Identification of cognitive factors that predict behavioural weight-loss intervention outcomes

Individuals vary widely in their response to behavioral weight-loss interventions, suggesting that neurocognitive differences may influence treatment success. We examined whether baseline cognitive performance predicted percent change in body weight over 8 months in a behavioral weight-loss trial. This secondary analysis used data from the Dietary Adaptation for Weight-loss maintenance at Yale (DAWLY) trial, a randomized, double-blind, placebo-controlled study of oleoylethanolamide (OEA) in adults with overweight or obesity. All participants completed a structured lifestyle behavioral weight-loss program (LEARN®) for four months (including dietary and physical activity guidance and behavioral strategies to achieve the lifestyle changes), followed by a four-month maintenance phase. Thirty-one participants completed the 8-month follow-up and a comprehensive neurocognitive battery. Cognitive variables were z-standardized and entered into principal component analysis; component scores were then used in regression models predicting percent weight change, adjusting for baseline weight, age, education, days tracked, sex, and treatment group. The first six components explained 73.8% of the variance in baseline cognition. Sex and PC5, characterized by strong loadings on probabilistic reinforcement learning and spatial working-memory tasks, were significantly associated with percent weight change. Individuals with higher PC5 scores and women showed greater 8-month weight loss. These results suggest that the ability to learn and update value contingencies and to use effective working-memory strategies may contribute to successful weight-loss during behavioral interventions. Clinical trial registration: www.ClinicalTrials.gov , identifier: NCT04614233.