Computerized neurocognitive training for improving dietary health and facilitating weight loss

Abstract

Nearly 70% of Americans are overweight, in large part because of overconsumption of high-calorie foods such as sweets. Reducing sweets is difficult because powerful drives toward reward overwhelm inhibitory control (i.e., the ability to withhold a prepotent response) capacities. Computerized inhibitory control trainings (ICTs) have shown positive outcomes, but impact on real-world health behavior has been variable, potentially because of limitations inherent in existing paradigms, e.g., low in frequency, intrinsic enjoyment, personalization, and ability to adapt to increasing ability. The present study aimed to assess the feasibility, acceptability, and efficacy of a gamified and non-gamified, daily, personalized, and adaptive ICT designed to facilitate weight loss by targeting consumption of sweets. Participants (N = 106) were randomized to one of four conditions in a 2 (gamified vs. non-gamified) by 2 (ICT vs. sham) factorial design. Participants were prescribed a no-added-sugar diet and completed 42 daily, at-home trainings, followed by two weekly booster trainings. Results indicated that the ICTs were feasible and acceptable. Surprisingly, compliance to the 44 trainings was excellent (88.8%) and equivalent across both gamified and non-gamified conditions. As hypothesized, the impact of ICT on weight loss was moderated by implicit preference for sweet foods [F(1,95) = 6.17, p = .02] such that only those with higher-than-average implicit preference benefited (8-week weight losses for ICT were 3.1% vs. 2.2% for sham). A marginally significant effect was observed for gamification to reduce the impact of ICT. Implications of findings for continued development of ICTs to impact health behavior are discussed.

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Acknowledgements

The authors would like to thank Cara Dochat, Valerie Everett, and Jerry Martin for their help coordinating the study, and Michael Wagner, Travis Chandler, Josh Korn, Ricardo Concha, and Rachel Buttry for their help creating and maintaining the project’s graphics and code.

Funding

This study was funded by the National Cancer Institute (R21CA191859; PI: E Forman).

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Correspondence to Evan M. Forman.

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Evan Forman declares that he has no conflict of interest. Stephanie Manasse declares that she has no conflict of interest. Diane Dallal declares that she has no conflict of interest. Rebecca Crochiere declares that she has no conflict of interest. Caitlin Loyka declares that she has no conflict of interest. Meghan Butryn declares that she has no conflict of interest. Adrienne Juarascio declares that she has no conflict of interest. Katrijn Houben declares that she has no conflict of interest.

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All procedures followed were in accordance with ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

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Forman, E.M., Manasse, S.M., Dallal, D.H. et al. Computerized neurocognitive training for improving dietary health and facilitating weight loss. J Behav Med 42, 1029–1040 (2019). https://doi.org/10.1007/s10865-019-00024-5

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Keywords

  • Inhibitory control training
  • Health behavior
  • Diet
  • Obesity
  • Weight loss
  • Gamification