Efficacy of a web-based executive function training program to induce healthier food choices and increase valuation of fruits and vegetables in adults a randomized controlled trial

Authors: Roemmich, James; NELSON, ALESE - University Of Wisconsin; STICE, ERIC - Stanford University; Hess, Julie; PALMER, DANIEL - University Of North Dakota; Casperson, Shanon

Submitted to: Journal of Medical Internet Research
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 7/2/2025
Publication Date: N/A
Citation: N/A

Interpretive Summary: Executive function (EF) includes the cognitive abilities thought to assist in conscious control of food choices. However, it is unclear whether EF training can change attitudes towards nutrient-poor foods to reduce their consumption while improving attitudes towards consumption of nutrient-dense foods, like fruits and vegetables. The goal of this research is to determine whether a web-based EF training program can mprove attitudes and consumption of nutrient-dense foods (i.e., fruits, vegetables) while worsening the same of nutrient-poor foods (i.e., candy, fried snacks). Participants will be assigned to complete EF training games that promote responding to fruits and vegetables and inhibits responses to nutrient poor food. EF will be tested before and after 8-weeks of training. Dietary intake will be measured before and after the 8-week intervention. The association of improved EF with healthy eating behaviors may be key to improving diet quality. If effective, this web-based EF training program could be made widely available to aid individuals in food-related decision-making.

Technical Abstract: Background: Executive function (EF) is a set of explicit (top-down) cognitive abilities theorized to assist in conscious control of eating behavior. However, it is unclear whether EF training can alter attitudes and perceptions of nutrient-poor foods, and consumption of those foods while concurrently improving valuation of, and consumption of nutrient-dense foods. Objective: The primary objective is to determine the efficacy of a web-based EF training program designed to concurrently improve attitudes, perceptions, and consumption of nutrient-dense foods (i.e., fruits, vegetables) while worsening the same of nutrient-poor foods (i.e., candy, fried snacks). Methods: Participants will include a U.S. nationally representative sample (n=500) of men and women aged 18–70 years with a BMI between 18.5–38 kg/m2. Participants will be randomized to EF training via a suite of four web-based games that promotes responding to fruits and vegetables and inhibits responses to nutrient poor foods and trains attention toward the former and away from the latter or sham training that involves images of flowers and songbirds. Training will occur at least twice per week. EF will be tested before and after 8-weeks of training. Dietary intake will be measured before and after the 8-week intervention. Results: Group and sex differences in frequencies of participants violating inhibitory signals will be assessed with log-linear models. Linear mixed effects models will test whether web-based EF training improves EF as measured via response inhibition and attention during computer-based game play (training). The independent and interactive associations of inhibitory and attentional learning on consumption of nutrient-poor foods will be tested with mixed model regression. If random assignment results in baseline imbalances across conditions on any variables, they will be used as covariates in the mixed models. Analyses will be both ‘intent to treat’ utilizing (restricted) maximum likelihood estimation and ‘completer’ to understand the results from those participants who completed the training at least twice per week. Conclusions: The association of improved EF with healthy eating behaviors may be key to improving diet quality. If effective, this web-based EF training program will provide a platform that can be made widely available to aid individuals in food-related decision-making. The platform could be modified to target other food choices and other health behaviors such as reducing sedentariness and increasing physical activity.