Effects of a multicomponent behavioral intervention on impulsivity and cognitive deficits in adolescents with excess weight

Abstract

The aim of this study was to explore the effects of a multidisciplinary behavioral intervention including cognitive behavioral therapy, structured physical activity, and dietary counseling on impulsive personality and cognitive skills and subsequent BMI loss in excess weight adolescents. Forty-two adolescents with excess weight (14 males and 28 females, range 12-17 years), as defined by the International Obesity Task Force Criteria, participated in our study. We used a longitudinal observational design with two assessments: before and after treatment. We collected baseline measures of impulsive personality (UPPS-P scale), cognitive performance (letter number sequencing, Stroop and Iowa gambling task), and biometric parameters. After 12 weeks of intervention, parallel measures were used to determine whether treatment-induced changes in impulsivity and cognition predicted changes in BMI. BMI showed a statistically significant reduction after treatment [from mean (SD) 29.36 (4.51) to 27.31 (4.41), Cohen's d=0.5]. Greater reductions in negative urgency (negative-emotion-driven impulsivity) and greater improvement in cognitive inhibitory control skills were associated with greater reductions in BMI. Because the design was correlational and lacked a control group, future studies should clarify whether these associations reflect a causal effect or just overlapping improvements associated with a third variable (e.g. increases in attention procurement or motivation).

A systematic review of community‐based interventions for the treatment of adolescents with overweight and obesity

“…Studies specifically targeting adolescents reported reductions in BMIz ranging from 3 to 4% to 9% at intervention end which was similar to those studies targeting the whole family (range 2% to 9% ). Online‐only programs which did not involve any face‐to‐face sessions had somewhat smaller reductions in BMI (between 1% and 2–4% ) compared with face‐to‐face only programs (1% to 7% ), and those which involved technology in addition to face‐to‐face sessions (reductions in BMIz; 2% to 4% End‐I, 3–4% to 9–10% FU) did not appear to be more effective than those without technology (reductions in BMIz; 5% to 9% End‐I; 8–12% to 16% at FU). Program length and study quality did not appear to be associated with weight management outcomes.…”

“…Study, program and participant characteristics are reported in Table . Half of the programs were from the United States (US; n = 11) with the remainder from Europe ( n = 7) , Australia ( n = 2) and the United Kingdom (UK; n = 1) . The programs were evaluated as controlled trials ( n = 15), both randomized ( n = 10) and non‐randomized ( n = 5) , and as pre–post case series ( n = 6) .…”

“…Study quality was assessed to be weak for five programs ; moderate for eight ; and strong for eight . More than half of the programs were rated as being weak for selection bias ( n = 11) , as they involved self‐referrals from community advertisements and public service announcements, as is commonplace for community interventions, and thus participants were not selected at random from the eligible population.…”

“…where effect size was greatest partway through the program at 3 months (6%), reduced at 6 months (4%) and remained stable at 12 months (4%) . Seven programs, ranging in length from 6 weeks to 4 months, reported BMI as an outcome measure and had smaller effect sizes which ranged from 1% to 7% . Two of these programs reported BMI after a period of follow‐up, with the direction of the effect increasing (from 3% at 6 weeks to 4% at 10 weeks ) for one program and decreasing (from 5 to 6% at 4 months to 3–5% at 12 months and 0–2% at 24 months) for the other ).…”

Physical activity, diet and other behavioural interventions for improving cognition and school achievement in children and adolescents with obesity or overweight

“…Emerging evidence has linked obesity in children and adolescents to lower brain grey and white matter volume in brain regions associated with cognitive control and learning when compared to children and adolescents with healthy weight (Alarcón 2016; Alosco 2014; Kennedy 2016; Maayan 2011; Ou 2015; Yau 2014). This suggests a direct association between obesity and reduced cognitive and academic abilities, and is consistent with findings from animal models where manipulation of fat mass has been shown to affect cognition, probably as a result of inflammatory mechanisms.…”