None listed
Conditions
Brief summary
Obesity is at epidemic proportions and current weight loss programs offer little respite. While many current interventions help individuals to reduce 5-10% of their body weight, most individuals regain the weight as soon as professional contact ends (Perri & Corsica, 2002). Treatment strategies that will aid with weight loss maintenance are urgently needed. Recently weight loss failure has been linked to cognitive difficulties, specifically problems with executive functioning. Executive functioning encompasses a range of processes that facilitate initiation, inhibition, planning, regulation, sequencing and achievement of complex goal-oriented behaviour. It is evident that executive functioning underlies many behaviours associated with successful weight management (Riggs, Spruitt-Metz, Chou & Pentz, 2012). Our review (Smith et al., 2011) found 22 out of 24 studies showed a negative association between obesity and executive function. Despite this, current treatments do not target executive function deficits. Manualised cognitive remediation therapy (CRT) is a face-to-face treatment approach with a focus on improving cognitive functioning. CRT consists of mental exercises aimed at improving cognitive strategies, thinking skills and information processing through practice (Tchanturia, 2014). There is evidence that CRT improves executive function and helps individuals regulate their eating. It has been shown to be effective at improving executive function in those with anorexia nervosa (Dingemans et al., 2014). Our recent pilot RCT on manualised CRT for obesity provides promising evidence for its efficacy (Raman, Hay & Smith, 2014). The results showed that those in the CRT group experienced a significant increase in executive function and a significant decrease in weight compared to controls and that changes in executive function predicted changes in weight. This study aims to determine the efficacy of CRT in reducing weight and improving executive function in obese patients. The following conditions will be compared; CRT plus behavioural weight loss (BWL) compared to BWL (standard care) alone. It is hypothesized that individuals who receive CRT will show greater weight-loss and improved executive functioning than those in the BWL alone, both at post-treatment and at 1-year follow-up (post-treatment). Treatment will continue for 5 months and be provided by two psychologists and a dietician. Participants aged 18 to 55, with a BMI of 30 or above will be randomly allocated to one of two conditions: 1) CRT group: Eight 50 minute weekly sessions of individual CRT plus twelve, 2hour, weekly sessions of group Behavioural Weight Loss (BWL) 2) BWL group: Eight 50 minute weekly sessions of individual BWL plus twelve, 2 hour, weekly sessions of group Behavioural Weight Loss (BWL)
Interventions
This randomised controlled trial aims to determine the efficacy of manualised Cognitive Remediation Therapy (CRT) in reducing weight and improving executive function in obese patients. Manualised cognitive remediation therapy is a face-to-face treatment approach with a focus on improving cognitive functioning. CRT consists of mental exercises aimed at improving cognitive strategies, thinking skills and information processing through practice (Tchanturia, 2014). The NHMRC guidelines strongly reco
This randomised controlled trial aims to determine the efficacy of manualised Cognitive Remediation Therapy (CRT) in reducing weight and improving executive function in obese patients. Manualised cognitive remediation therapy is a face-to-face treatment approach with a focus on improving cognitive functioning. CRT consists of mental exercises aimed at improving cognitive strategies, thinking skills and information processing through practice (Tchanturia, 2014). The NHMRC guidelines strongly recommend obese individuals lose weight through lifestyle modification interventions. The current standard evidence based approach is Behavioural Weight Loss (BWL), it uses behavioural techniques to help individuals modify eating and exercise habits. The following conditions will be compared; CRT plus behavioural weight loss (BWL) and BWL (standard care) alone. It is expected that individuals who receive CRT will show greater weight-loss and improved executive functioning than those in the BWL alone, post-treatment and at 1 year follow-up (post-treatment). Treatment will continue for 5 months and be provided by two psychologists. A dietician will facilitate groups related to the diet component of the BWL program. Participants aged 18 to 55, with a BMI of 30 or above will be randomly allocated to one of two conditions: 1) CRT group: Eight weekly sessions of individual CRT followed by twelve weekly sessions of group Behavioural Weight Loss (BWL) 2) BWL group: Eight weekly sessions of individual BWL followed by twelve weekly sessions of group Behavioural Weight Loss (BWL) Individual treatment will be conducted before group sessions commence. Twelve participants will be allocated to group treatment. Description of sessions: 1) CRT group: Eight 50-minute weekly sessions of individual CRT plus twelve 2 hour weekly sessions of group Behavioural Weight Loss (BWL) treatment. CRT Sessions: During CRT 10 cognitive training exercises will be delivered per session. An example of an exercise is the Map Task - the aim is to think in different ways when navigating and to use different cues (compass, street, location, etc). The psychologist will facilitate a discussion about thinking styles after the completion of tasks. Homework will be given after every session, homework should take about 15 mins to complete. Behavioural Weight Loss (BWL) Group sessions: During these sessions a modified version of the Look Ahead Trial manual will be delivered. The Look Ahead program is an intensive lifestyle intervention program that targets diet and exercise through behavioural modification techniques. During this program participants will be given weight loss information and be encouraged to set calorie and activity goals. Participants will be asked to monitor and record their behaviour. In the group setting participants are taught techniques such as: problem solving, stress management and mindful eating to assist them to reach their weight loss goals. Thoughts and emotions related to overeating and inactivity are also addressed in treatment sessions. 2) BWL group: Eight 50 minute weekly sessions of individual BWL plus twelve 2 hour weekly sessions of group Behavioural Weight Loss (BWL). This treatment group will experience an intensive BWL program. The addition of individual sessions will help to examine whether more sessions of BWL are beneficial. The individual sessions of BWL will focus upon providing detailed education about weight loss techniques and addressing any barriers that the participant may have in terms of changing their behaviour.
Sponsors
Dr Evelyn Smith
Study design
Allocation
Randomised controlled trial
Primary purpose
Treatment
Masking
Blinded (masking used) (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to 55 Years
Healthy volunteers
No
Inclusion criteria
Participants must be aged between 18 and 55 and have a BMI of 30 or above.
Exclusion criteria
Serious somatic conditions (e.g., neurological disorders, stroke, head injury); serious psychiatric/psychosomatic conditions (e.g., psychotic disorder, suicidality, substance use disorder, attention deficit hyperactivity disorder, developmental or intellectual disability; impediment in hearing, vision, or language with an effect on testing; previous or planned bariatric surgery; use of medication that impacts weight or executive functioning (e.g., antipsychotics, sedatives, hypnotics); and ongoing psychotherapy.
Outcome results
None listed