Episodic Future Thinking and Weight-Loss
Condition: Overweight and Obesity
MeSH terms: Overweight; Weight Loss
Study type: Interventional

Summary: 
      Monetary incentive programs can reduce weight short-term; however, many studies have shown
      weight regain when the incentive program ends. This relapse is unsurprising; it is
      well-established that a specific behavior is extinguished when reinforcement for the behavior
      is removed. It is unlikely, then, given the expense, that monetary incentive programs could
      be implemented long-term for chronic diseases like obesity. Thus, programs are needed to
      bridge the gap between the short-term effects of a monetary incentive program and long-term
      effects at program end.

      A program that could be effective at bridging this gap is thought training, namely, episodic
      future thinking (EFT). EFT teaches individuals to think prospectively about future events as
      if they are happening now. EFT can reduce delay discounting (DD) which is defined as
      discounting larger rewards in the future for smaller rewards now (e.g. people with high DD
      levels may place more value on eating an unhealthy food now vs. the future health benefits of
      forgoing the food). It is suggested that EFT increases the value of the future reward and
      helps individuals make choices with lasting benefits.

      Given the power of EFT to reduce DD, it is plausible that EFT training during an incentive
      program could help shift one's thought processes towards the long-term consequences of
      behavior, promoting behavioral change even after the incentive program ends. Thus, the
      purpose of this study is to assess whether EFT promotes weight-loss in N=40 parent/child
      dyads (BMI ≥ 25) after a monetary incentive program ends vs. a control thought training
      program, Healthy Thinking (HT).

      We hypothesize:

        -  The EFT and HT group will both have a reduction in BMI for adults/percent over BMI for
           children and weight from baseline during the monetary incentives program.

        -  The EFT vs. HT group will have a greater reduction in BMI/percent over BMI and weight
           from baseline during the monetary incentives program.

        -  The EFT group will maintain the reduction in BMI/percent over BMI and weight from
           baseline after the termination of the monetary incentives program.

        -  The HT group will not maintain the reduction in BMI/percent over BMI and weight from
           baseline after the termination of the monetary incentives program.

        -  The EFT vs. HT group will have a reduction in DD over time.
    

Detailed description: 
      The study program is organized into 20 sessions. There is a mix of group sessions, individual
      family in-person sessions, and individual family phone sessions. Each session is outlined
      below:

      Session 1 will be an in-lab screening session to ensure participants are eligible to
      participate. During this session, participants will have their height and weight measured and
      complete surveys: Eating Disorders Examination Questionnaire (EDE) for parents, Kid's Eating
      Disorders Survey (KEDS) for kids, Sociodemographic, and a clinical interview. Participants
      will also be instructed to track their eating and physical activity in MyFitnessPal.

      Session 2 will be a group workshop. Families will learn the core components of the program in
      presentations by the research staff. The workshop will also include activities to keep the
      families engaged and a meal will be provided. If the participants attend the workshop,
      successfully logged in MyFitnessPal, and still want to participate, they will be randomized
      to a treatment group and scheduled for a baseline session.

      Session 3 will be a baseline session. Participants will have their height, weight, and
      delayed discounting (DD) measured to establish baseline data. Participants will also complete
      baseline surveys including: Consideration of Future Consequences Scale (CFCS), Palatable
      Eating Motives Scale (PEMS), Relative Reinforcing Value, and Living to 75 assessment.
      Participants will also create their first EFT or HT cues.

      For EFT cue generation, participants will talk about a specific future positive event where
      they imagine themselves in vivid detail. To generate the cues, participants in the EFT group
      will be given standardized instructions asking them to think about and list specific events
      that they are looking forward to in the future (ex: parties, holidays). Participants will be
      instructed to generate the EFT cue by describing their events, including a detailed
      description of themselves at the specific event. After the participant has created their
      cues, they will save their cue for later use in the intervention.

      To control for the timing and attention of the EFT cue, participants in the HT group will
      generate cues that include specific nutrition statements that they feel will be of personal
      benefit. To generate the cues, participants in the HT group will select from a list of
      nutrition statements that they feel will be personally useful in making healthy
      decisions.After the participant has created their cues, the participant will save their cue
      for later use in the intervention.

      Sessions 4-19 will be intervention sessions split into 2 phases:

      Phase 1:

      Sessions 4-11 will be in person sessions between an individual family and a researcher.
      Participants will have weight measured, do the thought training program, and talk to staff
      about progress in the program. Phase 1 is when the monetary incentives program will be
      implemented.

      Phase 2:

      Sessions 12-19 will be phone sessions between an individual family and a researcher.
      Participants will do the thought training program and talk to staff about progress in the
      program.

      During both phases of intervention, participants will be encouraged to send weekly weights
      from a provided Bluetooth enabled scale. Participants will also be asked to log their
      activity related to the program in the MyFitnessPal app. Researchers will access the
      information and send feedback to the participants (via text, phone, and/or email) to help
      them succeed in the program.

      Session 20 will be an in person session between an individual family and the researcher. This
      session will act as a follow-up session as there will be an 8 week gap between Session 19 and
      Session 20 where there is no study intervention.
    

Intervention name(s): Episodic Future Thinking Group; Healthy Thinking Group
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Participants in the Episodic Future Thinking (EFT) Group will train with EFT throughout the entire study. As part of the training, research staff will help participants create "cues." Cues are descriptions of future events the participant can vividly imagine as happening right now.
Participants will be instructed to think about the EFT cues they created to help them focus on the future and importance of reaching their weight-loss goals. Participants will be instructed to use their EFT cues at least once per day, but will be encouraged to use their cues with every eating and physical activity decision.; Participants in the Healthy (HT) Group will train with HT throughout the entire study. As part of the training, research staff will help participants create "cues." Cues are statements about the nutrition of food and the health benefits of physical activity.
Participants will be instructed to think about the HT cues they created to help them focus on the future and importance of reaching their weight-loss goals. Participants will be instructed to use their HT cues at least once per day, but will be encouraged to use their cues with every eating and physical activity decision.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment