Computerized Response Training Obesity Treatment
Condition: Obesity; Hyperphagia; Feeding and Eating Disorders
MeSH terms: Obesity; Hyperphagia; Feeding and Eating Disorders
Study type: Interventional

Summary: 
      This project will test whether a food response training intervention produces lasting body
      fat loss, use objective brain imaging to examine the mechanism of effect of this treatment
      and investigate the generalizability of the training to non-training foods, and examine
      factors that should amplify intervention effects to provide a test of the intervention
      theory. This novel treatment represents a bottom-up implicit training intervention that does
      not rely on executive control, prolonged caloric deprivation, and expensive clinicians to
      deliver, like behavioral weight loss treatments that have not produced lasting weight loss.
      If this computer-based response training intervention produces sustained body fat loss in
      overweight individuals, it could be easily implemented very broadly at almost no expense,
      addressing a leading public health problem.
    

Detailed description: 
      Obesity causes 300,000 US deaths yearly, but most treatments do not result in lasting weight
      loss. People who show greater brain reward and attention region response, and less inhibitory
      region response, to high-calorie food images/cues show elevated future weight gain,
      consistent with the theory that overeating results from a strong approach response to
      high-calorie food cues paired with a weak inhibitory response. This implies that an
      intervention that reduces reward and attention region response to such food and increases
      inhibitory control region response should reduce overeating that is rooted in exposure to
      pervasive food cues. Computer-based response-inhibition training with high-calorie foods has
      decreased attentional bias for and intake of the training food, increased inhibitory control,
      and produced weight loss in overweight participants in 3 proof-of-concept trials, with
      effects persisting through 6-mo follow-up. A pilot trial found that overweight/obese adults
      who completed a multi-faceted 4-hr response-inhibition training with high-calorie food images
      and response-facilitation training with low-calorie food images showed reduced fMRI-assessed
      reward and attention region response to high-calorie training foods and greater body fat loss
      than controls who completed a rigorous 4-hr generic response-inhibition/response-facilitation
      training with non-food images (d=.95), producing a 7% reduction in excess body fat over the
      4-wk period. The investigators propose to evaluate a refined and extended version of this
      response-training intervention.

      Aim 1: Randomize 180 overweight/obese adults to a 4-wk response training obesity treatment or
      a generic inhibition training control condition that both include bi-monthly
      Internet-delivered booster training for a year and a smart phone response training app that
      can be used when tempted by high-calorie foods, assessing outcomes at pre, post, and at 3-,
      6-, and 12-month follow-ups (e.g., % body fat, the primary outcome).

      Aim 2: Use fMRI to test whether reduced reward and attention region response, and increased
      inhibitory region response to high-calorie food images used and not used in the response
      training mediate the effects of the intervention on fat loss. The investigators will also
      test whether during training participants show acute reductions in reward and attention
      region response, and increases in inhibitory response to high-calorie training food images to
      capture the learning process, assess generalizability of the intervention to food images not
      used in training, and collect behavioral data on mediators.

      Aim 3: Test whether intervention effects will be stronger for those who show less inhibitory
      control in response to high-calorie food images, a genetic propensity for greater dopamine
      signaling in reward circuitry, and greater pretest reward and attention region response, and
      weaker inhibitory region response to high-calorie food images, based on the theory that
      response training is more efficacious for those with a strong pre-potent approach tendency to
      high-calorie foods.

      During the Covid-19 shelter-at-home order, we will not measure in person only outcomes
      including BodPod assessments, height and weight measurement for BMI calculation,
      electrocardiogram (ECG) assessments and fMRI scanning for all participants that have
      assessments due during this order.
    

Intervention name(s): Computer Based Response Training Weight Loss Intervention; Generic Response Training Control Intervention
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Participants complete four computer based training tasks each visit, over the course of a few lab visits. Participants then perform weekly booster sessions in a more natural home or community environment over the internet using the same computer based training tasks.; Participants complete four computer based training tasks each visit, over the course of a few lab visits. Participants then perform weekly booster sessions in a more natural home or community environment over the internet using the same computer based training tasks.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Obesity; Dissonance; Response Training; Eating Disorder; Computer-based Training