Solving the Mystery of Weight Loss Failures
Research points to cognitive flexibility as the answer.
Posted August 18, 2021 | Reviewed by Tyler Woods
- Recent research has shown that training cognitive flexibility helps participants achieve greater weight loss.
- Obesity seems to cause and is itself a result of deficits in cognitive flexibility.
- It is possible to teach cognitive flexibility.
When we are attempting to lose weight and exercise more, often we hit a logjam. Something gets in the way. It is possible to fail without even knowing what happened. We follow advice, make a plan, find our motivation, and resolve to really do it this time.
In spite of all this, there is something missing that stops us in our tracks. We may conclude that there is something wrong with us. We may decide that we don’t actually have the ability to change, and we may give up.
Research Supporting a Solution
Recent research has shown definitively what is missing. A research group in Australia (2014, 2018) set up a randomized, controlled study to differentiate between a commonly used Behavioral Weight Loss Treatment (BWLT) and that same treatment augmented by what they termed Cognitive Remediation Therapy (CRT).
The focus of Cognitive Remediation Therapy was to tap into participants’ executive function, specifically cognitive flexibility. They used Cognitive Remediation Therapy to teach individuals how to think differently in order to impact the decision-making process. Insight into a patient's thinking process was followed by using revised thinking to find new solutions that hadn’t presented themselves previously.
The group proposed that using Cognitive Remediation Therapy would enhance participants’ ability to take advantage of what they learned via Behavioral Weight Loss Treatment. The results were significant. The CRT group showed a marked improvement in their cognitive flexibility, even after a three-month follow-up. Additionally, 68 percent of the CRT group achieved a weight loss of 5 percent or more compared to only 15 percent of those who had the BWLT without CRT.
What are the Elements of Cognitive Flexibility?
This research is supported by many findings showing that cognitive flexibility is a vital part of having the ability to switch behaviors. New behaviors can then be incorporated into daily living through sustained practice.
Briefly, cognitive flexibility allows a person to call upon complex mental processes to solve problems. It involves working memory (learning), impulse inhibition, organizing tasks, managing time, and being able to acquire skills in order to reach behavioral goals.
On the other hand, cognitive inflexibility (also known as deficits in executive function) tends to lead a person to see a problem as arising from a certain cause, and then seek solutions that are simplistic. Thoughts like, “I just need more motivation”, or “I know what to do, I just need to do it” are common. Additionally, cognitive inflexibility can result in an inability to plan, regulate impulses, or make thoughtful, creative decisions. These limitations often interfere with a person’s ability to judge the likelihood of failure.
Cognitive Causes and Effects of Obesity
Unfortunately, obesity has been linked again and again with cognitive inflexibility. The deficits make it very difficult to manage weight gain, maintain weight loss, or organize regular exercise.
While the cause of these deficits is not fully understood, it has been suggested that increased inflammatory markers and glucose control issues play a part. Obesity can cause high blood pressure, cardiovascular disease, and diabetes, all of which have been shown to adversely affect executive function. There is also a linear relationship between cognitive inflexibility and physical activity. Low levels of physical activity are particularly harmful to cognitive function.
There is a reciprocal relationship between obesity and cognitive inflexibility. Cognitive inflexibility can cause obesity, and obesity can cause cognitive inflexibility.
Developing Cognitive Flexibility
To support the importance of cognitive flexibility, we can look at other areas of treatment that have shown some success in producing and maintaining weight loss. They are each in some way related to teaching cognitive flexibility. A few are listed here:
- Fixed vs. Growth Mindset: In the book Mindset, Carol S. Dweck outlines the difference between a fixed and a growth mindset. A fixed mindset causes individuals to believe that any talents or abilities they have are fixed. When failure occurs, it is taken as part of the person’s fixed identity. On the other hand, a growth mindset enables the person to see each failure as a challenge, and an opportunity to re-think the solution.
- Mindfulness meditation: Mindfulness meditation has been shown to improve cognitive flexibility by developing attention and focus. This gives the individual the ability to step back, not act on impulse, and have the time and mental space to consider creative solutions.
- Behavior modification: This type of program targets health literacy and weight loss strategies. In addition, weight monitoring is encouraged, dietary guidelines are given, there is help with exercise planning, and perceived barriers are addressed. This type of program has been used successfully, perhaps because it takes into account the complexity of the problem, as well as empowering individuals to set up their own path via choosing which behaviors to work on.
- Problem-solving guidelines from the CDC: The agency's five steps to solving health problems goes like this: (1) Describe the problem, (2) Come up with options, (3) Choose the best option, (4) Make an action plan, and (5) Try it! The implication here is to work on a small, solvable problem (which involves focus and attention) and then to use decision-making, not impulse, to apply a solution.
A Final Word
Let’s go back to the research study mentioned in the beginning. According to the authors, cognitive flexibility can be taught. To do so, the teaching must include these three important concepts:
- There must be a process of learning, that is, acquiring new information that can be applied to personal experience.
- Finding solutions that are in line with the complex nature of the problem.
- Success then comes when a person practices the new solution again and again, until adaptation occurs.
Raman, J., Hay, P., Smith, E. (2014). Manualized Cognitive Remediation Therapy for adult obesity: study protocol for a randomized controlled trial. Trials, 15:426.
Raman, J., Hay, P., Tchanturia, K., Smith, E. (2018). A randomized controlled trial of manualized cognitive remediation therapy in adult obesity. Appetite, 123, 269-279.
Moore, A., Malinowski, P. (2009). Meditation, mindfulness and cognitive flexibility. Consciousness and Cognition, 18(1), 176-186.
Dweck, C. S. (2006, 2016). Mindset: The New Psychology of Success. Ballantine Books.
Favieri, F., Forte, G., Casagrande, M. (2019). The Executive Functions in Overweight and Obesity: A Systematic Review of Neuropsychological Cross-Sectional and Longitudinal Studies. Frontiers in Psychology, 10:2126.