Using prospection to improve obesity treatment

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 DESCRIPTION (provided by applicant): The inability to delay gratification is cross-sectionally and prospectively related to obesity, and the desire for immediate gratification is fundamental to the inability to delay gratification. People tend to devalue larger future rewards relative to smaller immediate rewards, with greater discounting of the future as the temporal distance between the immediate and delayed rewards increases. This pattern of temporal discounting is known as delay discounting (DD). A novel approach to reducing the bias towards immediate gratification is episodic future thinking (EFT), which can change the context of decision making by engaging the episodic memory to prospectively experience or simulate future events. Cueing individuals to think about future events during inter- temporal decision-making reduces DD. The overarching goal of this grant is to translate basic research on EFT into clinical interventions to treat pediatric obesity. We originally submitted this under grant mechanism PA-11- 063, "Translating Basic Behavioral and Social Science Discoveries into Interventions to Improve Health-Related Behaviors" as this provides for the opportunity to integrate basic and field studies to refine interventions that can be tested in a pilot clinical trial. We have demonstrated that EFT is associated with a reduction in DD in three samples of adults and one sample of children, that EFT has similar effects on DD in overweight/obese and non-overweight participants, and that EFT is associated with a reduction in energy intake in an ad lib eating task in adults and children. We have shown EFT effects in relation to a present thinking control task, as well as non-future and recent or past thinking control tasks. There has been no clinical research using EFT to modify DD in the treatment of obesity, but since EFT has been shown to decrease DD and energy intake in adults and children, it may be especially suited for a family-based treatment (FBT) of pediatric obesity. To translate EFT to a clinical intervention for pediatric obesity, we propose a series of laboratory, field and clinical studies for overweight/obese 8-12 year-old children and their parents. Specific Aims 1a-1b will assess the specificity of imagery, and process versus goal imagery on DD, energy intake and multiple measures of decision making. Specific Aim 2 is designed to determine the best dose of EFT (4, 8 or 12 weeks of training) to influence DD and energy intake, using the optimal EFT approach based on results of studies addressing Specific Aims 1a-b. Specific Aim 3 will use the optimal treatment package based on previous studies to assess the effects of adding EFT to evidence-based behavioral obesity treatment to evaluate the added benefits of EFT training. Developing effective ways to reduce discounting the future and improve delay of gratification may have important benefits in the treatment of pediatric obesity.