Background: A growing body of research demonstrated impaired executive functions in
individuals with severe obesity, including increased sensitivity to reward and impulsive
decision making under risk conditions. For the assessment of decision making in patients
with severe obesity, studies widely used the Iowa Gambling Task (IGT) or the Delay
Discounting Task (DDT), which cover short-term or long-term consequences of decisions
only. A further development originating from the field of addiction research is the Cards
and Lottery Task (CLT), in which each decision made has conflicting immediate and longterm
consequences at the same time. The present study aimed to validate the CLT in
individuals with severe obesity.
Methods: Patients with severe obesity (N = 78, 67% women, 42.9 ± 10.4 years old, body
mass index of 48.1 ± 8.3 kg/m2) were included. Convergent validity was evaluated using
the computerized Delay Discounting Task and well-established self-report questionnaires
assessing different aspects of impulsivity. For discriminant validity, CLT performance was
compared between symptom groups characterized by high versus low impulsivity. The
task’s clinical validity was evaluated based on associations with general and eating
disorder psychopathology, and body mass index. Test-retest reliability was determined by
administering the CLT in n = 31 participants without weight-loss treatment one year later.
The task’s sensitivity to change due to weight loss was evaluated by retesting n = 32
patients one year after receiving obesity surgery.
Results: The number of advantageous decisions in the CLT was significantly positively
associated with delay discounting and effortful control, and significantly negatively
correlated with behavioral impulsivity. CLT performance differed significantly between
individuals with and without symptoms of attention-deficit/hyperactivity disorder and
between samples with severe obesity and healthy controls. Clinically, CLT performance
was significantly associated with general, but not eating disorder psychopathology. The
CLT showed moderate test-retest reliability after one year in weight-stable individuals and
was sensitive to change in those undergoing obesity surgery.
Conclusions: This study identified the CLT to be a highly promising, new complex
measure of short- and long-term decision making with good reliability and validity in
individuals with severe obesity. Future studies should assess its association with the IGT
and predictive value for real-life health behavior