title: Behavioral economic predictors of overweight children's weight loss.
abstract: OBJECTIVE
  Our goal was to determine whether behavioral economic constructs-including impulsivity (i.e., steep discounting of delayed food and monetary rewards), the relative reinforcing value of food (RRVfood), and environmental enrichment (i.e., the presence of alternatives to unhealthy foods in the home and neighborhood environments)-are significant pretreatment predictors of overweight children's weight loss within family-based treatment.
  
  
  METHODS
  Overweight children (N = 241; ages 7-12 years; 63% female; 65% non-Hispanic White) enrolled in a 16-week family-based obesity treatment with at least one parent. At baseline, children completed a task to assess RRVfood and delay discounting measures of snack foods and money to assess impulsivity. Parents completed questionnaires to assess environmental enrichment.
  
  
  RESULTS
  Children who found food highly reinforcing and steeply discounted future food rewards at baseline showed a blunted response to treatment compared with children without this combination of risk factors. High environmental enrichment was associated with treatment success only among children who did not find food highly reinforcing. Monetary discounting rate predicted weight loss, regardless of children's level of RRVfood.
  
  
  CONCLUSIONS
  Investigation is warranted into novel approaches to obesity treatment that target underlying impulsivity and RRVfood. Enriching the environment with alternatives to unhealthy eating may facilitate weight loss, especially for children with low RRVfood.
authors.affiliation: Department of Psychiatry.
authors.forename: John R
authors.initials: JR
authors.lastname: Best
authors.affiliation: Department of Psychology.
authors.forename: Kelly R
authors.initials: KR
authors.lastname: Theim
authors.affiliation: Department of Psychology.
authors.forename: Dana M
authors.initials: DM
authors.lastname: Gredysa
authors.affiliation: Department of Psychiatry.
authors.forename: Richard I
authors.identifier: 0000-0003-1614-4845
authors.initials: RI
authors.lastname: Stein
authors.affiliation: Department of Psychiatry.
authors.forename: R Robinson
authors.initials: RR
authors.lastname: Welch
authors.affiliation: Seattle Children's Research Institute, University of Washington.
authors.forename: Brian E
authors.initials: BE
authors.lastname: Saelens
authors.affiliation: College of Public Health and Health Professions, University of Florida.
authors.forename: Michael G
authors.identifier: 0000-0003-3651-1542
authors.initials: MG
authors.lastname: Perri
authors.affiliation: Division of Biostatistics.
authors.forename: Kenneth B
authors.initials: KB
authors.lastname: Schechtman
authors.affiliation: Department of Pediatrics, University at Buffalo School of Medicine and Biomedical Sciences.
authors.forename: Leonard H
authors.initials: LH
authors.lastname: Epstein
authors.affiliation: Department of Psychiatry.
authors.forename: Denise E
authors.initials: DE
authors.lastname: Wilfley
mesh_terms: D002648:Child; D004777:Environment; D005247:Feeding Behavior / Q000523:psychology*; D005260:Female; D006801:Humans; D007175:Impulsive Behavior / Q000523:psychology*; D008297:Male; D050177:Overweight / Q000523:psychology* / Q000628:therapy; D016487:Parenting / Q000523:psychology; D010290:Parents / Q000523:psychology; D012054:Reinforcement, Psychology; D012931:Social Environment; D015431:Weight Loss