Missed by an inch or a mile? Predicting the size of intention–behaviour gap from measures of executive control

Obesity is associated with alterations in anatomical connectivity of frontal-corpus callosum

Obesity has been linked to abnormal frontal function, including the white matter fibers of anterior portion of the corpus callosum, which is crucial for information exchange within frontal cortex. However, alterations in white matter anatomical connectivity between corpus callosum and cortical regions in patients with obesity have not yet been investigated. Thus, we enrolled 72 obese and 60 age-/gender-matched normal weight participants who underwent clinical measurements and diffusion tensor imaging. Probabilistic tractography with connectivity-based classification was performed to segment the corpus callosum and quantify white matter anatomical connectivity between subregions of corpus callosum and cortical regions, and associations between corpus callosum-cortex white matter anatomical connectivity and clinical behaviors were also assessed. Relative to normal weight individuals, individuals with obesity exhibited significantly greater white matter anatomical connectivity of corpus callosum-orbitofrontal cortex, which was positively correlated with body mass index and self-reported disinhibition of eating behavior, and lower white matter anatomical connectivity of corpus callosum-prefrontal cortex, which was significantly negatively correlated with craving for high-calorie food cues. The findings show that alterations in white matter anatomical connectivity between corpus callosum and frontal regions involved in reward and executive control are associated with abnormal eating behaviors.

Cool executive functions and their association with body mass & fatness and the FTO gene in school-aged children

The FTO gene rs9936909 polymorphism is one of the well-documented single nucleotide polymorphisms in the context of increased risk of obesity, including in children. Few studies have tested the association of the FTO gene with cognitive functions. Deficits of "cool" executive functions (EFs) are considered a potential risk factor for excessive weight. The aims of our study were to investigate whether cool EFs are associated with the Body Mass Index, the Fat Mass Index and the risk of excess body mass and overfatness in neurotypically school-aged children, and whether the FTO gene polymorphism is involved in development of this possible association. The sample consisted of 553 children aged 6-12 years old. A body composition analysis, a neuropsychological assessment of EFs, and FTO polymorphism genotyping were performed in the children studied. The study found a significant association of an interference effect in theStroop Color-Word Interference Task and the risk of excessive body fatness, but not excessive body mass. There were no explicit associations between the FTO genotype and EFs deficits. Environmental factors, and particularly low maternal education, appeared to be the strongest contributors to the increased risk of obesity.

Obesity, multiple chronic conditions, and the relationship with physical function: Data from the national health and aging trends survey

BACKGROUND

The population of older adults living with multiple chronic conditions (MCC) continues to grow. MCC is independently associated with functional limitation and obesity. The aim of our study was to evaluate the association between obesity and MCC, and secondarily, the combined presence of obesity and functional limitations with MCC.

METHODS

We analyzed cross-sectional survey data from the National Health and Aging Trends Survey (NHATS) 2011 baseline data, a nationally representative Medicare beneficiary cohort of adults in the United States. We evaluated the coexistent prevalence of obesity and MCC overall, and by standard body mass index (BMI) categories. We then evaluated the prevalence of functional limitations (mobility, self-care, and household activities) and Fried-defined frailty status in persons with a BMI ≥ 30 kg/m2. Logistic regression was used to measure the association between MCC and BMI, and functional limitations and MCC among those with obesity.

RESULTS

In the 6,600 participants, the prevalence of concurrent obesity and MCC was 30.4%. Of those with obesity, the prevalence of MCC was 84.0%, and were more likely to have MCC (adjusted OR: 2.17, 95% CI 1.86, 2.54) compared to a normal BMI. Obesity and functional limitations or frailty were more likely have MCC than individuals with obesity alone.

CONCLUSIONS

We found that individuals with obesity is strongly associated with MCC and that functional limitations and frailty status have a greater association with having MCC than individuals with obesity without MCC. Future longitudinal analyses are needed to ascertain this relationship.

Do executive functions predict physical activity behavior? A meta-analysis

BACKGROUND

Executive functions (EFs) are important determinants of health behaviors. In the present study, a meta-analysis was conducted to investigate the relationship between EFs and physical activity (PA) behavior.

METHODS

Systematic searches were carried out in PsycInfo, MEDLINE, and SPORTDiscus databases throughout April 2021. Prospective empirical studies conducted with general healthy populations across the lifespan, which reported the relationship between baseline EFs and later PA behavior were selected.

RESULTS

Eight studies were found eligible. Results of the multilevel meta-analysis revealed a small but significant total effect size for EFs on PA behavior of z = 0.12. High heterogeneity was observed among studies. When potential moderators were tested, residual heterogeneity remained significant and the effects of the moderators were not significant. The effect size dropped when accounted for publication bias.

CONCLUSIONS

Despite limitations, the study provided evidence for EFs' determinant role on PA behavior. More research is however encouraged to inform PA promotion programs that are well-prepared for individual differences in EFs.

The role of cognitive flexibility in weight loss after severe obesity surgery-A retrospective study

Cognitive flexibility (CF) is a fundamental skill for behavioural regulation and adaptation during the weight-loss process. Research suggests that bariatric surgery (BS) candidates underperform consistently in the Wisconsin Card Sorting Test (WCST), which is a neuropsychological instrument that measures this ability. The current study explored the predictive value of preoperative performance in WCST CF dimensions alongside relevant psychological factors on weight loss after BS. The sample comprised 100 female patients who underwent BS in a public hospital in Lisbon, Portugal. We collected data using the WCST, the Hopkins Symptom Checklist-90-Revised (SCL-90-R), and the Binge Eating Scale (BES). Multiple linear regression (MLR) analyses were performed to obtain explanatory models of total weight loss at 12- and 24-postoperative months (TWL₁ and TWL₂ , respectively). MLR identified the number of preservative responses as a highly significant predictor of TWL₁ (p < 0.01)_, and the SCL-90-R obsession-compulsion and anxiety indices as highly significant predictors of TWL₁ and TWL₂ (p < 0.01). The number of preservative responses was a relevant predictor of weight loss at 12 months. Persisting in maladaptive cognitive strategies was associated with a lesser weight loss during the important period after BS that requires the adoption new lifestyle habits.

Predicting Physical Activity Behavior by Automatic and Reflective Self-Regulatory Processes

In this study, we examined the interaction of automatic (i.e., automatic affective evaluations) and reflective [i.e., reflective intention and executive functions (EFs)] processes on physical activity (PA) behavior based on dual-process theories. We expected main effects as well as significant interaction effects between automatic associations, intention, and EFs on behavior. In particular, a well-controlled implicit-association-test (IAT) was applied to assess automatic affective evaluation. A prospective study with two points of measurement (N=212 students) was conducted. At t1, age, sex, PA behavior (control variables), automatic associations, EFs (shifting, updating, inhibition), and PA intention (predictors and moderators) were assessed with standardized questionnaires and tests. At t2 (4weeks later), PA behavior (dependent variable) was measured with a standardized questionnaire. A hierarchical multiple linear regression analysis including two- and three-way interactions between IAT results, intention, and EFs on PA behavior was conducted. Results showed that the interactions Intention x Shifting and IAT x Intention x Inhibition were significant. Moderation analyses revealed that participants with higher intentions and lower inhibition values (improved inhibition abilities) showed a negative association between IAT and PA, while those with lower intentions and lower inhibition values showed a positive association between IAT and PA, which was documented in a significant slope difference test between these two groups. Thus, both automatic and reflective processes contribute and interact in predicting PA. As well as fostering more positive affective evaluations towards PA, interventions to strengthen PA intentions and to improve EFs could help to increase PA behavior.

Psychometric Properties of the German Version of the Self-Regulation of Eating Behavior Questionnaire

Background: The Self-Regulation of Eating Behavior Questionnaire (SREBQ) is an economical way of assessing an individual's self-regulatory abilities regarding eating behavior. Such scales are needed in the German population; therefore, the purpose of the present study was the translation and validation of a German version of the SREBQ.

Method: First, we conducted a pilot study (Study 1; N = 371) after the translation procedure. Second, we assessed the final scale in a representative sample of the German population (Sample 2; N = 2,483) and its underlying factor structure. Further, we tested for measurement invariance and evaluated the SREBQ's associations with related scales to explore convergent and discriminant validity. Finally, we considered differences in SREBQ based on sociodemographic variables and provided derived reference scores (norm values).

Results: Factor analysis revealed deficiencies in the original model. Thus, we shortened the scale based on statistical considerations and the adapted version showed improved fit in Confirmatory Factor Analysis and reliability. We also found evidence for partial strict invariance, which means the measure is equivalent for the tested groups of age and gender. Item and scale psychometric properties of the shortened version were satisfactory. In terms of diagnostic validity, it was shown that individuals with higher body mass index (kg/m²) have worse self-regulation of eating behavior than those with lower.

Conclusion: In sum, the SREBQ evidenced good validity and reliability and is suitable for application in medical, psychological, and nutritional research.

COVID-19 Stress and Food Intake: Protective and Risk Factors for Stress-Related Palatable Food Intake in U.S. Adults

(1) Background: The coronavirus (COVID-19) pandemic has caused disruptions to what people eat, but the pandemic's impact on diet varies between individuals. The goal of our study was to test whether pandemic-related stress was associated with food intake, and whether relationships between stress and intake were modified by appetitive and cognitive traits. (2) Methods: We cross-sectionally surveyed 428 adults to examine current intake frequency of various food types (sweets/desserts, savory snacks, fast food, fruits, and vegetables), changes to food intake during the pandemic, emotional overeating (EOE), cognitive flexibility (CF), and COVID-19-related stress. Models tested associations of stress, EOE, and CF with food intake frequency and changes to intake. (3) Results: Models demonstrated that the positive relationship between stress and intake of sweets/desserts was stronger with higher EOE, while the positive relationship between stress and intake of chips/savory snacks was weaker with higher CF. Higher EOE was associated with greater risk of increased intake of palatable foods. (4) Conclusions: Findings suggest that emotional overeating may escalate stress-associated intake of high-sugar foods, and cognitive flexibility may attenuate stress-associated intake of high-fat foods. Differences in appetitive and cognitive traits may explain changes to and variability in food intake during COVID-19, and efforts to decrease emotional overeating and encourage cognitive flexibility could help lessen the effect of COVID-19-related stress on energy dense food intake.

Impact of increasing the availability of healthier vs. less-healthy food on food selection: a randomised laboratory experiment

Background

Environmental cues shape behaviour, but few studies compare the impact of targeting healthier vs. less-healthy cues. One online study suggested greater impact on selection from increasing the number of less-healthy (vs. healthier) snacks. The current study aimed to: (1) extend the previous study by using physically-present snacks for immediate consumption; (2) explore responsiveness by socio-economic position; (3) investigate possible mediators (response inhibition, food appeal) of any socio-economic differences in selection.

Methods

In a between-subjects laboratory experiment UK adults (n = 417) were randomised according to their ID number (without blinding) to one of three ranges of options: Two healthier, two less-healthy [“Equal”] (n = 136); Six healthier, two less-healthy [“Increased Healthier”] (n = 143); Two healthier, six less-healthy [“Increased Less-Healthy”] (n = 138). Participants completed measures of response inhibition and food appeal, and selected a snack for immediate consumption from their allocated range. The primary outcome was selection of a healthier (over less-healthy) snack.

Results

The odds of selecting a less-healthy snack were 2.9 times higher (95%CIs:1.7,5.1) in the Increased Less-Healthy condition compared to the Equal condition. The odds of selecting a healthier snack were 2.5 times higher (95%CIs:1.5,4.1) in the Increased Healthier (vs. Equal) condition. There was no significant difference in the size of these effects (− 0.2; 95%CIs:-1.1,0.7). Findings were inconclusive with regard to interactions by education, but the direction of effects was consistent with potentially larger impact of the Increased Healthier condition on selection for higher-educated participants, and potentially larger impact of the Increased Less-Healthy condition for less-educated participants.

Conclusions

A greater impact from increasing the number of less-healthy (over healthier) foods was not replicated when selecting snacks for immediate consumption: both increased selections of the targeted foods with no evidence of a difference in effectiveness. The observed pattern of results suggested possible differential impact by education, albeit not statistically significant. If replicated in larger studies, this could suggest that removing less-healthy options has the potential to reduce health inequalities due to unhealthier diets. Conversely, adding healthier options could have the potential to increase these inequalities.

Trial registration

ISRCTN: ISRCTN34626166; 11/06/2018; Retrospectively registered.

Cognitive remediation-enabled cognitive behaviour therapy for obesity: a case series

PURPOSE

Despite varied treatment effects, weight recidivism is common and typically associated with the abandonment of prescribed weight management strategies. Literature suggests that difficulty with weight management is associated with deficits in executive functioning, in particular cognitive flexibility and response inhibition, the neurocognitive processes that are involved in goal-directed behaviours, such as dietary adherence. These processes are overlooked by mainstream weight loss programmes. The aim of the study was to assess the effectiveness of a cognitive remediation-enabled cognitive behaviour therapy (CR-CBT) in addressing the neurocognitive, psychological and behavioural correlates of weight loss. It was hypothesised that CR-CBT would improve cognitive flexibility and response inhibition, reduce binge eating, aid weight loss and improve metabolic health.

METHODS

Four adults with obesity (body mass index > 30 kg/m²) received 7 weeks of manualised CR-CBT and were assessed via a case series analysis at baseline, end of treatment and 3-month follow-up. Treatment included 3 weekly 90-min group-based behaviour weight loss sessions for 3 weeks, followed by twice-weekly 50-min individualised CR-CBT sessions for 4 weeks.

RESULTS

Cognitive remediation-enabled cognitive behaviour therapy produced improvements in response inhibition and cognitive flexibility, and reductions in binge eating frequency, weight, and metabolic health readings between baseline and 3-month follow-up.

CONCLUSIONS

This is the first study to assess the effectiveness of CR-CBT in the treatment of obesity. Preliminary indications of treatment success are discussed with respect to study limitations. In light of these results, we recommend further investigation via a randomised control trial (RCT).

LEVEL OF EVIDENCE

Level IV, case series.

Cognitive Training: Associations and Implications for Weight Management and Translational Research

Behavioral weight loss programs combining energy restriction and increased physical activity (PA) are generally successful in producing clinically significant weight loss (≥5%) over 3-6 mos. However, weight maintenance (≥ 2 yrs.) continues to be problematic, due in part to an inability of individuals to continue adherence to diet and PA recommendations. It is hypothesized that neurocognitive processes, specifically executive functions (EFs, i.e., inhibition, working memory, mental flexibility), underlie self-regulation, self-efficacy, and are essential for the adoption and maintenance of health behaviors. Behavioral weight loss programs generally attempt to improve self-regulation; however, these skills are difficult to implement long-term. Strengthening EFs through cognitive training may improve weight maintenance by improving self-efficacy and self-regulation, resulting in improved program attendance and improved adherence to dietary and PA recommendations. Although randomized trials have not been conducted to specifically evaluate this hypothesis, results from the available literature suggest the potential for cognitive training to improve weight maintenance.

Influence of a Planning Intervention on Physical Activity Behavior: the Moderating Role of Intentions and Executive Functions in a Randomized Controlled Trial

Background

Planning and executive functions (EFs; inhibition, updating, shifting) are self-regulatory variables that help people to become and stay physically active. The aim of this study was to examine how and for whom a planning intervention affects physical activity (PA) behavior in the short term. Therefore, the mediating role of planning and the moderating role of intentions and EFs for the planning–behavior link were examined.

Method

In a randomized control trial with two treatment groups (planning group vs. control group) and two points of measurement (t1 and t2, 1 week apart), n = 200 students participated in both measurements. At t1, participants filled in standardized questionnaires assessing PA behavior, intention, and planning. Computer-based tests assessed the following EFs: inhibition, updating, and shifting. At t2, planning and PA behavior were measured again. Moderated mediation analyses were conducted.

Results

A significant increase in PA between t1 and t2 was found for the planning group compared with the control group. Furthermore, planning cognitions significantly mediated the effect of the planning group on behavior and intention, as well as the EF updating moderated the association between planning and behavior. Forming plans was particularly beneficial for participants with high intentions and lower updating performance.

Conclusion

Planning enhances PA behavior, particularly when PA intention is high. Poor performance in updating can be compensated by planning since encouraging people to generate plans might facilitate automatic enactment of the behavior.

Snacks and The City: Unexpected Low Sales of an Easy-Access, Tasty, and Healthy Snack at an Urban Snacking Hotspot

: While many people declare an intention to eat and snack more healthily, a large body of research has found that these intentions often do not translate into actual behavior. This failure to fulfil intentions is regularly attributed to the obesogenic environment, on which basis it is assumed that changing the food environment may lead to more healthy snacking behavior. To test this premise in real life practice, the present research project investigated whether making a healthy snack easy-to-access in an urban environment characterized by unhealthy snacking would support people in their intentions of purchasing more healthy snacks. The urban snack project consisted of three phases. In Phase 1, a hotspot location for unhealthy snacking was determined by using a Global Positioning System to track people's snacking locations anda survey to verify the location . In Phase 2, an attractive snack was developed that met consumers' criteria of what constituted a healthy and tasty snack, together with corresponding branding that also included a small food truck from which to sell the newly developed snacks. In Phase 3, the snack was sold from the food truck located at the previously determined unhealthy snacking hotspot. We counted the number of snacks sold and canvassed people's opinions about the snack and its branding, finding that in spite of people's appreciation for the snack, the food truck, and the branding, actual sales of the snack were very low. In the Discussion, we name predominant eating and purchasing habits as possible reasons for these low sales. Future research could focus on placing the healthy snack directly beside people's habitual snack purchase location to ensure that the new choice gets better recognized. Overall, the findings suggest that merely placing healthy snacks more prominently in people's food environment is not sufficient to lead people to snack more healthily.

Association of self-reported executive function and mood with executive function task performance across adult populations

Executive function (EF) impacts behavior associated with health outcomes. EF can be measured using self-report and/or performance measures, but the correlations between these types of measures are mixed in the extant literature. This study examined self-report and performance-based measures of EF using data from 6 studies, including community and clinical populations (410 participants, ages 19-80, 71% female). Partial correlations revealed significant relationships between performance on the Trail making, Delay Discounting, and Stop Signal tasks with self-reported EF (p < .006 after controlling for age). Mood scores were significantly related to all self-reported domains of EF (p < .0001), and mood and EF scores were correlated over time. When also controlling for mood, correlations between delay discounting and stop signal tasks with self-reported EF remained significant (p < .006). Finally, examining EF scores in participants with and without clinically elevated mood scores showed a wider distribution of self-reported EF scores among those with clinically elevated mood symptoms than among those without. We conclude that self-reported EF is associated with tasks measuring delay discounting and response inhibition in our large, heterogenous population and that assessing EF may be particularly important for those with high levels of mood symptoms.

The role of executive functioning on the intention-behaviour relationship of health behaviours: a temporal self-regulatory perspective

OBJECTIVE

The current study employed the Temporal Self-Regulation theory (TST) to determine if self-regulatory capacity and prepotent behaviour moderate the relationship between intention and health behaviours (i.e., physical activity, and healthy eating) in college students.

DESIGN

220 students were surveyed across two time points to assess past/intended behaviour (Time 1) and follow-up behaviour (Time 2).

MAIN OUTCOME MEASURES

To address limitations in previous research, self-regulatory capacity was assessed using an ecologically valid rating scale (Barkley Deficits in Executive Functioning Scale). Multi-item assessment measures were utilised for physical activity (International Physical Activity Questionnaire) and healthy eating (All-Day Screener) behaviours.

RESULTS

A link between intention and follow-up behaviour was established and executive functioning (EF) and past behaviours were positively associated with follow-up behaviour. EF had no unique moderation effects on health behaviours, but combinations of Low, Moderate, and High levels of past behaviour and EF demonstrated moderation for physical activity and healthy eating.

CONCLUSION

This study demonstrated the utility of the TST in predicting health behaviour and emphasised the mutual necessity of EF and past behaviour in understanding the intention-behaviour relationship. Findings can be used to formulate studies and interventions that reduce barriers to health behaviours, therefore, lessening the need for high self-regulatory abilities.

Nutrition knowledge, attitudes, and self-regulation as predictors of overweight and obesity

BACKGROUND AND PURPOSE

Nutrition knowledge, attitudes, and eating self-regulation are important determinants of overweight and obesity. Eating self-regulation is the link between eating intention and behavior. However, the extent to which these factors influence overweight and obesity has not been thoroughly studied. The study examined nutrition knowledge, attitudes, and eating self-regulation as predictors of overweight and obesity among adults in a community setting.

METHODS

A total of 313 adults participated in an online survey, which included the General Nutrition Knowledge Questionnaire-Revised, the Nutrition Attitudes Questionnaire, and the Self-Regulation of Eating Behavior Questionnaire. Descriptive statistics, Kendall's tau tests, and multivariate logistic regression procedures were performed.

CONCLUSIONS

More than half of the participants were either overweight or obese (56.5%). The mean nutrition knowledge score was 74.1%, and only 28.1% correctly identified the body mass index for obesity. Positive predictors of overweight and obesity included poor eating self-regulation of giving up too easily on eating intentions (odds ratio [OR] = 3.81), male gender (OR = 2.0), and age (OR = 1.03), whereas nutrition attitudes were a negative predictor (OR = 0.74).

IMPLICATIONS FOR PRACTICE

The odds of overweight or obesity were nearly four times greater for those who gave up too easily on their eating intentions. Nurse practitioners can play a critical role in establishing healthy dietary habits to maintain weight control by promoting good eating self-regulation, despite the current obesogenic environment. After assessing patient readiness and motivation, it is important to help patients make eating self-regulation as manageable as possible to promote long-term weight management.

Acute coordinative exercise ameliorates general and food-cue related cognitive function in obese adolescents

Whether the acute coordinative exercise could affect the inhibitory control and food-cue related attention in obese adolescents remains understudied. Therefore, this study used the Stroop test and the food-cue related Stroop test to explore the impacts of 20 min of acute coordinative exercise on the cognitive tests involving inhibitory control and attentional bias towards food-cue related stimuli, respectively, in obese adolescents. Thirty-eight obese adolescents (mean age = 14.63 ± 0.69 years) were equally divided into exercise and control groups. The cognitive tests (i.e., the Stroop test and the food-cue related Stroop test) and hunger scores were conducted and assessed before and after an intervention. The exercise group had significantly larger negative pre-post response time difference in the congruent (-1.04 ± 0.29 ms) and incongruent (-5.76 ± 1.66 ms) conditions of the Stroop test than the control group (ps < 0.01), and a smaller post-interference (1.13 ± 0.14) than the pre-interference (1.31 ± 0.14, p = 0.04). Moreover, a significantly larger negative pre-post response time difference on the food-cue related Stroop test was observed in the exercise group (-4.42 ± 7.20 ms) than the control group (1.76 ± 8.37 ms, p = 0.02). Collectively, an acute coordinative exercise session could induce superior inhibitory control and less attentional bias towards food-cue related stimuli in obese adolescents.

Altering the availability of healthier vs. less healthy items in UK hospital vending machines: a multiple treatment reversal design

BACKGROUND

Altering the availability of healthier or less-healthy products may increase healthier purchases, but evidence is currently limited. The current study aimed to investigate the impact of altering the absolute-and-relative availability of healthier and less-healthy products - i.e. simultaneously altering the number of options available and the proportion of healthier options - in hospital vending machines.

METHODS

An adapted multiple treatment reversal design was used, altering products available in ten vending machines serving snack foods and/or cold drinks in one English hospital. Machines were randomised to one of two sequences for the seven 4-week study periods: ABCADEA or ADEABCA. In Condition A (study periods 1, 4 and 7) the proportions of healthier products were standardised across all machines, so that 25% of all snack slots and 75% of drink slots were healthier. In Condition B, 20% of vending machine slots were emptied by removing less-healthy products. In Condition C, the empty slots created in Condition B were filled with healthier products. Conditions D and E were operationalised in the same way as B and C, except healthier products were removed in D, and then less-healthy products added in E. Sales data were obtained from machine restocking records. Separate linear mixed models were conducted to examine the impact of altering availability on energy purchased (kcal) from (i) snacks or (ii) drinks each week, with random effects for vending machine.

RESULTS

The energy purchased from drinks was reduced when the number of slots containing less-healthy drinks was decreased, compared to standardised levels (- 52.6%; 95%CI: - 69.3,-26.9). Findings were inconclusive for energy purchased from snacks when less-healthy snack slots were reduced (- 17.2%; 95%CI: - 47.4,30.5). Results for altering the number of slots for healthier drinks or snacks were similarly inconclusive, with no statistically significant impact on energy purchased.

CONCLUSIONS

Reducing the availability of less-healthy drinks could reduce the energy purchased from drinks in vending machines. Further studies are needed to establish whether any effects might be smaller for snacks, or found with higher baseline proportions of healthier options.

Food Addiction: Implications for the Diagnosis and Treatment of Overeating

With the obesity epidemic being largely attributed to overeating, much research has been aimed at understanding the psychological causes of overeating and using this knowledge to develop targeted interventions. Here, we review this literature under a model of food addiction and present evidence according to the fifth edition of the Diagnostic and Statistical Manual (DSM-5) criteria for substance use disorders. We review several innovative treatments related to a food addiction model ranging from cognitive intervention tasks to neuromodulation techniques. We conclude that there is evidence to suggest that, for some individuals, food can induce addictive-type behaviours similar to those seen with other addictive substances. However, with several DSM-5 criteria having limited application to overeating, the term 'food addiction' is likely to apply only in a minority of cases. Nevertheless, research investigating the underlying psychological causes of overeating within the context of food addiction has led to some novel and potentially effective interventions. Understanding the similarities and differences between the addictive characteristics of food and illicit substances should prove fruitful in further developing these interventions.

Working memory moderates the association between condom use intentions and behavior among moderate-to-heavy drinking men who have sex with men

Men who have sex with men (MSM) are a high-risk population for HIV infection and this risk is increased for those who consume alcohol. Condomless anal intercourse (CAI) is the central transmission risk factor for this population. This study examined whether individual differences in working memory moderated the association between intentions to use condoms and the frequency of CAI among MSM who engaged in anal intercourse over a subsequent 6-week period. Moderate- and heavy-drinking MSM (n = 207) completed questionnaires regarding alcohol use and condom use intentions and an operation span task to assess working memory at baseline. Participants then completed 6 weeks of morning surveys via a mobile phone app to assess anal intercourse frequency with and without condoms. Negative binomial regression analyses showed that the association between intentions to use condoms and episodes of CAI during the monitoring period was moderated by working memory such that intentions predicted CAI for those high in working memory but not those low in working memory. These results support the view that self-reported intentions may be less-likely to translate into health behaviors among those with poorer executive functioning skills.

Food craving predicts the consumption of highly palatable food but not bland food

The impact of obesity on physical and psychological health is well recognized in the literature with, among others, evidence of alterations in cognition. Indeed, obese populations are characterized by lower executive functions as well as an enhanced food craving. However, the relationship between executive functions and food craving remains unexplored. Moreover, these two variables have also been shown to predict food intake, but studies in the context of obesity are lacking. Thus, this study had two objectives: (1) determining if executive functions and food craving are linked, and (2) examining the predictors of highly palatable food intake and bland food intake. First, it was hypothesized that executive functions would be negatively associated with food craving. Second, it was expected that food craving would predict positively highly palatable food intake but not bland food intake. Third, it was predicted that executive functions would predict negatively highly palatable food intake and positively bland food intake. 48 participants (34 females) with BMIs ranging from 17.9 to 46.4 took part in two experimental sessions. First, executive functions were assessed using the delayed discounting task (impulsivity towards food and money) and the color-word interference test (CWIT; inhibition/flexibility). Second, a cue-induced food craving protocol, with images as well as real food, was administered followed by an ad libitum food intake protocol including both highly palatable and bland food. The inhibition/flexibility condition of the CWIT was significantly and negatively correlated with food craving following induction. Highly palatable food intake was significantly predicted by food craving following induction, but bland food intake was not. This study reveals an association between lower inhibition/flexibility and susceptibility to food craving induction that is of great importance in obesogenic environments. Moreover, this study confirmed the link between food craving and food intake, and showed for the first time a specific contribution of food craving to highly palatable food intake but not to bland food intake, highlighting its potential influence in obesity. This work leads to future research questions regarding the possible benefits of cognitive remediation interventions, as well as interventions aiming at reducing food craving, in weight loss programs. LEVEL OF EVIDENCE: Level IV, quasi-experimental study.

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.

Does executive function moderate the relation between momentary affective and physical states and subsequent dietary lapse? An EMA investigation

The study explored whether baseline individual differences in executive function (EF) affect the relation between elevations in internal states and subsequent likelihood of lapsing from a dietary prescription. Participants were 189 adults with overweight/obesity in a behavioral weight loss treatment who completed a neuropsychological EF task at intake and a 2-week EMA protocol measuring internal states and dietary lapses at start of treatment. Generalized estimating equations found relations between momentary elevations in tiredness (b = .06, p = .01) and deprivation (b = .06, p = .047) and subsequent likelihood of lapsing were more robust for participants with lower EF, whereas the relation between momentary elevations in boredom and subsequent likelihood of lapsing (b = .04, p = .03) was more robust for participants with higher EF. Results provide support for EF impacting the relation between elevations in internal states and likelihood of dietary lapse, informing the development of personalized behavioral weight loss treatments.

Availability of healthier vs. less healthy food and food choice: an online experiment

BACKGROUND

Our environments shape our behaviour, but little research has addressed whether healthier cues have a similar impact to less healthy ones. This online study examined the impact on food choices of the number of (i) healthier and (ii) less healthy snack foods available, and possible moderation by cognitive load and socioeconomic status.

METHODS

UK adults (n = 1509) were randomly allocated to one of six groups (two cognitive load x three availability conditions). Participants memorised a 7-digit number (7777777: low cognitive load; 8529713: high cognitive load). While remembering this number, participants chose the food they would most like to eat from: (a) two healthier and two less healthy foods, (b) six healthier and two less healthy foods, or (c) two healthier and six less healthy foods.

RESULTS

Compared to being offered two healthier and two less healthy options, the odds of choosing a healthier option were twice as high (Odds Ratio (OR): 2.0, 95%CI: 1.6, 2.6) with four additional healthier options, while the odds of choosing a less healthy option were four times higher (OR: 4.3, 95%CI: 3.1, 6.0) with four additional less healthy options. There were no significant main effects or interactions with cognitive load or socioeconomic status.

CONCLUSIONS

This study provides a novel test of the impact of healthier vs. less healthy food cues on food choice, suggesting that less healthy food cues have a larger effect than healthier ones. Consequently, removing less healthy as opposed to adding healthier food options could have greater impact on healthier choices. Studies are now needed in which choices are made between physically-present foods.

Harnessing centred identity transformation to reduce executive function burden for maintenance of health behaviour change: the Maintain IT model

The inability to produce sustainable lifestyle modifications (e.g., physical activity, healthy diet) remains a major barrier to reducing morbidity and mortality from prevalent, preventable conditions. The objective of this paper is to present a model that builds on and extends foundational theory and research to suggest novel approaches that may help to produce lasting behaviour change. The model aims to integrate factors not typically examined together in order to elucidate potential processes underlying a shift from behaviour initiation to long-term maintenance. The central premise of the Maintain IT model builds on approaches demonstrating that in-tact executive function (EF) is critical for health behaviour initiation, for more complex behaviours beyond initiation, and in unsupportive environments and circumstances, but successful recruitment of EF is effortful and prone to error. Enduring changes are more likely if the underlying cognitive processes can become less effortful (non-conscious, automatic). The Maintain IT model posits that a centred identity transformation is one path leading to less effortful processing and facilitating successful recruitment of EF when necessary over the long term, increasing the sustainability of health behaviour change. A conceptual overview of the literature supporting the utility of this integrative model, future directions, and anticipated challenges are presented.

Self-regulation and obesity: the role of executive function and delay discounting in the prediction of weight loss

Obesity rates are rising worldwide. Executive function and delay discounting have been hypothesized to play important roles in the self-regulation of behavior, and may explain variance in weight loss treatment success. First, we compared individuals with obesity (n = 82) to healthy weight controls (n = 71) on behavioral and self-report measures of executive function (working memory, inhibition and shifting) and delay discounting. Secondly, the individuals with obesity took part in a multidisciplinary weight loss program and we examined whether executive function and delay discounting predicted weight change. Individuals with obesity displayed weaker general and food-specific inhibition, and weaker self-reported executive function. Better behavioral working memory and better self-reported inhibition skills in daily life were predictive of greater weight loss. As findings are correlational, future studies should investigate the causal relationship between executive function and weight loss, and test whether intervening on executive function will lead to better prevention and treatment of obesity.

Addressing Obesity in Aging Patients

Obesity in older adults affects not only morbidity and mortality but, importantly, quality of life and the risk of institutionalization. Weight loss interventions can effectively lead to improved physical function. Diet-alone interventions can detrimentally affect muscle and bone physiology and, without interventions to affect these elements, can lead to adverse outcomes. Understanding social and nutritional issues facing older adults is of utmost importance to primary care providers. This article will also discuss the insufficient evidence related to pharmacotherapy as well as providing an overview of using physiologic rather than chronologic age for identifying suitable candidates for bariatric surgery.

Executive Functions, Trait Self-Control, and the Intention-Behavior Gap in Physical Activity Behavior

Many people fail to translate their physical activity intentions into behavior. This intention-behavior gap can be explained by (a) explicit trait self-control, (b) implicit executive functions, and (c) their interactions. In 118 participants, the intention-behavior gap was measured in a prospective design. Trait self-control was assessed via self-report questionnaires, whereas executive functioning was measured with test performance in inhibition, updating, and shifting at baseline. Regression analysis showed that (a) higher trait self-control predicts a smaller intention-behavior gap; (b) updating performance is related with this gap; and (c) behavior in tests on inhibition, updating, and shifting moderate the relation between the trait self-control and the intention-behavior gap. The present study showed that the complex pattern that modulates the relation between intended and realized physical activity behavior includes trait self-control, executive functions, as well as the combination of these cognitive components supporting dual-process approaches of self-control including implicit and explicit processing components.

Executive function fails to predict smoking outcomes in a clinical trial to motivate smokers to quit

BACKGROUND

Executive function (EF) is considered an important mediator of health outcomes. It is hypothesized that those with better EF are more likely to succeed in turning their intentions into actual health behaviors. Prior studies indicate EF is associated with smoking cessation. Experimental and longitudinal studies, however, have yielded mixed results. Few studies have examined whether EF predicts post-treatment smoking behavior. Fewer still have done so prospectively in a large trial. We sought to determine if EF predicts quit attempts and cessation among community smokers in a large randomized trial evaluating the efficacy of motivational interventions for encouraging cessation.

METHODS

Participants (N=255) completed a baseline assessment that included a cognitive battery to assess EF (Oral Trail Making Test B, Stroop, Controlled Oral Word Association Test). Participants were then randomized to 4 sessions of Motivational Interviewing or Health Education or one session of Brief Advice to quit. Quit attempts and cessation were assessed at weeks 12 and 26.

RESULTS

In regression analyses, none of the EF measures were statistically significant predictors of quit attempts or cessation (all ps>0.20).

CONCLUSIONS

Our data did not support models of health behavior that emphasize EF as a mediator of health outcomes. Methodological shortcomings weaken the existing support for an association between EF and smoking behavior. We suggest methodological improvements that could help move this potentially important area of research forward.

Using Temporal Self-Regulation Theory to understand healthy and unhealthy eating intentions and behaviour

OBJECTIVES

The present research investigated whether Temporal Self-Regulation Theory (TST) can be used to help understand healthy and unhealthy eating intentions and behaviour.

DESIGN

A prospective design with two waves of data collection one week apart.

METHOD

An online survey measured the key components of TST (i.e., connectedness, timing and valence beliefs, intentions, past behaviour, habit strength, perceived environmental cues, and self-control) with respect to eating fruit and vegetables (F&V; N = 133) or unhealthy snacks (N = 125). Eating behaviour was assessed one week later.

RESULTS

The components of TST explained significant amounts of the variance in intentions and behaviour for intake of F&Vs (22% and 64%, respectively) and unhealthy snacks (18% and 35%, respectively). Beliefs about positive and negative short-term outcomes significantly predicted intentions to perform both behaviours. Intentions and past behaviour significantly predicted consumption of F&Vs, and past behaviour moderated the relationship between intention and behaviour which became stronger as past behaviour increased. Past behaviour and habit strength significantly predicted unhealthy snacking.

CONCLUSIONS

The findings suggest that TST may be a useful framework for understanding eating intentions and behaviour. However, research did not find support for all of the hypothesised relationships (e.g., self-regulatory capacity did not significantly predict eating behaviour and also failed to moderate the relationships between intentions and behaviour). Research using alternative measures of self-regulatory capacity, along with experimental manipulations of TST variables, may be needed to further understand eating intentions and behaviour.

Substituting activities mediates the effect of cognitive flexibility on physical activity: a daily diary study

Pursuit of physical activity goals often requires modifying plans, but research on these flexible processes is limited. Cognitive flexibility may heighten one's likelihood of using flexible self-regulatory strategies (e.g., substitution), thereby increasing physical activity. This study used daily diary methodology to test the indirect effect of cognitive flexibility on physical activity via activity substitution. A sample of 128 college students (73% female, mean age 19.9) completed baseline measures and cognitive flexibility assessments, then logged physical activity daily for 2 weeks. Activity substitution was defined as adopting an alternate activity on a day another planned activity was unfulfilled. Controlling for baseline activity, intentions, and time, a multilevel mediation model revealed a significant indirect effect of cognitive flexibility on physical activity via activity substitution (b = 81.36, p = .041). Our results indicate that people with greater cognitive flexibility are more likely to use flexible self-regulation, leading to greater physical activity.

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

Weight loss maintenance is a complex, multifaceted process that presents a significant challenge for most individuals who lose weight. A growing body of literature indicates a strong relationship between cognitive dysfunction and excessive body weight, and suggests that a subset of high-order cognitive processes known as executive functions (EF) likely play an important role in weight management. Recent reviews cover neuropsychological correlates of weight status yet fail to address the role of executive function in the central dilemma of successful weight loss maintenance. In this paper, we provide an overview of the existing literature examining executive functions as they relate to weight status and initial weight loss. Further, we propose a novel conceptual model of the relationships between EF, initial weight loss, and weight loss maintenance, mapping specific executive functions onto strategies known to be associated with both phases of the weight control process. Implications for the development of more efficacious weight loss maintenance interventions are discussed.

Executive functioning and dietary intake: Neurocognitive correlates of fruit, vegetable, and saturated fat intake in adults with obesity

Obesity is a significant public health issue, and is associated with poor diet. Evidence suggests that eating behavior is related to individual differences in executive functioning. Poor executive functioning is associated with poorer diet (few fruits and vegetables and high saturated fat) in normal weight samples; however, the relationship between these specific dietary behaviors and executive functioning have not been investigated in adults with obesity. The current study examined the association between executive functioning and intake of saturated fat, fruits, and vegetables in an overweight/obese sample using behavioral measures of executive function and dietary recall. One-hundred-ninety overweight and obese adults completed neuropsychological assessments measuring intelligence, planning ability, and inhibitory control followed by three dietary recall assessments within a month prior to beginning a behavioral weight loss treatment program. Inhibitory control and two of the three indices of planning each independently significantly predicted fruit and vegetable consumption such that those with better inhibition and planning ability consumed more fruits and vegetables. No relationship was found between executive functioning and saturated fat intake. Results increase understanding of how executive functioning influences eating behavior in overweight and obese adults, and suggest the importance of including executive functioning training components in dietary interventions for those with obesity. Further research is needed to determine causality as diet and executive functioning may bidirectionally influence each other.

A Bidirectional Relationship between Executive Function and Health Behavior: Evidence, Implications, and Future Directions

Physically active lifestyles and other health-enhancing behaviors play an important role in preserving executive function into old age. Conversely, emerging research suggests that executive functions facilitate participation in a broad range of healthy behaviors including physical activity and reduced fatty food, tobacco, and alcohol consumption. They do this by supporting the volition, planning, performance monitoring, and inhibition necessary to enact intentions and override urges to engage in health damaging behavior. Here, we focus firstly on evidence suggesting that health-enhancing behaviors can induce improvements in executive function. We then switch our focus to findings linking executive function to the consistent performance of health-promoting behaviors and the avoidance of health risk behaviors. We suggest that executive function, health behavior, and disease processes are interdependent. In particular, we argue that a positive feedback loop may exist whereby health behavior-induced changes in executive function foster subsequent health-enhancing behaviors, which in turn help sustain efficient executive functions and good health. We conclude by outlining the implications of this reciprocal relationship for intervention strategies, the design of research studies, and the study of healthy aging.

Development and validation of the Self-Regulation of Eating Behaviour Questionnaire for adults

Background

Eating self-regulatory capacity can help individuals to cope with the obesogenic environment and achieve, as well as maintain, a healthy weight and diet. At present, there is no comprehensive, reliable and valid questionnaire for assessing this capacity and measuring change in response to self-regulation interventions in adults. This paper reports the development of the Self-regulation of Eating Behaviour Questionnaire (SREBQ) for use in UK adults, and presents evidence for its reliability and construct validity.

The development of the SREBQ involved generation of an item pool, followed by two pilot studies (Samples 1 and 2) and a test of the questionnaire’s underlying factor structure (Sample 3). The final version of the SREBQ was then assessed for reliability and construct validity (Sample 4).

Results

Development of the SREBQ resulted in a 5-item questionnaire. The face validity was satisfactory, as assessed by the pilot studies. The factor structure analysis (Sample 3) suggested that it has a single underlying factor, which was confirmed in a second sample (Sample 4). The SREBQ had strong construct validity, showing a positive correlation with general measures of self-regulation. It was also positively correlated with motivation and behavioural automaticity, and negatively correlated with food responsiveness and emotional over-eating (p < 0.001). It showed good discriminant validity, as it was only weakly associated with satiety responsiveness, food fussiness and slowness in eating.

Conclusions

The SREBQ is a reliable and valid measure for assessment of eating self-regulatory capacity in the general UK adult population.

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-016-0414-6) contains supplementary material, which is available to authorized users.

Reduced Inhibitory Control Mediates the Relationship Between Cortical Thickness in the Right Superior Frontal Gyrus and Body Mass Index

Unhealthy eating behaviors often develop in the setting of inadequate inhibitory control, a function broadly ascribed to the prefrontal cortex (PFC). Regulation of inhibitory control by the PFC and its anatomical components and their contribution to increasing body mass index (BMI) are poorly understood. To study the role of PFC in the regulation of inhibitory control and body weight, we examined measures of cortical thickness in PFC sub-regions, inhibitory control (color-word interference task (CWIT)), and BMI in 91 healthy volunteers. We tested the predictive effect of PFC sub-regional cortical thickness on BMI and mediation by inhibitory control measured with CWIT. Measures of depression (BDI-II), anxiety (STAI-T) and trauma-related symptoms (TSC-40) were collected; the disinhibition scale of the three-factor eating questionnaire (TFEQ) was used to assess disinhibited eating. We then tested the relationship between BD-II, STAI-T, TSC-40, TFEQ, CWIT, and BMI with correlation analyses. Right superior frontal gyrus cortical thickness significantly predicted BMI (β=-0.91; t=-3.2; p=0.002). Mediation analysis showed a significant indirect effect of cortical thickness on BMI mediated by inhibitory control (95% CI=-6.1, -0.67). BMI was unrelated to BDI-II, STAI-T, TSC-40, or TFEQ scores. We found an inverse relationship between cortical thickness in the right-superior frontal gyrus and BMI, which was fully mediated by inhibitory control neurocognitive performance. Our results suggest possible targets for neuromodulation in obesity (ie superior frontal gyrus) and a quantifiable mediator of their effects (ie inhibitory control).

"You Can't Always Get What You Want": A Novel Research Paradigm to Explore the Relationship between Multiple Intentions and Behaviours

Objective

Research investigating cognitive moderators of the intention–behaviour relationship and psychological consequences of failure to enact intentions is usually conducted in a single‐behaviour paradigm. A multiple‐behaviour paradigm is introduced which overcomes bias inherent to single‐behaviour designs and allows testing of novel hypotheses. Two exploratory studies illustrate the utility of this new paradigm by investigating the role of cognitive predictors and psychological correlates of intention–behaviour relationships.

Method

The proposed method involves measuring multiple intentions across common areas of life activity at baseline and corresponding behaviours at follow‐up. In two studies, 51 intentions and behaviours were assessed (49 by self‐report, 2 objectively). In Study 1, participants (n = 126) also completed self‐reported measures of everyday cognitive failures and dysexecutive behaviours, crystallised intelligence (Mill Hill Vocabulary Scale) at baseline and Quality of Life (QoL; follow‐up). In Study 2, objective executive function measures (Stroop, Go/NoGo task and Word Fluency test) were completed by N = 30 participants.

Results

The total number of intentions, cognitive, and QoL measures were unrelated to the percentage of intentions enacted. Crystallised intelligence was related to successful intention implementation and problems with emotion regulation were associated with forming fewer intentions and with fewer failed intentions. QoL was strongly related with more intentions, regardless of whether or not these were implemented. Study 2 showed that cognitive flexibility (word fluency) and task errors, rather than Stroop effect and Go/No‐Go performance were related, to intention–behaviour congruence.

Conclusion

Intention–behaviour relationships might be better understood when considering the multiple intentions and behaviours that people are engaged in at once at any one point in time. A multiple‐behaviour paradigm suggests novel hypotheses. Preliminary findings reported here require replication. Anticipated applications of the paradigm are outlined and discussed.

Which behaviour change techniques are most effective at increasing older adults' self-efficacy and physical activity behaviour? A systematic review

BACKGROUND

Increasing self-efficacy is an effective mechanism for increasing physical activity, especially for older people.

PURPOSE

The aim of this review was to identify behaviour change techniques (BCTs) that increase self-efficacy and physical activity behaviour in non-clinical community-dwelling adults 60 years or over.

METHODS

A systematic search identified 24 eligible studies reporting change in self-efficacy for physical activity following an intervention. Moderator analyses examined whether the inclusion of specific BCTs (as defined by CALO-RE taxonomy) was associated with changes in self-efficacy and physical activity behaviour.

RESULTS

Overall, interventions increased self-efficacy (d = 0.37) and physical activity (d = 0.14). Self-regulatory techniques such as setting behavioural goals, prompting self-monitoring of behaviour, planning for relapses, providing normative information and providing feedback on performance were associated with lower levels of both self-efficacy and physical activity.

CONCLUSIONS

Many commonly used self-regulation intervention techniques that are effective for younger adults may not be effective for older adults.

The relationship between top-down attentional control and changes in weight

AIM

To investigate the relationship between top-down attentional control in the presence of food cues and weight change over a 3-month period.

METHOD

A Stroop task adapted to include background images of high-fat food and neutral items was completed by participants (N=60). Top-down attentional control was assessed by adaptation effects (Stroop effect is smaller when the previous trial is incongruent). To assess weight change, measurements were taken immediately after the Stroop task (T1) and again 3-months later (T2). Differences in weight between T1 and T2 were calculated and three groups formed: weight gain (n=20); weight loss (n=20); and no change in weight (n=20).

RESULTS

Differences in top-down attentional control were observed according to weight change. Participants who demonstrated reduced top-down attentional control also exhibited changes in weight (both loss and gain) over the 3-months. In contrast, the weight of participants who maintained top-down attentional control in the Stroop task remained stable.

CONCLUSIONS

Findings suggest that attentional control may have a role to play in actual eating behavior. Individuals who demonstrated reduced levels across of top-down attentional control also experienced changes in their weight over the 3-month period. Whether individuals lost or gained weight attentional control was reduced. This reduction was, however, not specific to high-fat food cues, but a general reduction in attentional control across both image conditions.

Sleep and food intake: A multisystem review of mechanisms in children and adults

The foods we eat have substantial impact on our health, and excessive food intake is associated with numerous long-term health conditions. It is therefore essential to understand the factors influencing this crucial health behavior. Research has identified sleep problems as one such factor; however, little research has examined how sleep problems impact food intake. Using a multisystemic perspective, this article proposes a variety of ways in which sleep problems likely increase food intake and illustrates the need for research to empirically examine these underlying mechanisms. Such research would have important treatment implications for health conditions often treated with dietary interventions.

Readiness for behaviour change in non-alcoholic fatty liver disease: implications for multidisciplinary care models

BACKGROUND & AIMS

Weight management is a cornerstone of treatment for overweight/obese persons with non-alcoholic fatty liver disease (NAFLD). This exploratory study sought to: (i) evaluate readiness to change weight-related behaviours; (ii) assess psychosocial characteristics that may interfere with weight loss; and (iii) evaluate how baseline psychosocial features associate with 6-month change in weight in persons with NAFLD receiving standard medical care. The purpose of this investigation was to develop hypotheses regarding relationships between psychosocial factors and weight for use in future fully powered studies and clinical interventions

METHODS

Fifty-eight overweight/obese participants with NAFLD completed baseline measures of personality, psychiatric symptoms and readiness for behaviour change and were followed up for 6 months in standard care.

RESULTS

One-third of participants (31.0%) were not interested in making weight-related behaviour changes; 58.6% were considering making a change, and 10.4% of individuals were actively working on or preparing to change. Six-month change in weight was non-significant and was not associated with baseline readiness for change. Depression, low conscientiousness and high neuroticism were associated with higher weight at 6-month follow-up with small to large effect sizes.

CONCLUSIONS

Although participants received nutritional education and guidance, very few individuals presented in the active stage of change. Although readiness for change did not predict subsequent change in weight, personality factors and psychiatric symptoms were associated with weight outcomes. Integrated multidisciplinary approaches that address psychiatric needs and provide behavioural support for weight loss may help patients with NAFLD implement sustained lifestyle changes.

A bidirectional relationship between physical activity and executive function in older adults

Physically active lifestyles contribute to better executive function. However, it is unclear whether high levels of executive function lead people to be more active. This study uses a large sample and multi-wave data to identify whether a reciprocal association exists between physical activity and executive function. Participants were 4555 older adults tracked across four waves of the English Longitudinal Study of Aging. In each wave executive function was assessed using a verbal fluency test and a letter cancelation task and participants reported their physical activity levels. Fixed effects regressions showed that changes in executive function corresponded with changes in physical activity. In longitudinal multilevel models low levels of physical activity led to subsequent declines in executive function. Importantly, poor executive function predicted reductions in physical activity over time. This association was found to be over 50% larger in magnitude than the contribution of physical activity to changes in executive function. This is the first study to identify evidence for a robust bidirectional link between executive function and physical activity in a large sample of older adults tracked over time.