Obesity and the four facets of impulsivity

Abstract

Objective

Obesity is a complex condition involving biological, psychological, sociocultural and environmental components. Impulsivity seems to be a particularly important factor. Whiteside and Lynam recently proposed dividing impulsivity into four separate dimensions: Urgency, lack of Premeditation, lack of Perseverance and Sensation Seeking (associated with a tendency to exaggerate the impact of rewards). The objective of this article is to examine how obesity and eating disorder symptoms may be related to the four facets of impulsivity.

Methods

Whiteside and Lynam's Impulsive Behavior Scale, the Sensitivity to Punishment and Sensitivity to Reward Questionnaire, the Eating Disorder Examination Questionnaire and the Mizes Anorectic Cognitions Questionnaire were used to explore the association between the cognitive and motivational facets of impulsivity and obesity in 47 overweight or obese persons with eating disorders and 47 normal-weight controls.

Results

Results suggest that overweight and obese persons have higher levels of Urgency, lack of Perseverance and Sensitivity to Reward.

Conclusion

These results suggest that obese and overweight persons have difficulty inhibiting automatic or dominant behavior and intrusive thoughts and a higher sensitivity to reward.

Practice implications

Overweight and obese persons may benefit from psychological interventions targeting self-control problems associated with impulsive eating behaviors.

Introduction

In western society, food temptations are everywhere; however, not everyone has difficulty regulating their food intake or resisting food temptations. What, then, makes overweight and obese persons different from the rest of the population? It is recognized that various biological (e.g., reduced thermogenesis), psychological (e.g., eating disorders, depression) and sociocultural (e.g., low socio-economic status) factors contribute to the development and maintenance of excess weight [1]. Among these factors, impulsivity plays a particularly important role in obesity and eating behaviors. Recent studies using self-report questionnaires and psychological tasks have shown that impulsivity contributes to the development and maintenance of obesity [2], [3], [4].

Impulsivity is an important construct that covers a wide range of behavioral, motivational and emotional phenomena. In this context, according to Whiteside and Lynam's work [5], impulsivity must be considered as a multifaceted construct, made up of four separate components, which are the basis for the creation of a scale called the UPPS Impulsive Behavior Scale:

• Urgency, defined as “the tendency to experience strong impulses, frequently under conditions of negative affect”;

• lack of Perseverance, defined as “the difficulty to remain focused on a task that may be boring or difficult”;

• lack of Premeditation, defined as “the difficulty to think and reflect on the consequences of an act before engaging in the act”;

• Sensation Seeking, defined as “a tendency to enjoy and pursue activities that are exciting, and openness for new experiences.”

Bechara and Van der Linden [6], [7] recently proposed to relate the various facets of impulsivity to specific cognitive and motivational processes (Fig. 1). They suggested that the facets “Urgency,” “lack of Perseverance” and “lack of Premeditation” may be related to cognitive/self-control mechanisms, while “Sensation Seeking” may be related to motivational factors [7]. More specifically, “Urgency” may be related to the inability to deliberately suppress dominant, automatic or prepotent responses, especially in conditions of intense emotions. “Lack of Perseverance” could be related to difficulty resisting intrusive thoughts or intrusive images, while “lack of Premeditation” could be related to the inability to take into account the positive or negative consequences of a decision on the basis of the emotional responses associated with it. Finally, “Sensation Seeking” may be related to a tendency to exaggerate the impact of rewards and may operate automatically [8], [9]. Each facet is supported by a specific cerebral network [7].

Several studies have assessed obese persons by means of self-report questionnaires and/or cognitive tasks that examine one or more of the four components of impulsivity.

The Urgency component has been measured by self-report questionnaires [10] and psychological tasks [11]. Urgency may contribute to an obese person's problem controlling eating in situations of strong emotion. Guerrieri et al. [12] found that difficulty suppressing an automatic response (as measured by stop signal reaction time) predicted heightened food intake.

To the best of our knowledge, lack of Perseverance has only been measured in obese persons by means of self-report questionnaires [1]. There is a link between obesity and the self-discipline facet of the well-known NEO Personality Inventory (NEO-PI-R), which is related to lack of Perseverance [10]. Obese persons who overeat have a strong tendency to suppress thoughts [13], which may make the suppressed thoughts (e.g., thoughts of food) become hyperaccessible, which in turn causes distress and increased food consumption [14]. This may explain why obese people overeat, despite their intentions to control their food intake. In the same vein, it has been shown that avoidance of body/shape concerns actually increases such preoccupations [15]. Thought control difficulties may discourage patients and interfere with their treatment.

The lack of Premeditation aspect of impulsivity has been measured by self-report questionnaires [10] and psychological tasks [16]. Previous studies have shown that obese persons choose immediate rewards even when future long-term negative consequences are associated with them. This reflects an inability to assess future impact, which may potentially contribute to disadvantageous decision-making (e.g., not considering the possible long-term negative consequences of overeating).

The Sensation Seeking dimension has been measured by self-report questionnaires [17], [18], [19] and a psychological task [20]. Overweight persons with binge eating disorders have enhanced sensitivity to rewards [19]. The tendency to seek rewards (e.g., food) is associated with food intake, overeating and subsequent weight gain, as well as difficulty maintaining or losing weight [21]. This tendency affects food intake, especially when varied food (food that varies in color, form, taste and texture) is offered [20]. It may be related to a heightened selective attention to food stimuli and may make it difficult to regulate eating, particularly in obese individuals who have impaired sensitivity to the hunger and satiety signals that normally regulate eating [22].