Abstract
BackgroundTwo 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.MethodEighty 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.ResultsParticipants 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.ConclusionThese 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 registrationThe RCT was registered with the Australian New Zealand Registry of Clinical Trials (trial id: ACTRN12613000537752).
Highlights
Two primary factors that contribute to obesity are unhealthy eating and sedentary behavior
Participants receiving Cognitive Remediation Therapy (CRT)-O demonstrated improvements in both measures of executive function and reductions in both unhealthy habit outcomes compared to control
These results suggest that the effectiveness of CRT for obesity (CRT-O) may result from the disruption of unhealthy habits made possible by improvements in executive function
Summary
Two primary factors that contribute to obesity are unhealthy eating and sedentary behavior. These behaviors are difficult to change in the long-term because they are often enacted habitually. Several studies have demonstrated that the more habitual a person’s eating and/or sedentary behavior is, the more likely they are to engage in that behavior [2, 8, 47]. Engaging in these behaviors leads to weight gain in the long term [32]
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