Although a central concern of public health is the self-management of chronic diseases, the cognitive demands required by behavior change are seldom explored. The purpose of this study was to examine the effect of cognitive limitations—with a focus on cognitive interference (i.e. “off task” thoughts)—on weight loss efforts through both an experimental and a qualitative approach. Individuals currently enrolled in a structured weight loss program completed positive and negative weight-loss related Stroop tasks to measure cognitive interference levels. Response times were compared between and within participants who were engaged (N=25) vs. unengaged (N=15) and successful (N=16) vs. unsuccessful (N=24) with the weight loss program. Successful participants had significantly faster response times (p=.01) on the positive Stroop compared to the negative Stroop (716.6 ± 98.1, 761.3 ± 106.4), as did the engaged participants (p=.02; 725.1 ± 96.7, 759.9 ± 111.7). No statistically significant differences were found between successful & unsuccessful or engaged & unengaged groups, however the experimental findings suggest that cognitive interference in response to weight-loss related cues may be related to success with and engagement in a weight loss program. A qualitative exploration of interview responses identified themes related to cognitive processes and interference and supported the supposition that unhealthy behaviors are often automatic, and changing them can have high cognitive demands. However, participant responses also indicated that healthy behaviors can be automatized with practice. In addition, the external factors that participants identified as influencing their health behavior choices indicate that a social and built environment that supports healthier decisions would make the health behavior changes less cognitively demanding. The public health significance of these findings is that they indicate that both cognitive limitations and environmental influences should be taken into account when examining the need for health behavior change and designing interventions to address this need. Further research into how cognitive factors affect lifestyle decision-making may contribute to a deeper understanding of how to promote self-care behaviors that lead to better health outcomes
