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

Abstract

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.

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

“…Only in recent years, the studies focused their attention on the relationship between excessive body weight and EFs (Fitzpatrick et al, 2013). This relationship appears to be confirmed by most of the studies, both cross-sectional (e.g., Verdejo-García et al, 2010; Cohen et al, 2011; Maayan et al, 2011; Dassen et al, 2018a) and longitudinal (e.g., Spitznagel et al, 2013; Alosco et al, 2014d, 2015; Augustijn et al, 2018), analyzed in this systematic review, despite the heterogeneity of the tasks used and the methodological framework adopted. Functional and neuroimaging studies confirmed changes in the cortical areas involved in executive functioning in participants with obesity (Stingl et al, 2012; Alarcón et al, 2016; Tsai et al, 2016) even when cognitive tasks failed to highlight any significant differences in performance between obesity and normal-weight conditions (Hendrick et al, 2012; Frank et al, 2014; Pearce et al, 2017).…”

“…Eleven studies (Pauli-Pott et al, 2010; Spitznagel et al, 2013, 2014; Kulendran et al, 2014; Galioto et al, 2015, 2016; Xu et al, 2017; Augustijn et al, 2018; Dassen et al, 2018a; Stinson et al, 2018) investigated the predictive role of performance on executive tasks on body weight changes, and observed that appropriate executive functioning predicted a reduction in body weight in participants with obesity or overweight.…”

“…Twenty-seven studies assessed the differences between groups on cognitive flexibility (see Table 3); only eight of them found no differences in cognitive flexibility between normal-weight and overweight/obese groups (Gonzales et al, 2010; Ariza et al, 2012; Delgado-Rico et al, 2012; Catoira et al, 2016; Schiff et al, 2016; Kittel et al, 2017; Sweat et al, 2017; Dassen et al, 2018a). In general, the results showed greater difficulty in performing tasks involving this function in participants with obesity compared to those with normal-weight.…”

Psychiatric Aspects of Obesity: A Narrative Review of Pathophysiology and Psychopathology

“…There are two main subtraits of impulsivity: rapid response impulsivity (or "motor impulsiveness" in Barrattian terminology) which is the tendency to react rapidly to internal or external stimuli, without adequate forethought; and reward delay or choice or decisional impulsivity (much similar to the "nonplanning" impulsiveness of Barratt's and Eysenck's scales) which is defined by the intolerance for reward delay and the increased rates of temporal discounting [117][118][119]. Both studies using self-report questionnaires and those using behavioral tasks support the concept that obesity and eating disorders are associated with various levels and types of impulsive subtraits, which are supposedly accounted for by a deficient top-down cognitive inhibitory control over prepotent responses and subsequent imbalance between impulsive and reflective systems [111,120]. In particular, the population with obesity as a whole seems to be more impulsive and more sensitive to reward than normal weight control subjects, and patients with BED seem to exhibit higher levels of "rapid response" or "motor" impulsivity [118,120,121].…”

“…Coherently, cognitive training approaches have recently demonstrated some effectiveness in facilitating weight loss and reducing unhealthy behaviors [108,109]. In addition, pretreatment cognitive functions have been suggested as a prognostic index for the success of weight loss programs and the outcome of bariatric surgery [110,111], although data on this association are still heterogeneous [112,113]. Obesity, in turn, is thought to biologically promote neuroprogression/-degeneration, and recent studies show that BMI reduction improves cognitive function and memory performances in patients with obesity, thus supporting the hypothesis of some obesity-driven brain dysfunctions [114][115][116].…”