in the observed effect sizes, but this was not explained by the examined moderators.

Conclusions

Although the meta-analysis indicates a significant effect for EF on health behaviour, effect size is small. Due to the complex nature of EF, more research is required to further elucidate the relationship between EF and health behaviour in its entire conceptualization.

Impulsive and Self-Regulatory Processes in Risky Driving Among Young People: A Dual Process Model

The present study empirically examined a novel dual process model of self-reported aberrant driving behavior in young and novice drivers that incorporates both impulsive and self-regulatory processes. Four hundred and nine participants aged 18-25 years (M age = 21.18 years, SD = 2.12; 65.5% females) completed online questionnaires on impulsivity, normlessness, sensation seeking, emotion and self-regulation, and attitudes toward driving safety. Path analysis showed that motor impulsivity was associated with self-reported driving violations, errors, and lapses, whereas sensation seeking was uniquely directly associated with self-reported errors. Non-planning impulsivity, normlessness and sensation seeking had significant indirect effects on self-reported errors, via self-regulation. Finally, motor impulsivity and normlessness had a significant indirect effect on self-reported violations, errors and lapses, via attitudes to driving safety. Based on our findings we suggest that a dual-process approach is relevant to the study of aberrant driving behavior in young and novice drivers, and the results of the present study have important implications for initiatives to promote driving safety in this population.

The relationship between dietary restraint and deficits in reasoning about causes of obesity

Objective: Increased levels of dietary restraint are associated with deficits on many cognitive tasks. Less is known about how individual differences in restraint influences complex cognition such as reasoning which is the focus of this research.Design: Two experimental studies are reported. In study 1, participants (n = 158) completed a causal conditional reasoning task with statements about weight-related and general causal relationships. Study 2 replicated and extended study 1. Participants (n = 108) completed a causal conditional reasoning task focusing on behavioural causes of weight change or general statements.Main outcome measure: Causal conditional reasoning task performance.Results: In study 1, levels of dietary restraint were negatively associated with reasoning abilities for weight-related statements only. Study 2 replicated the negative association between dietary restraint and reasoning finding the effect in both weight-related, and general, causal judgements.Conclusion: The novel findings show that individual differences in dietary restraint have a wider relationship with cognition than previously demonstrated. Results tentatively support theoretical explanations of a reduction in cognitive capacity, rather than differences in belief, explaining reasoning deficits. These findings open an interesting avenue for research and might have implications for effective decision making about personal health behaviours, such as food choice.

Eating in the absence of hunger in young children is related to brain reward network hyperactivity and reduced functional connectivity in executive control networks

BACKGROUND

Recent work has implicated disinhibited eating behaviours (DEB) as a potential pathway toward obesity development in children. However, the underlying neurobiology of disinhibited eating behaviours in young, healthy weight children, prior to obesity development, remains unknown.

OBJECTIVES

This study tested the relationship between DEB and intrinsic neuronal activity and connectivity in young children without obesity.

METHODS

Brain networks implicated in overeating including reward, salience and executive control networks, and the default mode network were investigated. DEB was measured by the eating in the absence of hunger (EAH) paradigm with postlunch kilocalories consumed from highly palatable foods (EAH kcal) used as the predictor. Intrinsic neuronal activity within and connectivity between specified networks were measured via resting-state functional magnetic resonance imaging. Eighteen typically developing children (mean age = 5.8 years) were included.

RESULTS

EAH kcal was positively associated with activity of the nucleus accumbens, a major reward network hub (P < 0.05, corrected). EAH kcal was negatively associated with intrinsic prefrontal cortex connectivity to the striatum (P < 0.01, corrected).

CONCLUSIONS

These results suggest that neural aspects of DEB are detectable in young children without obesity, providing a potential tool to better understand the development of obesity in this population.

A biopsychosocial approach to processes and pathways in the development of overweight and obesity in childhood: Insights from developmental theory and research

Childhood obesity has reached alarming proportions in many countries. There is consensus that both biological (especially genetic) and environmental (including psychosocial) factors contribute to weight gain and obesity in childhood. Research has identified extensive risk or predictive factors for childhood obesity from both of these domains. There is less consensus about the developmental processes or pathways showing how these risk factors lead to overweigh/obesity (OW/OB) in childhood. We outline a biopsychosocial process model of the development of OW/OB in childhood. The model and associated scholarship from developmental theory and research guide an analysis of research on OW/OB in childhood. The model incorporates biological factors such as genetic predispositions or susceptibility genes, temperament, and homeostatic and allostatic processes with the psychosocial and behavioral factors of parenting, parental feeding practices, child appetitive traits, food liking, food intakes, and energy expenditure. There is an emphasis on bidirectional and transactional processes linking child biology and behavior with psychosocial processes and environment. Insights from developmental theory and research include implications for conceptualization, measurement, research design, and possible multiple pathways to OW/OB. Understanding the developmental processes and pathways involved in childhood OW/OB should contribute to more targeted prevention and intervention strategies in childhood.

The influence of depressive symptoms on executive functioning in binge eating disorder: A comparison of patients and non-obese healthy controls

Executive functions are a set of cognitive processes that are necessary for the cognitive control of behavior. They play a role in mediating self-control, self-regulation and decision-making. It has been suggested that the inability to control eating behavior in binge eating disorder (BED) may indicate deficits in executive functioning. This may be worsened by depressive symptoms. The aim of the present study was to compare executive functioning of patients with BED and no-to-mild depressive symptoms (n = 25), patients with BED and moderate-to-severe depressive symptoms (n = 66), and healthy controls (Body Mass Index <30) (n = 56), matched on age, educational level and gender. The participants were assessed by means of neuropsychological tests and questionnaires. The neuropsychological tests did not show significant differences in executive functioning between the groups. However, eating disorder psychopathology and depressive symptoms are associated with self-reported difficulties in executive functioning in daily life. A self-report questionnaire which evaluates the functional, real-world impact of executive dysfunction expressed in everyday activities seems to be more useful in this population than neuropsychological tests. This study highlights the importance of taking depressive symptoms into account when studying executive functioning in patients with (binge) eating disorders.

Trait-level facets of impulsivity and momentary, naturalistic eating behavior in children and adolescents with overweight/obesity

Impulsivity, and specific subdomains of inhibitory control and reward sensitivity, are trait-level factors that have been implicated in the onset and maintenance of pediatric obesity and disordered eating, but their associations with real-world eating behavior are unknown. We investigated associations of these trait-level constructs with naturalistic, momentary measures of loss of control (LOC) eating and overeating severity in a heterogeneous sample of youth (n = 40), aged 8-14y, with overweight/obesity. Self-report, parent-report, and behavioral data on trait-level impulsivity, reward sensitivity, and inhibitory control, respectively, were collected in the context of a 14-day ecological momentary assessment (EMA) protocol in which participants reported on their eating behavior, mood, hunger, and palatability of foods consumed in real-time. Generalized estimating equations revealed that more perseverative errors on a behavioral measure of visuomotor processing speed and a lower self-reported tendency to act without thinking (at a trend level) were related to greater overall LOC severity. Momentary associations between negative affect and LOC severity were stronger among individuals with greater perseverative errors. Results suggest that trait-level facets of impulsivity may directly influence an individual's tendency to engage in dysregulated eating behaviors, and may also impact susceptibility to state-level factors associated with occurrence of these behaviors. Momentary interventions for LOC eating may require tailoring to address temperamental factors related to impulsivity and inhibitory control.

The Cognitive Control of Eating and Body Weight: It's More Than What You "Think"

Over the past decade, a great deal of research has established the importance of cognitive processes in the control of energy intake and body weight. The present paper begins by identifying several of these cognitive processes. We then summarize evidence from human and nonhuman animal models, which shows how excess intake of obesity-promoting Western diet (WD) may have deleterious effects on these cognitive control processes. Findings that these effects may be manifested as early-life deficits in cognitive functioning and may also be associated with the emergence of serious late-life cognitive impairment are described. Consistent with these possibilities, we review evidence, obtained primarily from rodent models, that consuming a WD is associated with the emergence of pathophysiologies in the hippocampus, an important brain substrate for learning, memory, and cognition. The implications of this research for mechanism are discussed within the context of a “vicious-cycle model,” which describes how eating a WD could impair hippocampal function, producing cognitive deficits that promote increased WD intake and body weight gain, which could contribute to further hippocampal dysfunction, cognitive decline, and excess eating and weight gain.

Executive Function, Eating Behavior, and Preoperative Weight Loss in Bariatric Surgery Candidates: An Observational Study

BACKGROUND

Individual differences in executive function may influence eating behavior, weight loss (WL), and WL maintenance in obesity treatment. Executive function, which designates top-down cognitive control processes, has been related to eating behaviors which may impact weight, and has been found to be predictive of WL in both behavioral WL programs and after bariatric surgery. Currently, we lack knowledge on the role of executive function in the period before bariatric surgery. If executive function impacts eating behavior and WL in the preoperative period, it may be a target for clinical attention in this stage.

OBJECTIVES

We aimed to examine the relationship between objective performance-based measures of executive function, eating patterns, and WL in the preoperative period.

METHOD

Baseline data in an ongoing observational longitudinal study of bariatric surgery patients were used. Eighty patients completed neuropsychological testing and self-report questionnaires 4 weeks prior to surgery.

RESULTS

We found that working memory predicted WL before surgery and inhibitory control predicted adherence to dietary recommendations.

CONCLUSION

Our study indicates that executive function may play a role in short-term WL and dietary adherence prior to surgery, suggesting that executive function in the preoperative period deserves an extended research focus.

Diabetes, Depression, and Cognition: a Recursive Cycle of Cognitive Dysfunction and Glycemic Dysregulation

PURPOSE OF REVIEW

The study aims to examine the effects of diabetes and depression on executive functioning (EF) and to review the effects of EF deficits on diabetes management.

RECENT FINDINGS

Both type 2 diabetes and depression influence EF, and in turn, EF has an impact on diabetes management. Individuals with both comorbidities (i.e., diabetes and depression) experience greater deficits in EF than individuals with just one of the morbidities (i.e., depression or diabetes). The disruption in EF results in poor diabetes management and poor emotion regulation which ultimately increases the probability of a recursive cycle of depression and hyperglycemia. This recursive cycle can ultimately lead to diabetes-related complications.

Group cognitive remediation therapy for adults with obesity prior to behavioural weight loss treatment: study protocol for a randomised controlled superiority study (CRT study)

INTRODUCTION

Individuals with obesity show deficits in executive functioning which have been implicated in decreased weight loss outcome. Preliminary evidence suggests that cognitive remediation therapy (CRT) improves executive functioning and weight loss in obesity. However, confirmatory support, especially for pre-weight loss use, is lacking. The CRT study aims at determining the efficacy of CRT versus no treatment control in patients with obesity before entering behavioural weight loss (BWL) treatment. It is hypothesised that individuals who receive CRT will show better weight loss outcome, improved executive functioning, greater weight loss-related behavioural changes and higher attendance of BWL treatment, 6 and 12 months after cessation of CRT.

METHODS AND ANALYSIS

In a single-centre, assessor-blinded, randomised, two-armed parallel-group superiority trial, 260 adults with body mass index ≥35.0 kg/m2 are centrally randomised to 8-week group-based CRT versus no treatment, before entering BWL treatment. Primary outcome is the amount of weight loss (%) at 6-month follow-up, compared with pre-treatment, derived from measured body weight. Secondary outcomes include improvement in executive functioning post-treatment and in weight loss-related behaviour, mental and physical health, and attendance to BWL treatment at 6-month and 12-month follow-up. Maintenance of weight loss at 12-month follow-up will be determined. Mixed model analyses based on intent-to-treat will be used to compare the CRT and control groups with respect to differences in weight change between pre-treatment and 6-month follow-up. Similar models will be used for analysing 12-month follow-up data and secondary outcomes. Further analyses will include additional covariates to identify predictors of treatment outcome.

ETHICS AND DISSEMINATION

The study was approved by the Ethical Committee of the University of Leipzig (256-15-13072015, version 'Final 1.0 from 28 May 2015). The study results will be disseminated through peer-reviewed publications.

TRIAL REGISTRATION NUMBER

DRKS00009333; Pre-results.

Measurement matters: higher waist-to-hip ratio but not body mass index is associated with deficits in executive functions and episodic memory

Background

The current study aimed to reconcile the inconsistent findings between obesity, executive functions, and episodic memory by addressing major limitations of previous studies, including overreliance on body mass index (BMI), small sample sizes, and failure to control for confounds.

Methods

Participants consisted of 3,712 midlife adults from the Cognitive Project of the National Survey of Midlife Development. Executive functions and episodic memory were measured by a battery of cognitive function tests.

Results

We found that higher waist-to-hip ratio was associated with deficits in both executive functions and episodic memory, above and beyond the influence of demographics, comorbid health issues, health behaviors, personality traits, and self-perceived obesity. However, higher BMI was not associated with deficits in executive functions and episodic memory. More importantly, these differential associations were robust and stable across adulthood.

Discussion

Our findings confirm the association between obesity and episodic memory while highlighting the need for better measures of obesity when examining its associations with individual differences in cognitive functions.