Cognitive training add-on to behavioral weight-loss intervention shows moderate BMI reductions at 6 months
Photo by Pawel Czerwinski / Unsplash
Key Takeaway
Consider cognitive training as a potential adjunct to behavioral weight loss, but effect magnitude remains unclear.
This randomized controlled trial enrolled 148 participants (mean BMI 31.62 kg/m², 85% women) with excess weight to evaluate a comprehensive cognitive training add-on to standard behavioral weight-loss intervention (BWLI). Participants were randomized to three groups: Cognitive (inhibitory control, approach-avoidance bias modification, implementation intentions, episodic future thinking plus BWLI), Sham (placebo cognitive interventions plus BWLI), or Control (BWLI only). The intervention was delivered via online group sessions, with 128 participants (86.5%) completing the study.
At post-treatment, 3-month, and 6-month follow-ups, the Cognitive group showed significantly greater reductions than the Control group across all measured outcomes. Group-by-time interactions were significant for BMI (p=0.009), weight (p=0.003), percentage of weight loss (p=0.004), and waist-to-height ratio (p=0.041). Effect sizes were described as moderate for the Cognitive group at 6 months, with a higher proportion achieving clinically meaningful weight loss compared to Control, though specific thresholds and absolute weight change numbers were not reported.
Safety and tolerability data were not reported. The study had a 13.5% discontinuation rate. Key limitations include the lack of reported absolute weight/BMI change values, reliance on descriptive effect size labels without numerical values, and unclear definition of 'clinically meaningful' weight loss. Funding and conflicts of interest were not disclosed.
While the RCT design supports causal inference, clinicians should interpret these findings cautiously. The results suggest cognitive training components may provide additional benefit when combined with standard behavioral approaches for weight management, with effects sustained over 6 months. However, the practical relevance remains uncertain without knowing the magnitude of absolute weight changes achieved.
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View Original Abstract ↓
OBJECTIVE: To evaluate the efficacy of a comprehensive cognitive intervention as an add-on to a standard behavioral weight-loss intervention (BWLI) in improving anthropometric measures in individuals with excess weight.
PARTICIPANTS: This randomized controlled trial included 148 participants (126 women; mean BMI = 31.62 kg/m²); 86.5% participants (n = 128) completed the study.
METHODS: Participants were randomized into three groups: (1) Cognitive group (received four cognitive trainings: inhibitory control, approach-avoidance bias modification, implementation intentions, and episodic future thinking); (2) Sham group (received placebo cognitive interventions); and (3) Control group (no cognitive intervention). All three groups received BWLI. Cognitive trainings were delivered through four consecutive 90-min online group sessions. BMI, weight, percentage of weight loss (%WL), and waist-to-height ratio (WHtR) were assessed at baseline, post-treatment, and 3- and 6-month follow-ups. Mixed 3 (group) × 3 (time point) analysis were conducted to examine changes over time and between groups. Chi-squared test was used to explore group differences in reaching a clinically meaningful %WL.
RESULTS: Significant group-by-time effects interactions were found for BMI (p = 0.009), weight (p = 0.003), %WL (p = 0.004) and WHtR (p = 0.041). Post hoc analyses showed greater reductions in all anthropometric measures in the Cognitive group compared to the Control group at post-intervention and at both follow-ups. Further, only the Cognitive group showed significant improvements over time. At 6-month follow-up, effect sizes were moderate in the Cognitive group, small in the Sham group, and negligible to small in the Control group. A higher proportion of participants in the Cognitive group achieved a clinically meaningful %WL.
CONCLUSIONS: A comprehensive cognitive training delivered as an add-on to BWLI improved anthropometric outcomes in individuals with excess weight, with sustained effects over 6 months.
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