A better understanding of cognitive issues could lead to improved weight loss therapies and help curb the obesity epidemic, according to three behavioral scientists who presented the Scientific Sessions symposium Cognitive Function in Obesity and Appetite Regulation.

The presentation can be viewed by registered meeting attendees at ADA2020.org through September 10, 2020. If you haven’t registered for the Virtual 80th Scientific Sessions, register today to access all of the valuable meeting content.

Luke E. Stoeckel, PhD, Program Director of Mechanistic and Translational Decision Science at the National Institute on Aging, opened the symposium with a look at the bidirectional relationship between obesity and executive function, or self control. Uncontrolled and undercontrolled eating, classified by Dr. Stoeckel as a phenotype of obesity, is driven by the low cost and abundance of food via appetitive drive and lowered executive function, he said.

Reward sensitivity interacts with executive function to determine food intake behavior, Dr. Stoeckel explained. Evidence shows that people with conditions such as obesity discount future rewards. The ability to wait, he said, is related to the ability to self-regulate.

“We found that the region of the brain involved in executive function, the dorsal-lateral prefrontal cortex, helped predict weight gain over a 1.3- to 2.9-year period,” he said.

Dr. Stoeckel and his research colleagues are developing a series of core questions that investigators can use in trials to address neuropsychological issues without requiring the researchers to have extensive expertise in neuropsychology.

“We need to do a better job of representing or assessing the broader spectrum of what the drivers of our uncontrolled eating are in our trials,” he said.

Misty A.W. Hawkins, PhD, Assistant Professor in the Department of Psychology at Oklahoma State University, reviewed research that highlights the positive role that neurocognitive factors can play in treating obesity. Pilot studies have shown that people with high executive function experience better weight loss than those with low executive function after controlling for demographics and body mass index.

For patients with low executive function, acceptance-based behavior treatment (ABT) shows great promise, Dr. Hawkins said. The COSMOS Study, which she conducted at Oklahoma State, found that ABT offered something similar to a “rescue effect” for people with low executive function when compared with standard behavioral therapy.

Cognitive function, especially executive function, may be a critical missing moderator of weight loss treatment effects, Dr. Hawkins said.

“You don’t prescribe blood pressure medication without knowing something about your patient’s heart. We don’t prescribe insulin without knowing about the function of the pancreas,” she explained. “I believe when it comes to behavioral weight loss treatments that require so much decision-making and so many different changes in your life, you should know about the organ responsible for that, as well. You should be looking at the brain to help people and set them up for success and not failure.”

Ashley Gearhardt, PhD, Associate Professor of Psychology at the University of Michigan, discussed the addictive nature of unhealthy foods, noting that naturally occurring foods typically come high in either fat or carbohydrates. But the modern food environment is dominated by foods that have unnaturally high levels of both refined carbohydrates and fat. People find this combination particularly enticing, actively seeking out and paying more for these foods, which engage reward-based neuro-structures in the brain and create a toxic environment to navigate, she said.

Why does the executive functioning system that has remained largely unchanged throughout human history now struggle to properly modulate food intake? Dr. Gearhardt believes that the over-refined food environment has become so much more intense and enticing that it overtaxes the existing system. And those with deficits in executive functioning are even more susceptible to the rewarding nature of these unnatural foods.

It’s time to acknowledge that the way food is processed and designed must be addressed when treating patients, she said.

“By ignoring the food and treating all foods as equal—there may be something subtly stigmatizing there, ‘If you just tried a little harder to figure out a way to regulate your emotions a little more effectively, then you might be able to sort this out’—while ignoring the fact that there’s a billion dollar industry engineering and designing foods to hook us, and then marketing and advertising them, especially to lower-income communities and minority communities,” Dr. Gearhardt said.