Date of Completion

3-18-2019

Embargo Period

3-17-2020

Keywords

weight loss, executive function, neuropsychology, behavioral intervention, environmental support, couples weight loss

Major Advisor

Amy A. Gorin, Ph.D.

Associate Advisor

Deborah Fein, Ph.D., ABPP

Associate Advisor

John Salamone, Ph.D.

Field of Study

Psychology

Degree

Doctor of Philosophy

Open Access

Open Access

Abstract

Weight loss is reliably achieved through standard behavioral programs, yet weight loss maintenance (WLM) has proven to be an elusive goal and is one of the field’s most significant dilemmas. Given the complex and multifaceted nature of WLM, a specific subset of cognitive processes known as executive functions (EF) involved in high-order or top-down cognitive functioning, are likely among the most highly implicated neural systems in successful weight management. The complexity of weight loss maintenance is unlikely to exist solely due to individual-level factors, and likely involves the larger environmental context in which an individual is nested. This study examined the relationship between EF and environmental supports on weight loss and WLM in a 6-month couples-based behavioral weight loss intervention. It was hypothesized that 1) stronger executive functions would predict better weight loss and maintenance outcomes and 2) that executive skills would improve over the course of the intervention. Finally, potential environmental moderators of the relationship between EF and weight management were explored.

Cohabitating spousal dyads (N=64) were randomized to 24-weeks of standard behavioral weight loss (BWL) or behavioral weight loss plus support training, guided by Self-Determination Theory (SDT-WL). Participants were weighed at baseline, 6, and 12-months, completed EF measures at baseline and program completion (6-months), and measures of social and environmental support at baseline, 3, 6, and 12 months.

Several EFs, including processing speed and inhibition, predicted initial weight loss. Cognitive flexibility predicted weight loss and maintenance. Measures of EF improved from baseline to program completion, particularly self-reported EF. Finally, moderation analyses revealed mixed findings for interactions between baseline executive skills and environmental supports predicting weight loss and maintenance success, such that stronger executive skills and high support environments generally predicted greater weight loss.

Participants’ baseline executive skills tended to predict weight loss and maintenance, however, many of these skills also improved during the intervention period, suggesting potential cognitive benefits inherent in standard behavioral weight loss interventions. Additionally, the combination of strong executive skills and high support environments, consistently predicted better weight outcomes. Future interventions might improve maintenance success by bolstering existing modules that promote improved executive abilities and social/environmental supports simultaneously.

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