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Randomized Controlled Trial
. 2012 Dec;80(6):1086-1096.
doi: 10.1037/a0029827. Epub 2012 Aug 27.

Behavioral economic predictors of overweight children's weight loss

John R Best  1 , Kelly R Theim  2 , Dana M Gredysa  2 , Richard I Stein  1 , R Robinson Welch  1 , Brian E Saelens  3 , Michael G Perri  4 , Kenneth B Schechtman  5 , Leonard H Epstein  6 , Denise E Wilfley  1
Affiliations
Randomized Controlled Trial

Behavioral economic predictors of overweight children's weight loss

John R Best et al. J Consult Clin Psychol. 2012 Dec.

Abstract

Objective: Our goal was to determine whether behavioral economic constructs-including impulsivity (i.e., steep discounting of delayed food and monetary rewards), the relative reinforcing value of food (RRVfood), and environmental enrichment (i.e., the presence of alternatives to unhealthy foods in the home and neighborhood environments)-are significant pretreatment predictors of overweight children's weight loss within family-based treatment.

Method: Overweight children (N = 241; ages 7-12 years; 63% female; 65% non-Hispanic White) enrolled in a 16-week family-based obesity treatment with at least one parent. At baseline, children completed a task to assess RRVfood and delay discounting measures of snack foods and money to assess impulsivity. Parents completed questionnaires to assess environmental enrichment.

Results: Children who found food highly reinforcing and steeply discounted future food rewards at baseline showed a blunted response to treatment compared with children without this combination of risk factors. High environmental enrichment was associated with treatment success only among children who did not find food highly reinforcing. Monetary discounting rate predicted weight loss, regardless of children's level of RRVfood.

Conclusions: Investigation is warranted into novel approaches to obesity treatment that target underlying impulsivity and RRVfood. Enriching the environment with alternatives to unhealthy eating may facilitate weight loss, especially for children with low RRVfood.

Trial registration: ClinicalTrials.gov NCT00759746.

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Figures

Figure 1
Figure 1
RRVfood moderated the effects of HED food discounting (top panel) and the effects of environmental enrichment (bottom panel) on change in children’s percent overweight over treatment. Error bars are standard errors of the slope. RRVfood = relative reinforcing value of food; Low = −1 SD below the mean; EE = environmental enrichment; Moderate = mean score; High = +1 SD above the mean. # p ≤ .10. * p < .05. ** p < .01.
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