The role of impulsivity in

childhood obesity

Myutan KulendranClinical Research Fellow

• 57th World Health Assembly (2004)

• Prevention and control of non-communicable diseases (NCD)

• NCD and social and economic inequalities

• Obesity is a major risk factor for morbidity and mortality internationally

Obesity

Health Consequences

Global rise in childhood obesity

Tracking of Obesity into adulthood

Freedman et al. 2001

Food advertising on and prevelence of overweight

Obesity Network

• Failure to act early

• No measurable change in right direction

• Environmental determinants misunderstood

• Window for effective action

• Normalisation of Obesity

The climate change of public health

Opportunities for intervention: Life course

Process Output Impact Outcome

Strategic policy and leadership

Policy Instruments• Service

delivery• Government

spending and taxations

• Advocacy• Laws and

regulation

BEHAVIOUR CHANGE

•Reduce energy intake•Increase physical activity

Supportive environment HealthHealth

EconomicEconomic

SocialSocial

EnvironmentEnvironment

Health Services

Monitoring, Evaluation and Research

Obesity Policy Action Framework

Fleurbaix Laventie Ville Sante Study

• Mindspace report published in March 2010

• Provides the operating framework for applying behavioural insight to public policy

• Behavioural Insights Team established in the Cabinet Office Strategy Unit

ImpulsivityBehavioural Economic Theory

Reinforcement

Setting

A muti-dimensional weight management camp for obese children, n=31

Boys Girls

n=12 n=19

6/12 funded by PCT 15/19 funded by PCT

14 years (12-17 years) 13 years (12-17 years)

5 weeks (3-8 weeks) 5 weeks (3-8 weeks)

102 kg (85kg-154 kg) 88 kg (55kg-111kg)

BMI 34 (26-43) BMI 33 (21-39)

Hypothesis‘Do obese children lose significant weight during

a multi-dimensional lifestlye intervention summer camp’

‘Does impulsivity predict weight loss maintenance after the camp setting’

‘Are children happier after losing weight in a

camp setting’

Method: Pre-post Study

8 weeks multi-dimensional intervention

3 month maintenance-phone contact

7 months

Week 1

1.Parent and Child Temperament Questionnaire2.Child Wellbeing Questionnaires3.On-line parental Impulsivity task

4. Temporal Discounting Task

5. Go/NoGo Task

C

ImpulsivityTemporal Discounting Task Motor Impulsivity

£2 tomorrow OR £20 in 4 weeks

Temporal Discounting Task

• Computerised task

• 120 hypothetical questions

• Mont Carlo Simulation

Outcome Measures

PrimaryAnthropometric measures

Child impulsivity scores Child wellbeing scores

SecondaryParent impulsivity scores

Reduction in Motor Impulsivity Post Camp

p>0.05

Significant findings…..

• Change in motor impulsivity significant– Control for age and duration of stay

• Longer duration of stay associated with greater reduction in impulsivity

• Older show an attenuation in the reduction of impulsivity scores

Wellbeing Improved Post CampDomains (Pre-

Post)Sig.(2-tailed)

ONS 0.658

School 0.045

Eating 0.097

Sport 0.214

Health 0.006

Looks 0.002

Time 0.033

Domains (Pre-Post

Sig.(2-tailed)

Family 0.949

Home 0.818

School 0.185

Local Area 0.432

Choices 0.081

Safety 0.201

Total 0.007

Conclusions

• Key role of impulsivity in obesity– Development– Maintenance

• Screening using personality traits• Development of behavioural interventions

– Effective in similar regulating environments

• Children are happier with weight loss

Further Work

• SMS study during maintenance phase of camp• Commitments vs Information

• Continue to monitor impulsivity and Wellbeing in a community based family intervention

• Use of pervasive technology to monitor physical activity

• Feedback and Social Norms