Relations Between Child Obesity and Executive Function Among Low-Income Latinx Families Participating in an Obesity Intervention: A Secondary Analysis

Abstract

Rates of obesity have tripled worldwide since 1975 (World Health Organization, WHO, 2017), with the epidemic affecting both pediatric and adult populations. Given the increasingly widespread prevalence of childhood obesity, research has focused on how childhood obesity affects long-term physical and mental health outcomes, such as executive functioning. Research supports a bidirectional relationship between childhood obesity and executive functioning. Executive functioning (EF) describes the cognitive capabilities necessary for an individual to engage in goal-directed behavior (Miyake & Friedman, 2012). It includes constructs such as cognitive flexibility, working memory, and inhibition (Miyake & Friedman, 2012). Executive functions affect obesity through influencing the individual’s ability to initiate healthy activities and to inhibit consumption of unhealthy food (Gettens & Gorin, 2017). This pattern of behaviors (i.e., failure to initiate healthy activities and overconsumption of unhealthy foods) results in weight gain over time. Conversely, obesity changes the physical structure of the brain through decreased blood flow to the pre-frontal cortex in adolescents and adults (Fitzpatrick, Gilbert, & Serpell, 2013), which could result in the development of EF deficits over time. Although there is research examining links between EF and obesity, few studies have examined if such links are found in Latinx communities and in young children. This dissertation explored relationships between childhood obesity, EF, and English language proficiency in a sample (n=44) of low-income, Latinx, immigrant, elementary school students. Childhood obesity was assessed through Body Mass Index (zBMI), waist circumference (cm), and blood sample measures. EF skills were assessed through the parent-report Spanish version of the Behavior Rating Inventory of Executive Function (BRIEF; Gioia, Isquith, Guy, & Kenworthy, 2015), the Child Behavior Checklist (CBCL; Achenbach & Rescorla, 2001), and a computerized go-no-go task (Fillmore, Rush, & Hays, 2006). English language proficiency of children was assessed via the English version of the Picture Vocabulary Test-III (PPVT-III; Dunn & Dunn, 1997) and parental reports of the child’s language competence. By design, all children were classified as obese at baseline, but none of the children met criteria for clinically significant deficits on the BRIEF, and only three of the children met criteria for clinically significant deficits on the CBCL. This study was a secondary analysis of data collected from the VALÉ program, which was a pediatric obesity intervention conducted in Prince William County. Although the original study included three cohorts, the current study only used the two cohorts (fall 2017 and spring 2018) who participated in additional EF and language assessment. Participants were recruited through referrals from school and community programs (Gallo et al., 2019). The participants were assessed twice - the first time at baseline (before the intervention began; n= 44) and the second time directly after the intervention was completed (10-12 weeks after baseline; n= 25). Following baseline testing, parents and children participated in a ten-week multi-modal family obesity intervention designed to improve weight maintenance for children who were experiencing pediatric obesity (Gallo et al., 2019). Concurrent correlational analyses at baseline indicated that child obesity (as measured by zBMI, weight circumference and blood markers) was generally not associated with the EF measures. Although small correlations (i.e., .11 to .30) were generally in the hypothesized direction, they were typically not significant given the small sample sizes, except for triglyceride counts (r= .27 to .38) which were positively related to parent-reported child EF and behavior problems. Sedentary activity scores (r = .29 to .69) were positively related to parent-reported child EF and behavior problems. Parental report of child English proficiency was negatively correlated with EF problems (r = -.28 to -.35). Although child obesity measures were unrelated to the English vocabulary assessment, they were positively associated with parent report of child English proficiency. Overall, there was a pattern of non-significant positive correlations between baseline EF scores and obesity change scores - children with higher baseline EF problems made slightly poorer progress following the intervention. The overall relationships between baseline EF and dietary change scores were not significant. Finally, relationships between baseline EF and change in child physical fitness markers were also not significant, but the trend was children with greater EF problems at baseline showed somewhat more reductions in sedentary activity and increases in physical activity overtime. Changes in EF over time were not related to changes in obesity, food intake, and physical activity. In conclusion, this study, although limited by attrition and small sample sizes, contributes to the literature by establishing preliminary estimates of how executive functioning abilities may be involved in weight loss behaviors in a minority population.