9/18/2019 COPE WEBINAR SERIES FOR HEALTH PROFESSIONALS FINDING - PDF document

9/18/2019 COPE WEBINAR SERIES FOR HEALTH PROFESSIONALS FINDING SLIDES FOR TODAY’S WEBINAR September 25, 2019 The Role of Executive Functioning in www.villanova.edu/COPE Behavioral Weight Loss Outcomes Click on Meghan Butryn Ph.D. webinar description page Moderator: Lisa Diewald, MS, RD, LDN Program Manager MacDonald Center for Obesity Prevention and Education M. Louise Fitzpatrick College of Nursing Nursing Education Continuing Education Programming Research Nursing Education Continuing Education Programming Research 1 2 OBJECTIVES DID YOU USE YOUR PHONE TO ACCESS THE WEBINAR? If you are calling in today rather than 1. Describe the relationship between executive using your computer to log on, and need function and lifestyle modification 2. Review the methods and results from a CE credit, please email recent study describing how executive cope@villanova.edu and provide your functioning may predict weight loss and name so we can send your certificate. physical activity outcomes 3. Discuss clinical and practical implications and future research directions Nursing Education Continuing Education Programming Research Nursing Education Continuing Education Programming Research 3 4 CE CREDITS CE DETAILS • This webinar awards 1 contact hour for nurses and 1 CPEU for Villanova University College of Nursing is accredited as a dietitians provider of continuing nursing education by the American Nurses Credentialing Center Commission on Accreditation • Suggested CDR Learning Need Codes: 5370, 6000, 6010, 9020 Villanova University College of Nursing Continuing • Level 2 Education/COPE is a Continuing Professional Education (CPE) Accredited Provider with the Commission on Dietetic Registration • CDR Performance Indicators: 6.25, 8.1.2, 8.3.6 Nursing Education Continuing Education Programming Research Nursing Education Continuing Education Programming Research 5 6 1

9/18/2019 The Role of Executive Functioning in DISCLOSURE Behavioral Weight Loss Outcomes Neither the planners or presenter have any conflicts of Meghan L. Butryn, PhD. interest to disclose. Director of Research Accredited status does not imply endorsement by Villanova Center for Weight, Eating, and Lifestyle Science University, COPE or the American Nurses Credentialing Drexel University Center of any commercial products or medical/nutrition advice displayed in conjunction with an activity. 7 8 The role of executive functioning in behavioral weight loss Lifestyle Modification outcomes • Recommended as a first line treatment for individuals with obesity Meghan L. Butryn, PhD. • However, changing diet and exercise behaviors is often challenging • More research is needed to identify individual‐level factors that facilitate or hinder weight‐related behavior change. 9 10 Obesity and Executive Function Executive Function Organization • Executive functions are A growing body of literature suggests that a subset of higher‐level cognitive top‐down cognitive processes, known as executive Set Shifting processes that are critical for functions (EF), likely play a key role in the onset, self‐regulation and goal‐ development, and maintenance of obesity. oriented behavior. Working Memory 11 12 2

9/18/2019 EF and Obesity Weight Control and EF • Compared to normal weight controls, individuals with obesity demonstrate poorer performance on a range of EF tasks (Dassen, • In our modern environment Houben, Allom, & Jansen, 2018; Fitzpatrick et al., 2013; Lavagnino et al., 2016; highly palatable foods are Martin & Davidson, 2014; Yang et al., 2018). omnipresent and sedentary • There is a possible bidirectional relationship between EF and obesity, lifestyles are common. with poor EF as both a risk factor and a consequence of obesity (Smith, • As such, weight regulation may Hay, Campbell, & Trollor, 2011). be particularly challenging for • Longitudinal studies also indicate improvements in EF following WL, individuals with weaknesses in (Veronese et al., 2017) suggesting potential cognitive benefits to WL. executive functioning. 13 14 Your examples: Examples of Role of EF in Weight Control Organization Planning Problem Set shifting Working Inhibition solving (switch from memory (use one task to relevant info Weight Control Goal Challenge EF another) in middle of Limit Calorie Intake Good‐tasting foods that are Enact inhibitory control by activity) readily available refraining from eating palatable Eating food behavior Physical Achieve adequate energy Sedentary workplace and long Use planning skills to create Activity expenditure commute leaves limited time opportunities for physical Other aspects for activity activity of weight Make eating and exercise Competing demands (e.g., Attention and working memory control (e.g., attending goals a priority related to family, career) may are likely required to keep one’s treatment seem more pressing in the long‐term goals in mind session, moment logging food) 15 16 EF and Weight Loss Outcomes EF and Weight Loss Outcomes • More research is needed to understand the multifaceted nature of EF • Majority of evidence comes from child and adolescent samples as it relates to WL outcomes. Only two prior studies measured (Augustijn et al., 2018; Naar‐King et al., 2016; Nederkoorn, Jansen, Mulkens, & multiple facets of EF in adults: Jansen, 2007; Xu et al., 2017). • Galioto et al., 2016: poorer set‐shifting and IC predicted worse 8‐week • In research with adult samples, two studies used a food‐specific percent weight loss outcomes in a medically‐supervised program using meal inhibitory control (IC) measure of EF to prospectively predict WL replacements. outcomes: • Dassen et al., 2018: better behavioral WM and self‐reported IC was • Brockmeyer et al., 2016: food‐specific IC interacted with hedonic liking of food associated with greater 6m WL outcomes. Behavioral tasks measuring to predict WL, such that low IC and high hedonic liking was associated with general and food‐specific inhibition and set‐shifting were not significantly worse WL outcomes. associated with WL outcomes. • Manasse et al., 2017: better performance on a food‐specific IC task at baseline predicted greater percent weight loss at 12 months. 17 18 3

9/18/2019 Summary EF and Physical Activity • Conceptual models of LM highlight the important role of EF in inhibiting and initiating key weight‐related behaviors (Buckley et al., • Engaging in PA leads to improved EF 2014; Gettens & Gorin, 2017; Sutin et al., 2018). (Guiney & Machado, 2013; Hugenschmidt et al., • Prospective research is needed to examine how EF might predict 2019; Moreau & Chou, 2019; Northey et al., 2018). treatment outcomes in adults with obesity. • However, it is unclear to what extent • Identifying pre‐treatment predictors of WL and PA may inform the baseline EF facilitates the adoption of PA. development of tailored interventions for individuals who are at risk • Prior research was conducted primarily for suboptimal outcomes. with older adults (Aartolahti, et al., 2015; Daly, McMinn, & Allan, 2014; Gothe et al., 2014; McAuley et al., 2011) who may differ in meaningful ways from the general population of WL‐seeking adults. 19 20 Current Study Participants • Participants were recruited from the community for a clinical trial (NCT02363010) of weight loss treatment This study aimed to test the hypothesis that in a sample of OW/OB • BMI 27‐45 kg/m 2 adults entering a lifestyle modification program, better EF at baseline • 18‐70 years old would predict greater WL and PA after 6 months of treatment. • No medical contraindications to participating and were physically able to begin exercising • Exclusion criteria: • Hx of bariatric surgery, the use of weight‐affecting medication, >5% weight loss in the a) Using a baseline measure of EF that was past 6 months, or a diagnosis of major medical or psychiatric condition that would Aimed to address gaps in the standardized, objective, and multi‐faceted. interfere with participation literature by: b) Objectively measuring changes in weight • Women who were currently nursing, pregnant, or planning to become pregnant over and physical activity. the course of the study 21 22 Intervention Measures • Group‐based lifestyle modification, 16 sessions over 6 months • Participant characteristics • Treatment protocol adapted from Look AHEAD and Diabetes Prevention Program. • Reported age, gender, race, and ethnicity at baseline • Emphasized self‐monitoring of calorie intake as a core skill. • Weight • Participants also learned stimulus control, problem solving, goal setting, and social • Measured in clinic at baseline and 6 months using a Tanita model WB‐3000 support skills. digital scale • Weight loss goal = 10% • Moderate‐to‐vigorous physical activity (MVPA) • PA goal = gradually increase to 250 minutes of MVPA per week • ActiGraph GT3X tri‐axial, solid state accelerometers • Accelerometers were distributed to participants at baseline and 6 months, with the instruction to wear them for the following seven consecutive days for all waking hours • Bouted MVPA calculated (10 min or more per episode) 23 24 4