The role of impulsivity in childhood obesity

1. The role of impulsivity in childhood obesity Myutan Kulendran Clinical Research Fellow

2. Obesity • 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

6. Health Consequences

7. Global rise in childhood obesity

9. Tracking of Obesity into adulthood Freedman et al. 2001

10. Food advertising on and prevelence of overweight

11. Obesity Network

12. The climate change of public health • Failure to act early • No measurable change in right direction • Environmental determinants misunderstood • Window for effective action • Normalisation of Obesity

13. Opportunities for intervention: Life course

14. Obesity Policy Action Framework Process Output Impact Outcome Supportive environment Health Policy Instruments • BEHAVIOUR CHANGE • Reduce energy intake • Increase physical activity Economic • Service delivery • Government spending and taxations • Advocacy • Laws and regulation Strategic policy and leadership Social Environment Health Services Monitoring, Evaluation and Research

15. Fleurbaix Laventie Ville Sante Study

18. 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

20. Behavioural Economic Theory Impulsivity Reinforcement

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

22. 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’

23. Method: Pre-post Study Week 1 Parent and Child Temperament Questionnaire Child Wellbeing Questionnaires On-line parental Impulsivity task C 7 months 8 weeks multi-dimensional intervention 3 month maintenance-phone contact Temporal Discounting Task Go/NoGo Task

24. Impulsivity Temporal Discounting Task Motor Impulsivity £2 tomorrow OR £20 in 4 weeks

25. Temporal Discounting Task • Computerised task • 120 hypothetical questions • Mont Carlo Simulation

26. Outcome Measures Primary Anthropometric measures Child impulsivity scores Child wellbeing scores Secondary Parent impulsivity scores

28. Reduction in Motor Impulsivity Post Camp p>0.05

29. 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

31. Wellbeing Improved Post Camp

32. 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

33. 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