Disrupting future discounting: a commentary on an underutilised psychological approach for improving adherence to diet and physical activity interventions

Food choice motives mediate the relationship between delay discounting and binge eating: A structural equation modelling approach

Binge eating (BE) is associated with psychological distress, functional impairment, and elevated risk of eating disorder diagnoses, and BE prevalence is increasing. Motivational and self-regulatory processes such as delay discounting may be important influences on BE; however, evidence is inconclusive, and lacks explanation of mechanisms. This study investigated how food choice motives mediate the pathway from delay discounting (DD) to BE symptomatology. Adult participants (N = 391, 80% female, mean age 38.93) completed the Monetary Choice Questionnaire (DD), Food Choice Questionnaire (food choice motives), and Binge Eating Scale online. We used structural equation modelling (SEM) to analyse hypothesised partially-mediated pathways from DD to BE via Health, Mood, and Sensory Appeal food choice motives, incorporating participant age, sex, BMI, and Weight Control motives. The best fitting SEM indicated steeper DD was associated with greater BE, but this effect was fully mediated by lesser endorsement of Health motives. Greater endorsement of Mood and Weight Control motives, along with female sex and higher BMI, also accompanied greater BE symptomatology. Counter to hypotheses, Mood and Sensory Appeal did not mediate the relationship between DD and BE. The novel finding that Health motives mediated the effect of DD on BE suggests steeper discounting may hinder the longer-term perspective needed to value the health attributes of food, and thus promote food intake for immediate reinforcement. The significant effects of Weight Control and Mood motives independent of DD suggest support for overvaluation of weight and shape and negative reinforcement mechanisms in the etiology of BE. Our study highlights the influence of food choice motives and DD in BE, and supports the integration of individualised motivational and neurocognitive interventions in eating disorder treatment.

Episodic future thinking improves intertemporal choice and food choice in individuals with higher weight: A systematic review and meta-analysis

Episodic future thinking (EFT) strengthens self-regulation abilities by increasing the perceived value of long-term reinforcements and reducing impulsive choice in delay discounting tasks. As such, EFT interventions have the potential to improve dietary and eating-related decision-making in individuals with obesity or binge eating symptoms, conditions associated with elevated delay discounting. Here, we meta-analyzed evidence from 12 studies that assessed whether EFT interventions improve delay discounting and real-world food choice compared to control interventions. Included studies involved 951 adults with overweight or obesity (body mass index [BMI] ≥25). There were no studies involving participants with binge eating disorder. EFT intervention pooled effects were significant, improving delay discounting with a medium effect, g = 0.55, p < 0.0001, and subsequent food choice outcomes with a small effect, g = 0.31, p < 0.01. Notably, our review is the first to analyze mechanisms of effect in this population, demonstrating that improvements were greater when temporal horizons of EFT episodes were aligned with delay discounting tasks and more distant horizons predicted far-transfer to subsequent dietary and eating-related choices. Our findings thus show that EFT is an effective intervention for individuals with higher weight at risk of adverse health consequences.

Examining the association between delay discounting, delay aversion and physical activity in Chinese adults with type-2 diabetes mellitus

BACKGROUND

The role of physical activity in diabetes is critical, influencing this disease's development, man-agement, and overall outcomes. In China, 22.3% of adults do not meet the minimum level of physical activity recommended by the World Health Organization. Therefore, it is imperative to identify the factors that contributing to lack of physical activity must be identified.

AIM

To investigate the relationship among delay discounting, delay aversion, glycated hemoglobin (HbA1c), and various levels of physical activity in Chinese adults diagnosed with type 2 diabetes mellitus (T2DM).

METHODS

In 2023, 400 adults with T2DM were recruited from the People's Hospital of Linxia Hui Autonomous Prefecture of Gansu Province. A face-to-face questionnaire was used to gather demographic data and details on physical activity, delay discounting, and delay aversion. In addition, HbA1c levels were measured in all 400 participants. The primary independent variables considered were delay discounting and delay aversion. The outcome variables included HbA1c levels and different intensity levels of physical activity, including walking, moderate physical activity, and vigorous physical activity. Multiple linear regression models were utilized to assess the relationship between delay discounting, delay aversion, and HbA1c levels, along with the intensity of different physical activity measured in met-hours per week.

RESULTS

After controlling for the sample characteristics, delay discounting was negatively associated with moderate physical activity (β = -2.386, 95%CI: -4.370 to -0.401). Meanwhile, delay aversion was negatively associated with the level of moderate physical activity (β = -3.527, 95% CI: -5.578 to -1.476) in the multiple linear regression model, with statistically significant differences.

CONCLUSION

Elevated delay discounting and increased delay aversion correlated with reduced levels of moderate physical activity. Result suggests that delay discounting and aversion may influence engagement in moderate physical activity. This study recommends that health administration and government consider delay discounting and delay aversion when formulating behavioral intervention strategies and treatment guidelines involving physical activity for patients with T2DM, which may increase participation in physical activity. This study contributes a novel perspective to the research on physical activity in adults with T2DM by examining the significance of future health considerations and the role of emotional responses to delays.

The use of episodic future thinking in people with overweight or obesity: A scoping review

A growing number of studies have applied Episodic Future Thinking (EFT) to cognitive interventions in specific population. However, The variability in study populations may lead to inconsistent results and present challenges in the optimal intervention approach and scope of adaptation. This scoping review aimed to identify and describe specific methods, considerations, and results collected and reported in randomized controlled trials of EFT applied to diet and weight management in people with overweight or obesity. A systematic scoping review was conducted by published guidelines for this review. We conducted a structured search of English-language articles in Web of Science, PubMed, Embase, CINAHL, ProQuest, and Cochrane, with the literature focusing on studies published up to December 28, 2022. After screening and full-text review, 16 studies were included. The studies included people of all ages with overweight or obesity, including women, children, and home-based EFT interventions. The vast majority of intervention studies screened participants for psychological characteristics, and the effects of EFT applied in people with overweight or obesity were somewhat significant, although there was some variation in the literature. Although the individual heterogeneity of studies makes the synthesis of results somewhat variable, it still demonstrates the breadth and accessibility of EFT interventions in people with overweight or obesity. The application of EFT to individualized interventions in people with overweight or obesity is a further complement and optimization of weight management through behavioral cognitive therapy.