Download - The role of impulsivity in childhood obesity
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