Patients with obesity show riskier decision making

Decision-making abilities in risky scenarios, in which information about contingencies was available, were impaired among people with obesity compared with those without obesity, according to recently published findings from France.

Decisions made under ambiguous scenarios, in which information about the contingencies of different choices was not available, were similar among those with and without obesity, according to researchers.

“Many studies have reported impairments in executive functions associated with obesity both in children and adults,” Jean-Yves Rotge, MD, PhD, of the Service de Psychiatrie d’Adultes, Groupe Hospitalier Pitie-Salpetriere, Paris, and colleagues wrote. “Although some inconsistencies appear across studies, a recent qualitative review highlighted strong deficits in decision-making, planning or problem solving in obese patients. Possible impairments in decision-making associated with obesity have to be elucidated.”

The researchers identified seven studies that compared Iowa gambling task results — the gold standard for studying decision-making abilities — across groups of patients with obesity and healthy controls. None of the patients had an eating disorder. Rotge and colleagues calculated the standardized mean differences for both the patients’ total scores and the course of Iowa gambling task scores, and performed meta-regression analyses to evaluate how clinical variables influenced standardized mean differences.

Data for 250 patients with obesity and 362 healthy controls were included in the studies. Mean age ranged from 14.3 to 52.2 years, and mean BMI ranged from 30.8 to 42.2 kg/m² in patients with obesity.

Rotge and colleagues reported that patients with obesity had significantly lower Iowa gambling task scores, indicating less advantageous choices, compared with controls (SMD = –0.83; 95% CI, –1.34 to –0.33). Performances did not differ between groups in the first trials of the task and showed a high degree of heterogeneity in the last trials, the researchers wrote. Rotge and colleagues noted that a single study drove heterogeneity, according to leave-one-out analyses.

“In conclusion, the results of this study suggest that obesity might be associated with impairments in decision-making under risk,” the researchers wrote. “The clinical impact of such decision-making deficits remains to be further investigated, especially regarding its influence on how obese individuals perform in daily life and regarding weight loss outcomes.” – by Andy Polhamus

Disclosure: One researcher reports grants and honoraria from Janssen, Lundbeck and Servier.