A systematic review of the evidence for enhancing childhood obesity treatment from a dual-process perspective.

Childhood obesity is a growing public health problem worldwide. Although existing interventions are effective in producing weight loss, they often fail to procure sustained weight loss. To enhance childhood obesity treatments, further insight is needed into the mechanisms that determine excess caloric intake and associated weight gain. One possible explanation for the poor outcomes of existing therapies is that overweight youngsters have a heightened responsivity to high calorie food cues coupled with poor self-regulatory control. The aim of the present review was to evaluate the evidence for the self-regulation failure hypothesis from a dual-process models perspective. According to dual-process models, eating regulation and weight management are determined by the interplay between automatic and regulatory processes. Relevant publications were identified through a systematic search of six electronic databases (Embase, Medline, PsycInfo, PubMed, Scopus and Web of Science). Eligible studies recruited a child or adolescent sample; measured or manipulated one or more automatic (attentional bias, approach bias) and/or regulatory processes (working memory, inhibitory control, executive function); used a cross-sectional, longitudinal or experimental design; and included a primary outcome measure that was eating/weight related and/or pertained to the underlying process(es). A total of 135 such studies were identified, most of which were of high quality. There were, however, substantial methodological variations and inconsistent findings across studies. Nevertheless, on balance, the evidence shows a stronger impact of automatic processes and in particular a reduced capacity for regulatory processing in overweight children and adolescents. In addition, emerging evidence suggests that these dual-processes can be modified through targeted training to reduce caloric intake and associated body weight. Thus, an intervention protocol based on the dual-process framework holds promise for enhancing current childhood obesity treatment programs. However, further research in the form of adequately powered, methodologically sound randomised controlled trials is needed.