A randomised controlled trial of cognitive remediation therapy for the obese - a preliminary investigation

INTERVENTION: There is one intervention group that will undergo both the Behaviour Weight Loss Programme (BWL) and Cognitive Remediation Therapy (CRT). For this group, the Cognitive Remediation Therapy will run immediately after completion of BWL. The Behavioural Weight Loss Programme will be run in a group format (small group sessions of 6 to 8 people) by a Clinical Psychologist, once weekly, 90 minutes for 3 consecutive weeks. The BWL program in this study targets diet and exercise through behavioural modification techniques. Participants receive comprehensive education about nutrition. Problem solving techniques are taught so that participants can effectively deal with difficult situations that threaten their weight control efforts. Toward the end of treatment, attention is given to motivation enhancement and relapse prevention to help individuals maintain their weight loss. A record of attendance will be kept to monitor adherence. CRTwill be run on a individual basis by a Clinical Psychologist who has had special training in CRT. The CRT sessions will be conducted twice weekly for four weeks (a total of 8 sessions) each session lasting for approximately an hour. A record of attendance will be kept to monitor attendance. Cognitive exercises in the form of puzzles, games, memory tasks will form the content of CRT, where the focus is not on performance per se but learning and reflection. Homework tasks will be provided in between sessions to facilitate generalization of skills gained in therapy. CONDITION: depression emotion regulation executive function habitual cluster behaviours health literacy obesity PRIMARY OUTCOME: Cognitive Functioning. Outcome assessed through a neuro‐psychological test battery comprising of (a) Rey Complex Figure Test (b) Trail Making Task (c) Wisconsin Card Sorting Task (d) National Adult Reading Test (e) Reward Loss Task (f) BRIEF A and (g) Digit Span subtest of WAIS III weight loss‐ assessed by digital scales SECONDARY OUTCOME: Depression assessed by the psychometric inventory DASS 21 Emotion regulation‐ assessed by the psychometric inventory DERS Habitual Cluster Behaviours‐ assessed by the (modified) Self‐Report Habit Index (SRHI); Health Literacy‐ assessed by‐ Modified version of the Bulimia Mental Health Literacy Questionnaire INCLUSION CRITERIA: Inclusion criteria for this group are: having a BMI > 30, age 18‐ 55 years, current weight under 180 kgs, ability to consent and having completed 10 years of education in English. Participants who are depressed and wish to take part of the trial will be included. Patients with hypertension (medicated or not medicated), type 2 diabetes, or high cholesterol will be included. Those with binge eating disorder will not be excluded. We aim for equal number of females and males, but based on past weight loss studies, 60% will be females.