Breaking bad habits by improving executive function in individuals with obesity

Vanessa Allom; Barbara Mullan; Evelyn Smith; Phillipa Hay; Jayanthi Raman

doi:10.1186/s12889-018-5392-y

Breaking bad habits by improving executive function in individuals with obesity

BMC Public Health. 2018 Apr 16;18(1):505. doi: 10.1186/s12889-018-5392-y.

Authors

Vanessa Allom¹, Barbara Mullan¹, Evelyn Smith^{2

3}, Phillipa Hay⁴, Jayanthi Raman⁵

Affiliations

¹ Health Psychology and Behavioral Medicine Research Group, School of Psychology and Speech Pathology, Curtin University, Perth, Australia.
² Eating disorders and Obesity Psychology Research Clinic (EDOC), School of Social Sciences and Psychology, Western Sydney University, Penrith, NSW, 2751, Australia. Evelyn.Smith@westernsydney.edu.au.
³ Clinical and Health Psychology Research Initiative, School of Social Sciences and Psychology, Western Sydney University, Sydney, Australia. Evelyn.Smith@westernsydney.edu.au.
⁴ School of Medicine, Western Sydney University, Sydney, Australia.
⁵ Clinical Psychology, Graduate School of Health, University of Technology Sydney (UTS), Sydney, Australia.

Abstract

Background: Two primary factors that contribute to obesity are unhealthy eating and sedentary behavior. These behaviors are particularly difficult to change in the long-term because they are often enacted habitually. Cognitive Remediation Therapy has been modified and applied to the treatment of obesity (CRT-O) with preliminary results of a randomized controlled trial demonstrating significant weight loss and improvements in executive function. The objective of this study was to conduct a secondary data analysis of the CRT-O trial to evaluate whether CRT-O reduces unhealthy habits that contribute to obesity via improvements in executive function.

Method: Eighty participants with obesity were randomized to CRT-O or control. Measures of executive function (Wisconsin Card Sort Task and Trail Making Task) and unhealthy eating and sedentary behavior habits were administered at baseline, post-intervention and at 3 month follow-up.

Results: Participants receiving CRT-O demonstrated improvements in both measures of executive function and reductions in both unhealthy habit outcomes compared to control. Mediation analyses revealed that change in one element of executive function performance (Wisconsin Card Sort Task perseverance errors) mediated the effect of CRT-O on changes in both habit outcomes.

Conclusion: These results suggest that the effectiveness of CRT-O may result from the disruption of unhealthy habits made possible by improvements in executive function. In particular, it appears that cognitive flexibility, as measured by the Wisconsin Card Sort task, is a key mechanism in this process. Improving cognitive flexibility may enable individuals to capitalise on interruptions in unhealthy habits by adjusting their behavior in line with their weight loss goals rather than persisting with an unhealthy choice.

Trial registration: The RCT was registered with the Australian New Zealand Registry of Clinical Trials (trial id: ACTRN12613000537752 ).

Keywords: Executive function; Habit; Obesity; Sedentary; Weight loss intervention.

Publication types

Randomized Controlled Trial

MeSH terms

Adolescent
Adult
Eating / psychology
Executive Function / physiology*
Female
Habits
Health Behavior
Humans
Male
Middle Aged
Obesity / prevention & control*
Obesity / psychology*
Program Evaluation
Sedentary Behavior
Weight Reduction Programs / methods*
Young Adult