An ecological momentary episodic future thinking intervention on mother's weekly food purchases

Improving adult eating behaviours by manipulating time perspective: a systematic review and meta-analysis

There is a growing body of research on improving health behaviours through future thinking but that in improving eating behaviour remains unclear. Hence, we conducted a systematic review and meta-analysis on the effectiveness of time perspective manipulation in improving adult eating behaviours. Articles published from inception through 17 March 2022 were retrieved from eight databases (CINAHL, Embase, ProQuest, PsycINFO, PubMed, Scopus, The Cochrane library, and Web of Science). Meta-analysis was conducted using random effects models with effect sizes reported in Hedges' g. Sixteen experimental studies were included, representing 1,914 participants with mean ages ranging from 20.5 to 44.1 years old and mean baseline BMI of 22.0 kg/m2 to 37.2 kg/m2. The interventions included were episodic future thinking (EFT; n = 12), message framing (n = 2), and varying inter-meal intervals (IMI; n = 2) in improving food choices, food intake and portion size. Two studies reported significant interventional effectiveness for domain-specific EFT while all studies on message framing and IMI reported significant interventional effectiveness. Message framing seemed to be more effective when both temporal distance and valence frames were manipulated. However, the pooled effect sizes of all the interventions did not result in a significant interventional effect (n = 5; g = -0.49; 95% confidence interval (CI) = -1.44, 0.47; p = 0.23; I2=87.2%). More rigorous research is needed to ascertain the effectiveness of manipulating time perspective in improving eating behaviours before such interventions are more widely used.

Effects of episodic future thinking in health behaviors for weight loss: A systematic review and meta-analysis

BACKGROUND

Obesity and related diseases have become one of the leading causes of death worldwide, which has been linked to biopsychosocial effects such as type 2 diabetes, cardiovascular disease, various cancers, depression, and weight stigma. Episodic future thinking (EFT) has been found to support the development of changes in health behaviors. However, the effectiveness of EFT in enhancing weight loss behavior and health outcomes is not well supported.

OBJECTIVE

To establish implementation options for the EFT intervention, and critically synthesize the data that assesses the impact of EFT on weight loss behavior and health outcomes.

METHODS

Searches were performed across 5 Chinese and 9 English databases systematically from inception to March 2023. Randomized controlled trials, written in English or Chinese were included. Two independent reviewers evaluated all relevant studies, who also assessed the risk of bias, and extracted the data. Meta-analyses were conducted using Review Manager 5.4.1. The quantity of evidence's certainty was assessed using the Risk bias assessment tool RoB2 (revised version 2019). This study was registered in PROSPERO.

RESULTS

A total of 1740 participants were included, and 18 studies were eligible for inclusion. Meta-analysis reported a statistically significant effect size favoring EFT on delay discounting (AUC) (MD = 0.1, 95 % CI: [0.02, 0.17], P = 0.01; I2 = 73 %), delay discounting (K) (MD = -0.85, 95 % CI: [-1.44, -0.26], P = 0.005; I2 = 77 %), energy intake (MD = -107.59, 95 % CI: [-192.21, -22.97], P = 0.01; I2 = 57 %), grocery purchased (SMD: -0.91, 95 % CI:[-1.48, -0.34], P = 0.002; I2 = 63 %), and BMI (MD = -2.73, 95 % CI: [-5.13, -0.32], P = 0.03; I2 = 0 %, two studies).

CONCLUSIONS

EFT was found to have favorable effects on delay discounting, energy intake, grocery purchased, and BMI of individuals. The presence of high heterogeneity is evident in most of the outcomes. The modalities of EFT intervention are still in the exploratory phase, there is no consensus on the valence, context type, longest delay time, and practice strategy, and it needs to be further explored for different populations. It is anticipated that additional well-designed studies will continue developing high-quality evidence in this field.

A Novel Smartphone-Based Intervention Aimed at Increasing Future Orientation via the Future Self: a Pilot Randomized Controlled Trial of a Prototype Application

We developed and tested a smartphone-based intervention, FutureU, that aims to stimulate future-oriented thinking and behavior by strengthening the degree to which people identify with their future self. In order to examine the potential of this intervention prototype and opportunities for further optimization, we evaluated 1) the immediate and long-term efficacy of the intervention, and 2) intervention effects after each of three intervention modules. To this end, we conducted a randomized controlled pilot study among first-year university students (N = 176). Results showed a decrease in goal commitment immediately after the intervention. At 3-months follow-up, trends showed an increase in future orientation and in self-efficacy. During the intervention, there was a positive effect on vividness of the future self after the first module. Although there is scope for improvement, the findings highlight the potential of the intervention to increase people's future-oriented thinking and behavior.

Episodic future thinking in type 2 diabetes: Further development and validation of the Health Information Thinking control for clinical trials

Episodic Future Thinking (EFT) reduces delay discounting and may have the potential as a clinical tool to increase the likelihood of health-promoting behaviors. However, evaluations of EFT in clinical settings require control conditions that match the effort and frequency of cue generation, as well as participants' expectations of improvement. The Health Information Thinking (HIT) control addresses these issues, but how this control affects delay discounting in individuals with diabetes and obesity when utilizing diabetes-management specific health-information vignettes is unknown. Moreover, little research has explored whether EFT reduces delay discounting in individuals with type 2 diabetes. To this end, we examined the impact of EFT, HIT, and a secondary no-cue control condition (NCC; assessments as usual) on delay discounting in 434 adults with self-reported type 2 diabetes and obesity recruited using Amazon Mechanical Turk. After completing an initial screening questionnaire, eligible participants reported demographics, then were randomized to EFT, HIT, or NCC conditions. Following the generation of seven EFT or HIT cues, participants assigned to EFT or HIT conditions completed a delay discounting task while imagining EFT or HIT cues; no-cue participants completed the task without cues. EFT participants demonstrated significantly lower delay discounting levels than HIT or NCC participants; no differences in delay discounting between HIT and NCC participants were observed. These results suggest that engaging in EFT, but not diabetes-specific HIT, results in lower delay discounting in adults with type 2 diabetes and obesity. This provides further evidence for the appropriateness of the HIT control for clinical trials examining the effect of EFT on delay discounting in adults with self-reported type 2 diabetes.

A future orientation intervention delivered through a smartphone application and virtual reality: study protocol for a randomized controlled trial

BACKGROUND

Short-term mindsets are associated with self-defeating behaviors, such as delinquency and alcohol use. In contrast, people who consider the longer-term consequences of their decisions tend to report positive outcomes, like feeling more competent and enhanced goal achievement. We evaluate an intervention, FutureU, that aims to stimulate future-oriented thinking, increase goal achievement, and reduce self-defeating behavior, by strengthening people's identification with their future self. The intervention will be delivered through a smartphone application (app) or immersive Virtual Reality (VR). We test the effectiveness of FutureU for both delivery methods, examine working mechanisms, and identify potential moderators of intervention effects.

METHODS

In this Randomized Controlled Trial, a total of 240 first-year university students (n = 80 per condition) will be randomized into one of three conditions: (1) a smartphone condition, (2) a VR condition, and (3) an active control condition. We will assess proximal (i.e., future self-identification) and distal intervention outcomes (e.g., future orientation, self-defeating behaviors, goal achievement), user engagement, and examine usage data and goal content. Assessments will take place at baseline, during the intervention, immediately after the intervention, and at 3- and 6-months follow-up.

DISCUSSION

This study will provide information on the effectiveness of the intervention and allows for comparisons between delivery methods using novel technologies, a smartphone app versus immersive VR. Knowledge gained through this study can be used for further intervention development as well as theory building. Trial registration This trial is registered on Clinicaltrials.gov (NCT05578755) on 13 October 2022.

Delay Discounting as a Potential Therapeutic Target for Weight Loss in Breast Cancer Survivors

Obesity in breast cancer (BC) survivors is associated with increased mortality. Delay discounting (DD) is a behavioral economic measure of how individuals value future outcomes. Higher DD correlates with obesity in the general population. Valuation of the future may be associated with obesity differently in cancer survivors. This study evaluated the relationship between DD and obesity in BC survivors. We report an exploratory analysis assessing cross-sectional associations between DD, BMI, and lifestyle behaviors (vegetable and fruit consumption, exercise) related to obesity in 89 women with hormone receptor positive non-metastatic BC. Multivariate linear regression analysis examined demographic and lifestyle behavior variables associated with both BMI and DD. Greater willingness to wait for larger, delayed rewards (lower DD) was significantly associated with lower BMI (standardized beta = −0.32; p < 0.01), independent of age, race, income, time since diagnosis, and menopausal status. There was no significant association between DD and fruit consumption or exercise frequency. Vegetable consumption was significantly associated with lower DD (standardized beta = 0.24; p < 0.05). Higher DD is associated with obesity and decreased frequency of vegetable consumption in BC survivors. Future studies should investigate DD as a therapeutic target for behavioral interventions to facilitate weight loss and promote longevity in this population.

Stimulating a future-oriented mindset and goal attainment through a smartphone-based intervention: Study protocol for a randomized controlled trial

BACKGROUND

Short-term mindsets interfere with the consideration of future consequences and therefore predict negative behaviors. We developed a smartphone-based intervention aiming to increase a future-oriented mindset and personal goal attainment by strengthening future self-identification and stimulating episodic future thinking. The aims of the study are 1) to examine users' experiences with the application and their treatment adherence, 2) to examine the effectiveness of the intervention, and 3) to explore which intervention modules generate the strongest changes in key outcomes.

METHODS

First-year university students (N = 166) will be randomly assigned to two conditions: 1) the smartphone-based intervention, or 2) a goal-setting control group. The intervention consists of three week-long modules. Data will be collected at the start of the intervention, at weekly intervals during the intervention, immediately after the intervention, and at 3-month follow-up (and at parallel time points for the control group). We will assess users' experiences, application usage data, primary intervention outcomes (e.g., self-defeating behavior, future orientation, future self-identification), and secondary intervention outcomes (e.g., psychosocial wellbeing, self-efficacy).

DISCUSSION

The study will provide information about users' experiences with the application, the intervention's general effectiveness, and which intervention modules show most promise. This information will be used to further develop the application and optimize this novel intervention.

TRIAL REGISTRATION

The trial is registered in the Netherlands Trial Register (number: NL9671) on 16 August 2021.

Effects of 6-month episodic future thinking training on delay discounting, weight loss and HbA1c changes in individuals with prediabetes

People with prediabetes are at risk for type 2 diabetes. They may discount the future delay discounting (DD), and not engage in preventive health behaviors. Episodic future thinking (EFT) can reduce DD when future scenarios are cued, but research is needed to assess long-term effects of EFT and when EFT is not cued. This study tested EFT training compared to control for people with prediabetes enrolled in a 6-month weight loss program on DD, weight, HbA1c, and physical activity. Results showed a reliable EFT effect on reducing DD in cued (p = 0.0035), and uncued DD tasks (p = 0.048), and significant overall changes in weight (p < 0.001), HbA1c (p, 0.001) and physical activity (p = 0.003), but no significant differences in these outcomes by group (p’s > 0.05). Sixty-eight percent of the sample ended below the prediabetes HbA1c range. These results suggest that DD can be modified over extended periods, and the effects of EFT can be observed without EFT cues. However, these data do not suggest that changes in weight, HbA1c or physical activity were due to EFT training. The study was initiated before the COVID-19 pandemic which provided the opportunity to compare differences for people treated in-person or remotely. Analyses showed no differences in DD, weight, HBA1c or physical activity outcomes were observed between in-person and remote treatment, suggesting telehealth is a scalable approach to treating prediabetes.

Digital Food Retail: Public Health Opportunities

For over two decades, digital food retail services have been emerging alongside advances in mobile technology and improved access to wi-fi. Digitalization has driven changes within the food environment, complicating an already complex system that influences food-related behaviors and eating practices. Digital food retail services support an infrastructure that enhances commercial food systems by extending access to and availability of highly processed foods, further escalating poor dietary intakes. However, digital food retail services are heterogeneous–food delivery apps, online groceries, and meal kits–and can be feasibly adapted to nutrition interventions and personalized to individual needs. Although sparse, new evidence indicates great potential for digital food retail services to address food insecurity in urban areas and to support healthy eating by making it easier to select, plan, and prepare meals. Digital food retail services are a product of the digital transformation that reflect consumers’ constant need for convenience, which must be addressed in future research and interventions. This paper will discuss public health opportunities that are emerging from the global uptake of digital food retail services, with a focus on online groceries, food delivery apps, and meal kits.

Temporal discounting as a candidate behavioral marker of obesity

Although obesity is a result of processes operating at multiple levels, most forms result from decision-making behavior. The aim of this review was to examine the candidacy of temporal discounting (TD) (i.e. the reduction in the value of a reinforcer as a function of the delay to its receipt) as a behavioral marker of obesity. For this purpose, we assessed whether TD has the ability to: identify risk for obesity development, diagnose obesity, track obesity progression, predict treatment prognosis/outcomes, and measure treatment effectiveness. Three databases (Pubmed, PsycINFO, and Web of Science) were searched using a combination of terms related to TD and obesity. A total of 153 papers were reviewed. Several areas show strong evidence of TD's predictive utility as a behavioral marker of obesity (e.g., distinguishing obese from non obese). However, other areas have limited and/or mixed evidence (e.g., predicting weight change). Given the positive relationship for TD in the majority of domains examined, further consideration for TD as a behavioral marker of obesity is warranted.

A story to tell: the role of narratives in reducing delay discounting for people who strongly discount the future

Delay Discounting (DD) or devaluing a future, larger reward in favour of a smaller, more immediate reward, has been linked to negative health behaviours. One intervention that reduces DD is Episodic Future Thinking (EFT). EFT has participants generate cues representing positive future events that correspond to temporal windows during the DD task. The current study examined if incorporating EFT cues into narratives would strengthen effects on DD. One hundred and sixty adults were recruited from Amazon Mechanical Turk and were randomised to traditional or narrative EFT. Results showed that participants in narrative EFT discounted the future less (p = 0.034) than participants who engaged in traditional EFT. This novel approach to EFT is well grounded in research and theory on the power of narratives to influence behaviour and can open a new window into ways to reduce DD to strengthen engagement in positive choices.

Mothers' DASH diet adherence and food purchases after week-long episodic future thinking intervention

Prospection has helped participants forego the temptation to buy and eat higher calorie nutrient poor foods in favor of buying and eating fewer calories and healthier macronutrient profiles in laboratory tasks and brief field studies. This pilot study examines whether episodic future thinking (EFT) improves mothers' dietary behavior and food purchasing over a longer 7-10-day period. The study utilized a 2 × 2 factorial design with mothers (N = 60) randomized to EFT or standardized episodic thinking (SET) crossed with dietary approaches to stop hypertension (DASH) diet education or a food safety education control. Participants listened to their cues (e.g., recordings of themselves imagining a future event or recalling a past episode) using a mobile ecological momentary intervention (EMI) tool and returned to complete a follow-up dietary recall and submit food receipts. Results showed diets of mothers in the EFT groups became more concordant with the DASH diet (η_p² = 0.08, p < .05) than mothers in the SET group. When considering food purchases for the family, there was an EFT effect on milligrams of sodium purchased (η_p² = 0.07, p < .05) and a trend towards a decrease in grams of fat purchased (η_p² = 0.06, p = .06), however, these findings were no longer significant after correcting for multiple comparisons. There were no DASH education effects and no DASH by EFT interactions observed. The dietary intake and food purchasing results should be replicated in larger more representative samples.