Top

BMC Public Health

Published in:

Open Access 01-12-2018 | Research article

Breaking bad habits by improving executive function in individuals with obesity

Authors: Vanessa Allom, Barbara Mullan, Evelyn Smith, Phillipa Hay, Jayanthi Raman

Published in: BMC Public Health | Issue 1/2018

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).

Note that change in WCST perseverance errors and change in TMT performance variables are calculated as the difference between baseline and post-intervention scores as the intervention was hypothesized to influence this ability immediately, whereas change in unhealthy eating habit and change in unhealthy sedentary behaviour are calculated as the difference between baseline and follow-up scores as habit theory would suggest that change in habit strength may be delayed or not discernible immediately after intervention. Analysis revealed that changes in WCST and TMT observed from baseline to post-intervention were maintained from post-intervention to follow-up, and examining change from baseline to follow-up did not alter the results.

Allan JL, McMinn D, Daly M. A bidirectional relationship between executive function and health behavior: evidence, implications, and future directions. Front Neurosci. 2016;10 https://doi.org/10.3389/fnins.2016.00386.

Allom V, Mullan B. Self-regulation versus habit: the influence of self-schema on fruit and vegetable consumption. Psychol Health. 2012;27:7–24. https://doi.org/10.1080/08870446.2011.605138.CrossRefPubMed

Allom V, Mullan B. Individual differences in executive function predict distinct eating Behaviors. Appetite. 2014;80:123–30. https://doi.org/10.1016/j.appet.2014.05.007.CrossRefPubMed

Allom V, Mullan B, Hagger M. Does inhibitory control training improve health behavior? A meta-analysis. Health Psychol Rev. 2016;10:168–86. https://doi.org/10.1080/17437199.2015.1051078.CrossRefPubMed

Baddeley A. Exploring the central executive. Quart J Exp Psychol. 1996;49:5–28. https://doi.org/10.1080/713755608.CrossRef

Buchsbaum BR, Greer S, Chang WL, Berman KF. Meta-analysis of neuroimaging studies of the Wisconsin card-sorting task and component processes. Hum Brain Mapp. 2005;25:35–45. https://doi.org/10.1002/hbm.20128.CrossRefPubMed

Carels RA, Burmeister JM, Koball AM, Oehlhof MW, Hinman N, LeRoy M, et al. A randomized trial comparing two approaches to weight loss: differences in weight loss maintenance. J Health Psychol. 2014;19:296–311. https://doi.org/10.1177/1359105312470156.CrossRefPubMed

Conroy DE, Maher JP, Elavsky S, Hyde AL, Doerksen SE. Sedentary behavior as a daily process regulated by habits and intentions. Health Psychol. 2013;32:1149. https://doi.org/10.1037/a0031629.CrossRefPubMedPubMedCentral

Dombrowski SU, Knittle K, Avenell A, Araujo-Soares V, Sniehotta FF. Long term maintenance of weight loss with non-surgical interventions in obese adults: systematic review and meta-analyses of randomised controlled trials. BMJ. 2014;348:g2646. https://doi.org/10.1136/bmj.g2646.CrossRefPubMedPubMedCentral

10.

Fagundo AB, De La Torre R, Jiménez-Murcia S, Agüera Z, Granero R, Tárrega S, et al. Executive functions profile in extreme eating/weight conditions: from anorexia nervosa to obesity. PLoS One. 2012;7:e43382. https://doi.org/10.1371/journal.pone.0043382.CrossRefPubMedPubMedCentral

11.

Fitzpatrick S, Gilbert S, Serpell L. Systematic review: are overweight and obese individuals impaired on behavioral tasks of executive functioning? Neuropsychol Rev. 2013;23:138–56. https://doi.org/10.1007/s11065-013-9224-7.CrossRefPubMed

12.

Gardner B, de Bruijn G-J, Lally P. A systematic review and meta-analysis of applications of the self-report habit index to nutrition and physical activity Behaviors. Ann Behav Med. 2011;42:174–87. https://doi.org/10.1007/s12160-011-9282-0.CrossRefPubMed

13.

Gardner B, Sheals K, Wardle J, McGowan L. Putting habit into practice, and practice into habit: a process evaluation and exploration of the acceptability of a habit-based dietary behavior change intervention. Int J Behav Nutr Phys Act. 2014;11:135. https://doi.org/10.1186/s12966-014-0135-7.CrossRefPubMedPubMedCentral

14.

Gardner B, Smith L, Lorencatto F, Hamer M, Biddle SJ. How to reduce sitting time? A review of behavior change strategies used in sedentary behavior reduction interventions among adults. Health Psychol Rev. 2016;10:89–112. https://doi.org/10.1080/17437199.2015.1082146.CrossRefPubMed

15.

Grant DA. Perceptual versus analytical responses to the number concept of a Weigl-type card sorting test. J Exp Psychol. 1951;41:23. https://doi.org/10.1037/h0059713.CrossRefPubMed

16.

Harris M. Wisconsin card sorting test: computer version. Odessa: Psychological Assessment Resources; 1988.

17.

Hayes, A. F. (2012). Process: a versatile computational tool for observed variable mediation, moderation, and conditional process modeling [white paper]. From http://www.afhayes.com/public/process2012.pdf

18.

Heaton RK. A manual for the Wisconsin card sorting test. Odessa: Psychological Assessment Resources, Inc.; 1981.

19.

Hillman CH, Motl RW, Pontifex MB, Posthuma D, Stubbe JH, Boomsma DI, De Geus EJ. Physical activity and cognitive function in a cross-section of younger and older community-dwelling individuals. Health Psychol. 2006;25:678. https://doi.org/10.1037/0278-6133.25.6.678.CrossRefPubMed

20.

Hofmann W, Schmeichel BJ, Baddeley AD. Executive functions and self-regulation. Trends Cogn Sci. 2012;16(3):174–80.CrossRefPubMed

21.

Institute of Medicine. Weighing the options: criteria for evaluating weight-management programs. Washington DC: National Academies Press; 1995.CrossRef

22.

Jager W. Breaking ‘bad habits’: a dynamical perspective on habit formation and change. In: Hendrickx L, Jager W, Steg L, editors. Human decision making and environmental perception. Understanding and assisting human decision making in real-life settings. Groningen: University of Groningen; 2003.

23.

Jolly K, Lewis A, Beach J, Denley J, Adab P, Deeks JJ, et al. Comparison of range of commercial or primary care led weight reduction Programmes with minimal intervention control for weight loss in obesity: lighten up randomised controlled trial. BMJ. 2011;343:d6500. https://doi.org/10.1136/bmj.d6500.CrossRefPubMedPubMedCentral

24.

Jurado MB, Rosselli M. The elusive nature of executive functions: a review of our current understanding. Neuropsychol Rev. 2007;17:213–33. https://doi.org/10.1007/s11065-007-9040-z.CrossRefPubMed

25.

Kliemann N, Vickerstaff V, Croker H, Johnson F, Nazareth I, Beeken RJ. The Role of Self-Regulatory Skills and Automaticity on the Effectiveness of a Brief Weight Loss Habit-Based Intervention: Secondary Analysis of the 10 Top Tips Randomised Trial. Int J Behav Nutr Phys Act. 2017;14(1):119.

26.

Kurtz MM, Moberg PJ, Gur RC, Gur RE. Approaches to cognitive remediation of neuropsychological deficits in schizophrenia: a review and meta-analysis. Neuropsychol Rev. 2001;11:197–210. https://doi.org/10.1023/A:1012953108158.CrossRefPubMed

27.

Lally P, Van Jaarsveld CH, Potts HW, Wardle J. How are habits formed: modelling habit formation in the real world. Eur J Soc Psychol. 2010;40:998–1009. https://doi.org/10.1002/ejsp.674.CrossRef

28.

Matei R, Thuné-Boyle I, Hamer M, Iliffe S, Fox KR, Jefferis BJ, Gardner B. Acceptability of a theory-based sedentary behavior reduction intervention for older adults (‘on your feet to earn your seat’). BMC Public Health. 2015;15:1. https://doi.org/10.1186/s12889-015-1921-0.CrossRef

29.

McEachan RR, Lawton RJ, Conner M. Classifying health-related Behaviors: exploring similarities and differences amongst Behaviors. Br J Health Psychol. 2010;15:347–66. https://doi.org/10.1348/135910709X466487.CrossRefPubMed

30.

Milner B. Effects of different brain lesions on card sorting: the role of the frontal lobes. Arch Neurol. 1963;9:90–100. https://doi.org/10.1001/archneur.1963.00460070100010.CrossRef

31.

Miyake A, Friedman NP, Emerson MJ, Witzki AH, Howerter A, Wager TD. The Unity and Diversity of executive functions and their contributions to complex “frontal lobe” tasks: a latent variable analysis. Cogn Psychol. 2000;41:49–100. https://doi.org/10.1006/cogp.1999.0734.CrossRefPubMed

32.

Mozaffarian D, Hao T, Rimm EB, Willett WC, Hu FB. Changes in diet and lifestyle and long-term weight gain in women and men. N Engl J Med. 2011;364:2392–404. https://doi.org/10.1056/NEJMoa1014296.CrossRefPubMedPubMedCentral

33.

Nederkoorn C, Houben K, Hofmann W, Roefs A, Jansen A. Control yourself or just eat what you like? Weight gain over a year is predicted by an interactive effect of response inhibition and implicit preference for snack foods. Health Psychol. 2010;29:389. https://doi.org/10.1037/a0019921.CrossRefPubMed

34.

Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional, and National Prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the global burden of disease study 2013. Lancet. 2014;384:766–81. https://doi.org/10.1016/S0140-6736(14)60460-8.CrossRefPubMedPubMedCentral

35.

Nudelman G, Shiloh S. Understanding behavioral clusters: identifying differences between clusters of health Behaviors on key constructs. Psychol Health. 2016:1–35. https://doi.org/10.1080/08870446.2016.1208822.

36.

Raman J, Hay P, Smith E. Manualised cognitive remediation therapy for adult obesity: study protocol for a randomised controlled trial. Trials. 2014;15:426. https://doi.org/10.1186/1745-6215-15-426.

37.

Raman J, Hay P, Tchanturia K, Smith E. A randomised controlled trial of manualized cognitive remediation therapy in adult obesity. Appetite. 2018;123:269–79. https://doi.org/10.1016/j.appet.2017.12.023. Epub 2017 Dec 24.

38.

Reitan RM. Qualitative versus quantitative mental changes following brain damage. J Psychol. 1958;46:339–46. https://doi.org/10.1080/00223980.1958.9916299.CrossRef

39.

Roberts ME, Tchanturia K, Stahl D, Southgate L, Treasure J. A systematic review and meta-analysis of set-shifting ability in eating disorders. Psychol Med. 2007;37:1075–84. https://doi.org/10.1017/S0033291707009877.CrossRefPubMed

40.

Rothman AJ, Sheeran P, Wood W. Reflective and automatic processes in the initiation and maintenance of dietary change. Ann Behav Med. 2009;38:4–17. https://doi.org/10.1007/s12160-009-9118-3.CrossRef

41.

Sanchez-Cubillo I, Perianez J, Adrover-Roig D, Rodriguez-Sanchez J, Rios-Lago M, Tirapu J, Barcelo F. Construct validity of the trail making test: role of task-switching, working memory, inhibition/interference control, and Visuomotor abilities. J Int Neuropsychol Soc. 2009;15:438–50. https://doi.org/10.1017/S1355617709090626.CrossRefPubMed

42.

Smith E, Hay P, Campbell L, Trollor J. A review of the association between obesity and cognitive function across the lifespan: implications for novel approaches to prevention and treatment. Obes Rev. 2011;12:740–55. https://doi.org/10.1111/j.1467-789X.2011.00920.x.CrossRefPubMed

43.

Strack F, Deutsch R. Reflective and impulsive determinants of social behavior. Pers Soc Psychol Rev. 2004;8(3):220–47.

44.

Tchanturia K. Cognitive remediation therapy (Crt) for eating and weight disorders. New York: NY: Routledge; 2015.

45.

Tchanturia K, Campbell IC, Morris R, Treasure J. Neuropsychological studies in anorexia nervosa. Int J Eat Disord. 2005;37:S72–6. https://doi.org/10.1002/eat.20119.CrossRefPubMed

46.

van’t Riet J, Sijtsema SJ, Dagevos H, De Bruijn G-J. The importance of habits in eating behavior. An overview and recommendations for future research. Appetite. 2011;57:585–96. https://doi.org/10.1016/j.appet.2011.07.010.CrossRefPubMed

47.

Verhoeven AA, Adriaanse MA, Evers C, de Ridder DT. The power of habits: unhealthy snacking behavior is primarily predicted by habit strength. Br J Health Psychol. 2012;17:758–70. https://doi.org/10.1111/j.2044-8287.2012.02070.x.CrossRefPubMed

48.

Verplanken B, Orbell S. Reflections on past behavior: a self-report index of habit strength. J Appl Soc Psychol. 2003;33:1313–30. https://doi.org/10.1111/j.1559-1816.2003.tb01951.x.CrossRef

49.

World Health Organisation. Noncommunicable diseases: fact sheet. 2015. from http://www.who.int/mediacentre/factsheets/fs355/en/.

Title: Breaking bad habits by improving executive function in individuals with obesity
Authors: Vanessa Allom
Barbara Mullan
Evelyn Smith
Phillipa Hay
Jayanthi Raman
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: BMC Public Health / Issue 1/2018
Electronic ISSN: 1471-2458
DOI: https://doi.org/10.1186/s12889-018-5392-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Breaking bad habits by improving executive function in individuals with obesity

Abstract

Background

Method

Results

Conclusion

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Method

Results

Conclusion

Trial registration

Please log in to get access to this content

Other articles of this Issue 1/2018

Associations between national viral hepatitis policies/programmes and country-level socioeconomic factors: a sub-analysis of data from the 2013 WHO viral hepatitis policy report

Are we really “eating well with Canada’s food guide”?

Human-animal interaction as a social determinant of health: descriptive findings from the health and retirement study

Gender-dependent association between sleep duration and overweight incidence in CHINESE school children: a national follow-up study

Playground activities and gender variation in objectively measured physical activity intensity in Australian primary school children: a repeated measures study

Neighborhood social capital and sleep duration: a population based cross-sectional study in a rural Japanese town