A group of PRIME researchers, led by Giulia Testa and Fernando Fernandez-Aranda have discovered that individuals with obesity on average show more compulsive behavioural characteristics. They have also found that having obesity and diabetes is linked to certain impulsive behaviours. These findings are important for healthcare professionals treating individuals with obesity, because impulsive and compulsive behaviours may hinder adherence to certain treatments.
Description of the research
What was the goal of your research or experiment?
The goal of the research was to describe and compare different clinical populations in terms of impulsivity and compulsivity features. In particular, the study focused on individuals with obesity in the presence or absence of type 2 diabetes, compared with a group of healthy normal-weight individuals, and with other clinical groups that are typically described as being impulsive (namely, patients with gambling disorders) or compulsive (namely, patients with anorexia nervosa).
How did you measure or test this?
Assessment measures included a series of neuropsychological tests and questionnaires, specifically designed to assess impulsivity and compulsivity. Impulsivity is reflected in the tendency to seek out new situations and stimuli, and in impulsive decisions based on obtaining immediate gratification, despite negative long-term consequences. On the other hand, measures of compulsivity included repetitive and persistent, often harmful, behaviour and the inability to flexibly adapt behaviour to the demands of a changing environment.
What were the main results or findings?
Individuals with obesity and diabetes showed highly impulsive decision-making, similar to that observed in patients with anorexia nervosa and gambling disorder. However, while these patients also showed a tendency to seek new stimuli and experiences, to get bored easily and to avoid monotony, individuals with obesity (either with or without diabetes) on average did not show these behavioural features. Furthermore, the patients who showed more rigid and compulsive characteristics were individuals with obesity in the absence of diabetes. This group showed inflexible attitudes, reflecting their inability to adapt to the changing environment, and a tendency to be motivated by the desire to avoid adverse experiences, which is closely related to compulsive attitudes.
What does this mean?
The results of this research highlighted the relationship between obesity in the presence of diabetes and impulsivity, especially in terms of impulsive decision-making. One possible explanation is that insulin alterations in diabetic patients potentially impact dopaminergic systems in the brain, which play a central role in cognitive functions related to impulsivity. Regardless of the presence of diabetes, obesity has been associated with compulsive characteristics that may have a negative impact on eating behaviours, and this cognitive rigidity may contribute to maintaining unhealthy eating habits and thus be linked to high body weight. However, it should be stressed that we did not investigate causal effects, so we cannot conclude that obesity is the result of impulsive and/or compulsive behaviours.
For the healthcare professionals, identifying and understanding the presence of impulsivity and compulsivity characteristics that may act as a barrier to treatment adherence can improve the success rates of diabetes management and obesity weight loss treatments.
What is the next step?
Future research in this field is needed to extend current knowledge and better identify the clinical and cognitive profiles of individuals with obesity in the presence or absence of diabetes and their impact on treatment. To do so, some important factors should be considered in future studies, including the duration of diabetes, the effect of medications, which may affect cognitive function. Furthermore, considering the complex nature of impulsivity and compulsivity, a broader assessment including biological markers and neuroimaging measures would be informative and is therefore recommended.
Title: Transdiagnostic Perspective of Impulsivity and Compulsivity in Obesity: From Cognitive Profile to Self-Reported Dimensions in Clinical Samples with and without Diabetes
Authors: Giulia Testa, Bernat Mora-Maltas, Lucía Camacho-Barcia, Roser Granero, Ignacio Lucas, Zaida Agüera, Susana Jiménez-Murcia, Rosa Baños, Valerie Bertaina-Anglade, Cristina Botella, Mònica Bulló, Felipe F. Casanueva, Søren Dalsgaard, José-Manuel Fernández-Real, Barbara Franke, Gema Frühbeck, Montserrat Fitó, Carlos Gómez-Martínez, Xavier Pintó, Geert Poelmans, Francisco J. Tinahones, Rafael de la Torre, Jordi Salas-Salvadó, Lluis Serra-Majem, Stephanie Vos, Theresa Wimberley and Fernando Fernández-Aranda.