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

9/18/2019 COPE WEBINAR SERIES FOR HEALTH PROFESSIONALS September 25, 2019 The Role of Executive Functioning in Behavioral Weight Loss Outcomes 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 1 FINDING SLIDES FOR TODAY’S WEBINAR www.villanova.edu/COPE Click on Meghan Butryn Ph.D. webinar description page Nursing Education Continuing Education Programming Research 2 DID YOU USE YOUR PHONE TO ACCESS THE WEBINAR? If you are calling in today rather than using your computer to log on, and need CE credit, please email cope@villanova.edu and provide your name so we can send your certificate. Nursing Education Continuing Education Programming Research 3 1

9/18/2019 OBJECTIVES 1. Describe the relationship between executive function and lifestyle modification 2. Review the methods and results from a recent study describing how executive functioning may predict weight loss and physical activity outcomes 3. Discuss clinical and practical implications and future research directions Nursing Education Continuing Education Programming Research 4 CE DETAILS Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center Commission on Accreditation Villanova University College of Nursing Continuing Education/COPE is a Continuing Professional Education (CPE) Accredited Provider with the Commission on Dietetic Registration Nursing Education Continuing Education Programming Research 5 CE CREDITS • This webinar awards 1 contact hour for nurses and 1 CPEU for dietitians • Suggested CDR Learning Need Codes: 5370, 6000, 6010, 9020 • Level 2 • CDR Performance Indicators: 6.25, 8.1.2, 8.3.6 Nursing Education Continuing Education Programming Research 6 2

9/18/2019 The Role of Executive Functioning in Behavioral Weight Loss Outcomes Meghan L. Butryn, PhD. Director of Research Center for Weight, Eating, and Lifestyle Science Drexel University 7 DISCLOSURE Neither the planners or presenter have any conflicts of interest to disclose. Accredited status does not imply endorsement by Villanova University, COPE or the American Nurses Credentialing Center of any commercial products or medical/nutrition advice displayed in conjunction with an activity. 8 The role of executive functioning in behavioral weight loss outcomes Meghan L. Butryn, PhD. 9 3

9/18/2019 Lifestyle Modification • Recommended as a first line treatment for individuals with obesity • 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. 10 Obesity and Executive Function A growing body of literature suggests that a subset of top‐down cognitive processes, known as executive functions (EF), likely play a key role in the onset, development, and maintenance of obesity. 11 Executive Function Organization • Executive functions are higher‐level cognitive Set Shifting processes that are critical for self‐regulation and goal‐ oriented behavior. Working Memory 12 4

9/18/2019 EF and Obesity • Compared to normal weight controls, individuals with obesity demonstrate poorer performance on a range of EF tasks (Dassen, Houben, Allom, & Jansen, 2018; Fitzpatrick et al., 2013; Lavagnino et al., 2016; Martin & Davidson, 2014; Yang et al., 2018). • There is a possible bidirectional relationship between EF and obesity, with poor EF as both a risk factor and a consequence of obesity (Smith, Hay, Campbell, & Trollor, 2011). • Longitudinal studies also indicate improvements in EF following WL, (Veronese et al., 2017) suggesting potential cognitive benefits to WL. 13 Weight Control and EF • In our modern environment highly palatable foods are omnipresent and sedentary lifestyles are common. • As such, weight regulation may be particularly challenging for individuals with weaknesses in executive functioning. 14 Examples of Role of EF in Weight Control Weight Control Goal Challenge EF Limit Calorie Intake Good‐tasting foods that are Enact inhibitory control by readily available refraining from eating palatable food Achieve adequate energy Sedentary workplace and long Use planning skills to create expenditure commute leaves limited time opportunities for physical for activity activity Make eating and exercise Competing demands (e.g., Attention and working memory goals a priority related to family, career) may are likely required to keep one’s seem more pressing in the long‐term goals in mind moment 15 5

9/18/2019 Your examples: Organization Planning Problem Set shifting Working Inhibition solving (switch from memory (use one task to relevant info another) in middle of activity) Eating behavior Physical Activity Other aspects of weight control (e.g., attending treatment session, logging food) 16 EF and Weight Loss Outcomes • Majority of evidence comes from child and adolescent samples (Augustijn et al., 2018; Naar‐King et al., 2016; Nederkoorn, Jansen, Mulkens, & Jansen, 2007; Xu et al., 2017). • In research with adult samples, two studies used a food‐specific inhibitory control (IC) measure of EF to prospectively predict WL outcomes: • Brockmeyer et al., 2016: food‐specific IC interacted with hedonic liking of food to predict WL, such that low IC and high hedonic liking was associated with worse 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 EF and Weight Loss Outcomes • More research is needed to understand the multifaceted nature of EF as it relates to WL outcomes. Only two prior studies measured multiple facets of EF in adults: • Galioto et al., 2016: poorer set‐shifting and IC predicted worse 8‐week percent weight loss outcomes in a medically‐supervised program using meal replacements. • Dassen et al., 2018: better behavioral WM and self‐reported IC was associated with greater 6m WL outcomes. Behavioral tasks measuring general and food‐specific inhibition and set‐shifting were not significantly associated with WL outcomes. 18 6

9/18/2019 EF and Physical Activity • Engaging in PA leads to improved EF (Guiney & Machado, 2013; Hugenschmidt et al., 2019; Moreau & Chou, 2019; Northey et al., 2018). • However, it is unclear to what extent baseline EF facilitates the adoption of PA. • Prior research was conducted primarily 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 Summary • Conceptual models of LM highlight the important role of EF in inhibiting and initiating key weight‐related behaviors (Buckley et al., 2014; Gettens & Gorin, 2017; Sutin et al., 2018). • Prospective research is needed to examine how EF might predict treatment outcomes in adults with obesity. • Identifying pre‐treatment predictors of WL and PA may inform the development of tailored interventions for individuals who are at risk for suboptimal outcomes. 20 Current Study This study aimed to test the hypothesis that in a sample of OW/OB adults entering a lifestyle modification program, better EF at baseline would predict greater WL and PA after 6 months of treatment. a) Using a baseline measure of EF that was Aimed to address gaps in the standardized, objective, and multi‐faceted. literature by: b) Objectively measuring changes in weight and physical activity. 21 7

9/18/2019 Participants • Participants were recruited from the community for a clinical trial (NCT02363010) of weight loss treatment • BMI 27‐45 kg/m 2 • 18‐70 years old • 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 past 6 months, or a diagnosis of major medical or psychiatric condition that would interfere with participation • Women who were currently nursing, pregnant, or planning to become pregnant over the course of the study 22 Intervention • Group‐based lifestyle modification, 16 sessions over 6 months • Treatment protocol adapted from Look AHEAD and Diabetes Prevention Program. • Emphasized self‐monitoring of calorie intake as a core skill. • Participants also learned stimulus control, problem solving, goal setting, and social support skills. • Weight loss goal = 10% • PA goal = gradually increase to 250 minutes of MVPA per week 23 Measures • Participant characteristics • Reported age, gender, race, and ethnicity at baseline • Weight • Measured in clinic at baseline and 6 months using a Tanita model WB‐3000 digital scale • Moderate‐to‐vigorous physical activity (MVPA) • 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) 24 8