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

57 th 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

ProcessOutputImpactOutcome 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 Health Economic Social Environment 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

Impulsivity Behavioural Economic Theory Reinforcement

Setting A muti-dimensional weight management camp for obese children, n=31 BoysGirls n=12n=19 6/12 funded by PCT15/19 funded by PCT 14 years (12-17 years)13 years (12-17 years) 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 Questionnaire 2.Child Wellbeing Questionnaires 3.On-line parental Impulsivity task 4.Temporal Discounting Task 5.Go/NoGo Task C

Impulsivity Temporal Discounting TaskMotor Impulsivity £2 tomorrowOR£20 in 4 weeks

Temporal Discounting Task Computerised task 120 hypothetical questions Mont Carlo Simulation

Outcome Measures Primary Anthropometric measures Child impulsivity scores Child wellbeing scores Secondary Parent 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 Camp Domains (Pre- Post) Sig.(2-tailed) ONS0.658 School0.045 Eating0.097 Sport0.214 Health0.006 Looks0.002 Time0.033 Domains (Pre- Post Sig.(2-tailed) Family0.949 Home0.818 School0.185 Local Area0.432 Choices0.081 Safety0.201 Total0.007

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