Episodic future thinking improves intertemporal choice and food choice in individuals with higher weight: A systematic review and meta-analysis

Episodic future thinking (EFT) strengthens self-regulation abilities by increasing the perceived value of long-term reinforcements and reducing impulsive choice in delay discounting tasks. As such, EFT interventions have the potential to improve dietary and eating-related decision-making in individuals with obesity or binge eating symptoms, conditions associated with elevated delay discounting. Here, we meta-analyzed evidence from 12 studies that assessed whether EFT interventions improve delay discounting and real-world food choice compared to control interventions. Included studies involved 951 adults with overweight or obesity (body mass index [BMI] ≥25). There were no studies involving participants with binge eating disorder. EFT intervention pooled effects were significant, improving delay discounting with a medium effect, g = 0.55, p < 0.0001, and subsequent food choice outcomes with a small effect, g = 0.31, p < 0.01. Notably, our review is the first to analyze mechanisms of effect in this population, demonstrating that improvements were greater when temporal horizons of EFT episodes were aligned with delay discounting tasks and more distant horizons predicted far-transfer to subsequent dietary and eating-related choices. Our findings thus show that EFT is an effective intervention for individuals with higher weight at risk of adverse health consequences.