Delay Discounting, Glycemic Regulation and Health Behaviors in Adults with Prediabetes.

The majority of people with prediabetes transition to type 2 diabetes. Research has suggested that persons with type 2 diabetes are likely to discount the future and focus on immediate rewards. This study was designed to assess whether this process of delay discounting (DD) is associated with glycemic regulation, medication adherence and eating and exercise behaviors in adults with prediabetes. Participants included 81 adults with prediabetes who were also prescribed hypertension or dyslipidemia drugs, which is common for people with prediabetes. Participants completed adjusting amount DD $100 and $1000 tasks, as well assessments of glycemic control (Hemoglobin (Hb) A1c), medication adherence, diet quality, and objectively measured physical activity. Relationships between DD and these variables were assessed. Results showed higher rates of DD were related to higher HbA1c; as well as poorer medication adherence, lower diet quality and lower physical activity. Hierarchical regression showed that the association between minority status, a known risk factor for type 2 diabetes, was moderated by DD, as minorities with higher DD had greater HbA1c values. Delay discounting may represent a novel target to prevent progression from prediabetes to type 2 diabetes.

Less is more: Negative income shock increases immediate preference in cross commodity discounting and food demand.

Negative income shock, or the rapid reduction in financial stability, has previously been shown to increase impulsive choice for money and demand for fast food. The interplay of these conditions for obesity is called reinforcer pathology. The present work examines the impact of negative income shock on monetary and fast food discounting using a cross-commodity delay discounting task and on purchasing of fast food and an alternative commodity. An obese sample (n = 120) was recruited from Amazon Mechanical Turk and assigned to read one of two narratives: negative income shock (n = 60) or control (n = 60). Participants then completed both within- and cross-commodity discounting tasks of money and food, and purchase tasks for fast food and bottled water. The negative income shock group demonstrated greater impulsive choice across discounting tasks, as well as higher intensity of demand for fast food but not for a non-caloric control commodity (bottled water). These results suggest that negative income shock increases preference for immediate reinforcement regardless of commodity type (money or fast food), but has specific effects increasing demand for particular commodities (fast food but not an alternative). In a reinforcer pathology framework, negative income shock increasing discounting of the future while increasing demand for fast food specifically represents a high-risk state for negative health behavior in obesity.

Bleak Present, Bright Future: Online Episodic Future Thinking, Scarcity, Delay Discounting, and Food Demand.

Obesity is associated with steep discounting of the future and increased food reinforcement. Episodic future thinking (EFT), a type of prospective thinking, has been observed to reduce delay discounting (DD) and improve dietary decision making. In contrast, negative income shock (i.e., abrupt transitions to poverty) has been shown to increase discounting and may worsen dietary decision-making. Scalability of EFT training and protective effects of EFT against simulated negative income shock on DD and demand for food were assessed. In two experiments we showed online-administered EFT reliably reduced DD. Furthermore, EFT reduced DD and demand for fast foods even when challenged by negative income shock. Our findings suggest EFT is a scalable intervention that has implications for improving public health by reducing discounting of the future and demand for high energy dense food.

Think fast: rapid assessment of the effects of episodic future thinking on delay discounting in overweight/obese participants.

Accumulating laboratory-based evidence indicates that reducing delay discounting (devaluation of delayed outcomes) with the use of episodic future thinking (EFT; mental simulation of future events) improves dietary decision-making and other maladaptive behaviors. Recent work has adapted EFT for use in the natural environment to aid in dietary and weight control by engaging participants in EFT repeatedly throughout the day. These efforts may benefit from minimizing the amount of time required for measurement and implementation of EFT. Using Amazon Mechanical Turk in the present study, we show that EFT effectively reduces delay discounting in overweight/obese participants (N = 131) using the recently developed 5-trial, adjusting-delay discounting task, which can be completed rapidly (25 s) and is therefore ideally suited for ecological momentary assessment. Moreover, measures of delay discounting from this task were strongly correlated with those from the commonly used adjusting-amount task (r = .859). Significant effects of EFT on discounting, however, depended on the number of future events participants generated and imagined. Use of a range of events and future time frames (as is typical in the literature) significantly reduced delay discounting, whereas use of only a single event did not.

Web-Based and Mobile Delivery of an Episodic Future Thinking Intervention for Overweight and Obese Families: A Feasibility Study.

BACKGROUND: The bias toward immediate gratification is associated with maladaptive eating behaviors and has been cross-sectionally and prospectively related to obesity. Engaging in episodic future thinking, which involves mental self-projection to pre-experience future events, reduces this bias and energy intake in overweight/obese adults and children. To examine how episodic future thinking can be incorporated into clinical interventions, a Web-based system was created to provide training for adults and children in their everyday lives. OBJECTIVE: Our study examined the technical feasibility, usability, and acceptability of a Web-based system that is accessible by mobile devices and adapts episodic future thinking for delivery in family-based obesity interventions. METHODS: We recruited 20 parent-child dyads (N=40) from the surrounding community and randomized to episodic future thinking versus a nutritional information thinking control to test the feasibility of a 4-week Web-based intervention. Parents were 44.1 (SD 7.8) years of age with BMI of 34.2 (SD 6.8) kg/m(2). Children were 11.0 (SD 1.3) years of age with BMI percentile of 96.0 (SD 1.8). Families met weekly with a case manager for 4 weeks and used the system daily. Adherence was collected through the Web-based system, and perceived acceptance of the Web-based system was assessed postintervention. Measurements of body composition and dietary intake were collected at baseline and after the 4 weeks of intervention. RESULTS: All 20 families completed the intervention and attended all sessions. Results showed parents and children had high adherence to the Web-based system and perceived it to be easy to use, useful, and helpful. No differences between conditions were found in adherence for parents (P=.65) or children (P=.27). In addition, results suggest that basic nutrition information along with episodic future thinking delivered through our Web-based system may reduce energy intake and weight. CONCLUSIONS: We showed that our Web-based system is an accepted technology and a feasible utility. Furthermore, results provide initial evidence that our system can be incorporated into family-based treatments targeting behaviors related to weight control. These results show promising utility in using our Web-based system in interventions.