Intuitive eating is associated with interoceptive sensitivity. Effects on body mass index

Fat Tissue Accretion in Children and Adolescents: Interplay between Food Responsiveness, Gender, and the Home Availability of Snacks

The appetitive trait “food responsiveness” is assumed to be a risk factor for adiposity gain primarily in obesogenic environments. So far, the reported results are inconsistent in school-aged children, possibly because these studies did not take into account important moderators such as gender and the food-environment. In order to better inform caregivers, clinicians and the developers of targeted obesity-prevention interventions on the conditions in which food responsiveness precedes adiposity gain, the current study investigated if this relationship is stronger in girls and in children exposed to a higher home availability of energy-dense snacks. Age- and sex-independent Fat and Lean Mass Index z-scores were computed based on air-displacement plethysmography at baseline and after 2 years in a community sample of 129 children (48.8% boys) aged 7.5–14 years at baseline. Parents reported at baseline on children's food responsiveness and the home availability of energy-dense snacks. Food responsiveness was a significant predictor of increases in Fat Mass Index z-scores over 2 years in girls but not boys. The home availability of energy-dense snacks did not significantly moderate the relation of food responsiveness with Fat Mass Index z-score changes. The results suggest that food responsiveness precedes accelerated fat tissue accretion in girls, and may inform targeted obesity-prevention interventions. Further, future research should investigate to which food-environmental parameters children high in food responsiveness mainly respond.

The Clinical Significance of Posterior Insular Volume in Adolescent Anorexia Nervosa

OBJECTIVE

The diagnostic criterion disturbance in the experience of the body remains a poorly understood and persistent feature of anorexia nervosa (AN). Increased sophistication in understanding the structure of the insular cortex-a neural structure that receives and integrates visceral sensations with action and meaning-may elucidate the nature of this disturbance. We explored age, weight status, illness severity, and self-reported body dissatisfaction associations with insular cortex volume.

METHODS

Structural magnetic resonance imaging data were collected from 21 adolescents with a history of AN and 20 age-, sex-, and body mass index-matched controls. Insular cortical volumes (bilateral anterior and posterior regions) were identified using manual tracing.

RESULTS

Volumes of the right posterior insula demonstrated the following: (a) a significant age by clinical status interaction (β = -0.018 [0.008]; t = 2.32, p = .02) and (b) larger volumes were associated with longer duration of illness (r = 0.48, p < .04). In contrast, smaller volumes of the right anterior insula were associated with longer duration of illness (r = -0.50, p < .03). The associations of insular volume with body dissatisfaction were of moderate effect size and also of opposite direction, but a statistical trend in right posterior (r = 0.40, p < .10 in right posterior; r = -0.49, p < .04 in right anterior).

CONCLUSIONS

In this exploratory study, findings of atypical structure of the right posterior insular cortex point to the importance of future work investigating the role of visceral afferent signaling in understanding disturbance in body experience in AN.

The determinants of food choice

Health nudge interventions to steer people into healthier lifestyles are increasingly applied by governments worldwide, and it is natural to look to such approaches to improve health by altering what people choose to eat. However, to produce policy recommendations that are likely to be effective, we need to be able to make valid predictions about the consequences of proposed interventions, and for this, we need a better understanding of the determinants of food choice. These determinants include dietary components (e.g. highly palatable foods and alcohol), but also diverse cultural and social pressures, cognitive-affective factors (perceived stress, health attitude, anxiety and depression), and familial, genetic and epigenetic influences on personality characteristics. In addition, our choices are influenced by an array of physiological mechanisms, including signals to the brain from the gastrointestinal tract and adipose tissue, which affect not only our hunger and satiety but also our motivation to eat particular nutrients, and the reward we experience from eating. Thus, to develop the evidence base necessary for effective policies, we need to build bridges across different levels of knowledge and understanding. This requires experimental models that can fill in the gaps in our understanding that are needed to inform policy, translational models that connect mechanistic understanding from laboratory studies to the real life human condition, and formal models that encapsulate scientific knowledge from diverse disciplines, and which embed understanding in a way that enables policy-relevant predictions to be made. Here we review recent developments in these areas.

Changes in interoceptive processes following brain stimulation

The processing and perception of individual internal bodily signals (interoception) has been differentiated to comprise different levels and processes involved. The so-called heartbeat-evoked potential (HEP) offers an additional possibility to examine automatic processing of cardiac signals. Knowledge on neural structures potentially supporting different facets of interoception is still sparse. One way to get insights into neuroanatomical function is to manipulate the activity of different brain structures. In this study, we used repetitive transcranial magnetic stimulation (rTMS) and a continuous theta-burst protocol to inhibit specific central locations of the interoceptive network including the right anterior insula and the right somatosensory cortices and assessed effects on interoceptive facets and the HEP in 18 male participants. Main results were that inhibiting anterior insula resulted in a significant decline in cardiac and respiratory interoceptive accuracy (IAc) and in a consistent decrease in perception confidence. Continuous theta-burst stimulation (cTBS) over somatosensory cortices reduced only cardiac IAc and affected perception confidence. Inhibiting right anterior insula and right somatosensory cortices increased interoceptive sensibility and reduced the HEP amplitude over frontocentral locations. Our findings strongly suggest that cTBS is an effective tool to investigate the neural network supporting interoceptive processes.This article is part of the themed issue 'Interoception beyond homeostasis: affect, cognition and mental health'.

Atypical Self-Focus Effect on Interoceptive Accuracy in Anorexia Nervosa

Background: Interoceptive abilities are known to be affected in anorexia nervosa (AN). Previous studies could show that private self-focus can enhance interoceptive accuracy (IAcc) in healthy participants. As body dissatisfaction is high in AN, confrontation with bodily features such as the own face might have a directly opposed effect in AN. Whether patients with AN can benefit from self-focus in their IAcc and whether this pattern changes over the time-course of cognitive behavioral therapy was investigated in this study.

Methods: Fifteen patients with AN from the Psychosomatic Clinic in Windach were assessed three times in the time course of a standardized cognitive-behavioral therapy. They were compared to 15 controls, recruited from Ulm University and tested in a comparable setting. Both groups performed the heartbeat perception task assessing IAcc under two conditions either enhancing (“Self”) or decreasing (“Other”) self-focused attention. Furthermore, body dissatisfaction was assessed by a subscale of the Eating Disorder (ED) Inventory 2.

Results: Patients with AN scored higher in IAcc when watching others’ faces as compared to one’s own face while performing the heartbeat perception task. The opposite pattern was observed in controls. IAcc remained reduced in AN as compared to controls in the time-course of cognitive-behavioral therapy, while body-dissatisfaction improved in AN. High body dissatisfaction was related to poorer IAcc in the “Self” condition.

Conclusions: Our findings suggest that using self-focused attention reduces IAcc in AN while the opposite pattern was observed in controls. Confronting anorexic patients with bodily features might increase body-related avoidance and therefore decrease IAcc. The current study introduces a new perspective concerning the role of interoceptive processes in AN and generates further questions regarding the therapeutic utility of methods targeting self-focus in the treatment of AN.

Eating Behaviors in Cuban Adults: Results from an Exploratory Transcultural Study

This study aims to investigate eating behaviors in Cuban adults and compare them with those of a developed Western country, Italy. The study also aimed to determine the overall accuracy of a predictive model intended to define variables which could be used to discriminate between nationalities. Participants were 283 normal weight individuals from Cuba (n = 158) and Italy (n = 125). Italians had higher scores for restrained eating on the questionnaire than Cubans with a considerable effect size. This trend was also found for emotional eating and binge eating, as well as number of current dieters, despite the fact that effect sizes were small. On the other hand, Cubans, when compared to Italians reported higher scores for food thought suppression with reward responsiveness and restrained eating emerging as significant predictors of between-country differences. To conclude, eating behaviors in Cubans could be different from those reported in European countries, perhaps as a consequence of Cuba's recent history.

The Water Load Test As a Measure of Gastric Interoception: Development of a Two-Stage Protocol and Application to a Healthy Female Population

The sensitivity for one’s own internal body signals (i.e., interoception) has been demonstrated to play an important role in the pathogenesis of eating and weight disorders. Most previous measures assessing interoceptive processing have not, or only partly, captured perception of hunger and satiety cues, which is a core aspect of interoceptive deficits in eating disorders. In addition, methods used to measure sensitivity to gastric signals are heterogeneous and findings inconsistent. The primary aim of the present study was to establish a standardised test to measure gastric interoception, and to provide normative data using a non-clinical adult sample. The two-step Water Load Test (WLT-II) involves ingestion of non-caloric water until perceived satiation (step 1) and until maximum fullness (step 2). The WLT-II consists of several variables: Besides volumes of water ingested until satiation and maximum fullness expressed in ml, percentage of satiation to maximum fullness is calculated as an individual index of gastric interoception that is not confounded with stomach capacity. Ninety-nine healthy women participated in the study. Measures included the WLT-II, the heartbeat tracking test, a self-report questionnaire assessing subjective sensations, and the Eating Disorder Inventory-2. Twenty-eight participants underwent test-retest of the WLT-II. Results suggest that the WLT-II is a valid and reliable measure of gastric interoception. Importantly, satiation volume and percentage of satiation to maximum fullness were strongly positively related to self-reported bulimic symptoms, indicating that the WLT-II could emerge as a useful clinical tool to measure interoceptive processing in the field of eating disorders.

When life gives you lemons: The effectiveness of culinary group intervention among cancer patients

RATIONALE

Previous studies have shown that the dietary habits of cancer patients and survivors have significant implications for their recovery and quality of life. The current study examined the effectiveness of an innovative culinary group intervention on cancer patients' quality of life through changes in their eating behaviors, as manifested by an increase in their tendency towards intuitive eating and healthy food choices.

METHODS

In total, 190 cancer patients participated in this study, and were allocated to an intervention or a wait-list control group. A battery of self-report questionnaires assessing food choices, intuitive eating, health-related quality of life, and subjective well-being was administered at two time points: Before the intervention (T1) and at the end of the three month intervention (T2).

RESULTS

Analyses revealed an increase in health-related quality of life and well-being among the intervention group. Intuitive eating and healthy food choices also increased among the intervention but not wait-list control group. Finally, results indicated that participation in the culinary group intervention and improvements in health-related quality of life and well-being were mediated by changes in eating behaviors.

CONCLUSIONS

Our findings demonstrate that nutrition and eating behaviors have a significant effect on cancer patients' physical and emotional adjustment. A culinary group intervention seems to target patients' physical and emotional needs and promote their adjustment.

A weight-neutral versus weight-loss approach for health promotion in women with high BMI: A randomized-controlled trial

Weight loss is the primary recommendation for health improvement in individuals with high body mass index (BMI) despite limited evidence of long-term success. Alternatives to weight-loss approaches (such as Health At Every Size - a weight-neutral approach) have been met with their own concerns and require further empirical testing. This study compared the effectiveness of a weight-neutral versus a weight-loss program for health promotion. Eighty women, aged 30-45 years, with high body mass index (BMI ≥ 30 kg/m(2)) were randomized to 6 months of facilitator-guided weekly group meetings using structured manuals that emphasized either a weight-loss or weight-neutral approach to health. Health measurements occurred at baseline, post-intervention, and 24-months post-randomization. Measurements included blood pressure, lipid panels, blood glucose, BMI, weight, waist circumference, hip circumference, distress, self-esteem, quality of life, dietary risk, fruit and vegetable intake, intuitive eating, and physical activity. Intention-to-treat analyses were performed using linear mixed-effects models to examine group-by-time interaction effects and between and within-group differences. Group-by-time interactions were found for LDL cholesterol, intuitive eating, BMI, weight, and dietary risk. At post-intervention, the weight-neutral program had larger reductions in LDL cholesterol and greater improvements in intuitive eating; the weight-loss program had larger reductions in BMI, weight, and larger (albeit temporary) decreases in dietary risk. Significant positive changes were observed overall between baseline and 24-month follow-up for waist-to-hip ratio, total cholesterol, physical activity, fruit and vegetable intake, self-esteem, and quality of life. These findings highlight that numerous health benefits, even in the absence of weight loss, are achievable and sustainable in the long term using a weight-neutral approach. The trial positions weight-neutral programs as a viable health promotion alternative to weight-loss programs for women of high weight.

Validation of the Japanese Version of the Body Vigilance Scale

The Body Vigilance Scale is a self-report measure of attention to bodily sensations. The measure was translated into Japanese and its reliability, validity, and factor structure were verified. Participants comprised 286 university students (age: 19 ± 1 years). All participants were administered the scale, along with several indices of anxiety (i.e., Anxiety Sensitivity Index, Short Health Anxiety Inventory Illness Likelihood Scale, Social Interaction Anxiety Scale, and Hospital Anxiety and Depression Scale). The Japanese version of the Body Vigilance Scale exhibited a unidimensional factor structure and strong internal consistency. Construct validity was demonstrated by significant correlations with the above measures. Results suggest that the Japanese version of the scale is a reliable, valid tool for measuring body vigilance in Japanese university students.

Intuitive eating is inversely associated with body weight status in the general population-based NutriNet-Santé study

OBJECTIVE

To examine the relationship between intuitive eating (IE), which includes eating in response to hunger and satiety cues rather than emotional cues and without having forbidden foods, and weight status in a large sample of adults.

METHODS

A total of 11,774 men and 40,389 women aged ≥18 years participating in the NutriNet-Santé cohort were included in this cross-sectional analysis. Self-reported weight and height were collected as well as IE levels using the validated French version of the Intuitive Eating Scale-2. The association between IE and weight status was assessed using multinomial logistic regression models.

RESULTS

A higher IE score was strongly associated with lower odds of overweight or obesity in both men and women. The strongest associations were observed in women for both overweight [quartile 4 vs. 1 of IE: odds ratio, 95% confidence interval: (0.19, 0.17-0.20)] and obesity (0.09, 0.08-0.10). Associations in men were as follows: for overweight (0.43, 0.38-0.48) and obesity (0.14, 0.11-0.18).

CONCLUSIONS

IE is inversely associated with overweight and obesity which supports its importance. Although no causality can be inferred from the reported associations, these data suggest that IE might be relevant for obesity prevention and treatment.

The Relationship Between Interoception and Metacognition

Abstract. Recently, Garfinkel and Critchley (2013) proposed to distinguish between three facets of interoception: interoceptive sensibility, interoceptive accuracy, and interoceptive awareness. This pilot study investigated how these facets interrelate to each other and whether interoceptive awareness is related to the metacognitive awareness of memory performance. A sample of 24 healthy students completed a heartbeat perception task (HPT) and a memory task. Judgments of confidence were requested for each task. Participants filled in questionnaires assessing interoceptive sensibility, depression, anxiety, and socio-demographic characteristics. The three facets of interoception were found to be uncorrelated and interoceptive awareness was not related to metacognitive awareness of memory performance. Whereas memory performance was significantly related to metamemory awareness, interoceptive accuracy (HPT) and interoceptive awareness were not correlated. Results suggest that future research on interoception should assess all facets of interoception in order to capture the multifaceted quality of the construct.

Contributions of mindful eating, intuitive eating, and restraint to BMI, disordered eating, and meal consumption in college students

PURPOSE

Mindful eating and intuitive eating are promoted as means to circumvent potentially maladaptive dietary restraint while maintaining a healthy weight. Although theoretically related, no studies have examined the correlations between intuitive eating, mindful eating, and restraint in the same sample. This study sought to examine these constructs and their correlations with body mass index (BMI), eating-disordered behaviors, and meal consumption in a college sample.

METHODS

Participants (N = 125) completed a laboratory taste-test meal and measures of each eating-related construct using the EDDS, IES, MEQ, and TFEQ-Restraint Subscale.

RESULTS

Mindful eating, intuitive eating, and restraint were not strongly correlated. Hierarchical multiple regression analyses indicated that restraint and intuitive eating accounted for significant variance in disordered eating and BMI. Elevated restraint was associated with increased BMI and disordered eating; elevated intuitive eating was associated with decreased BMI and disordered eating. Mindful eating did not correlate with any outcome variables. Follow-up analyses suggested that specific intuitive eating subscales accounted for unique variance in the relation between intuitive eating and disordered eating. Intuitive eating was the only construct that was significantly associated with meal consumption.

CONCLUSIONS

Intuitive eating and restraint appear to be only weakly correlated, and each is differentially associated with meal consumption. Mindful eating does not appear to relate to outcome variables.

Interoceptive Processes in Anorexia Nervosa in the Time Course of Cognitive-Behavioral Therapy: A Pilot Study

OBJECTIVE

Previous studies report reduced interoceptive abilities in anorexia nervosa (AN) using various methods. Recent research suggests that different levels of interoceptive processes aiming at different subdomains of interoceptive abilities must be further distinguished as these levels can be differentially affected. Two important levels refer to interoceptive accuracy (IA) derived from objective performance tasks such as the heartbeat detection task and interoceptive sensibility (IS) as assessed by self-report. There is a lack of studies investigating both IA and IS in AN and examining them in the time course of therapy. The aim of this pilot study was to evaluate the different interoceptive processes - especially IA and IS - in the time course of therapy.

METHODS

Fifteen patients with AN (restricting type) from the Psychosomatic Clinic in Windach were investigated three times (T1, T2, T3) during a standardized cognitive-behavioral therapy and compared with 15 matched healthy controls assessed at Ulm University in a comparable design. All participants performed the heartbeat detection task examining IA and completed standard psychological assessments including an assessment of IS.

RESULTS

Patients with AN showed a significantly decreased weight, higher levels of depression, and both reduced IA and IS compared to healthy controls at T1. Following therapy, patients recovered in terms of weight and depression symptomatology. A descriptive trend for recovering from IA and IS was observed.

DISCUSSION

Our findings suggest that interoceptive deficits are present in recovered patients. Therefore, further investigations are needed with more patients, differentiating between relapsed and recovered patients, and more specific training methods to improve interoceptive processes.

SRT-Joy - computer-assisted self-regulation training for obese children and adolescents: study protocol for a randomized controlled trial

Background

Obesity is not only a highly prevalent disease but also poses a considerable burden on children and their families. Evidence is increasing that a lack of self-regulation skills may play a role in the etiology and maintenance of obesity. Our goal with this currently ongoing trial is to examine whether training that focuses on the enhancement of self-regulation skills may increase the sustainability of a complex lifestyle intervention.

Methods/Design

In a multicenter, prospective, parallel group, randomized controlled superiority trial, 226 obese children and adolescents aged 8 to 16 years will be allocated either to a newly developed computer-training program to improve their self-regulation abilities or to a placebo control group. Randomization occurs centrally and blockwise at a 1:1 allocation ratio for each center. This study is performed in pediatric inpatient rehabilitation facilities specialized in the treatment of obesity. Observer-blind assessments of outcome variables take place at four times: at the beginning of the rehabilitation (pre), at the end of the training in the rehabilitation (post), and 6 and 12 months post-rehabilitation intervention. The primary outcome is the course of BMI-SDS over 1 year after the end of the inpatient rehabilitation. Secondary endpoints are the self-regulation skills. In addition, health-related quality of life, and snack intake will be analyzed.

Discussion

The computer-based training programs might be a feasible and attractive tool to increase the sustainability of the weight loss reached during inpatient rehabilitation.

Trial registration

The present study protocol was registered on 13 July 2015 at German Clinical Trials Register: DRKS00007879.

Maternal intuitive eating as a moderator of the association between concern about child weight and restrictive child feeding

Mothers who are concerned about their young child's weight are more likely to use restrictive feeding, which has been associated with increased food seeking behaviors, emotional eating, and overeating in young children across multiple prospective and experimental studies. In the present study, we examined whether mothers' intuitive eating behaviors would moderate the association between their concern about their child's weight and their use of restrictive feeding. In a sample of 180 mothers of young children, two maternal intuitive eating behaviors (i.e., eating for physical reasons, trust in hunger and satiety cues) moderated this association after controlling for maternal age, body mass index, years of education, race/ethnicity, awareness of hunger and satiety cues and perceptions of child weight. More specifically, concern about child weight was unrelated to restrictive feeding for mothers with higher levels of eating for physical reasons and trust in hunger and satiety cues. However, concern about child weight was positively related to restrictive feeding among mothers with lower or average levels of eating for physical reasons and trust in hunger and satiety cues. These findings indicate that it may be important address maternal intuitive eating within interventions designed to improve self-regulated eating in children, as mothers who attend these interventions tend to be highly concerned about their child's weight and, if also low in intuitive eating, may be at risk for using restrictive feeding behaviors that interfere with children's self-regulated eating.

Recollections of pressure to eat during childhood, but not picky eating, predict young adult eating behavior

Picky eating is a childhood behavior that vexes many parents and is a symptom in the newer diagnosis of Avoidant/Restrictive Food Intake Disorder (ARFID) in adults. Pressure to eat, a parental controlling feeding practice aimed at encouraging a child to eat more, is associated with picky eating and a number of other childhood eating concerns. Low intuitive eating, an insensitivity to internal hunger and satiety cues, is also associated with a number of problem eating behaviors in adulthood. Whether picky eating and pressure to eat are predictive of young adult eating behavior is relatively unstudied. Current adult intuitive eating and disordered eating behaviors were self-reported by 170 college students, along with childhood picky eating and pressure through retrospective self- and parent reports. Hierarchical regression analyses revealed that childhood parental pressure to eat, but not picky eating, predicted intuitive eating and disordered eating symptoms in college students. These findings suggest that parental pressure in childhood is associated with problematic eating patterns in young adulthood. Additional research is needed to understand the extent to which parental pressure is a reaction to or perhaps compounds the development of problematic eating behavior.

The Relevance of Interoception in Chronic Tinnitus: Analyzing Interoceptive Sensibility and Accuracy

In order to better understand tinnitus and distress associated with tinnitus, psychological variables such as emotional and cognitive processing are a central element in theoretical models of this debilitating condition. Interoception, that is, the perception of internal processes, may be such a psychological factor relevant to tinnitus. Against this background, 20 participants suffering from chronic tinnitus and 20 matched healthy controls were tested with questionnaires, assessing interoceptive sensibility, and participated in two tasks, assessing interoceptive accuracy: the Schandry task, a heartbeat estimation assignment, and a skin conductance fluctuations perception task assessing the participants' ability to perceive phasic increases in sympathetic activation were used. To test stress reactivity, a construct tightly connected to tinnitus onset, we also included a stress induction. No differences between the groups were found for interoceptive accuracy and sensibility. However, the tinnitus group tended to overestimate the occurrence of phasic activation. Loudness of the tinnitus was associated with reduced interoceptive performance under stress. Our results indicate that interoceptive sensibility and accuracy do not play a significant role in tinnitus. However, tinnitus might be associated with a tendency to overestimate physical changes.

A systematic review of the psychosocial correlates of intuitive eating among adult women

Intuitive eating has been proposed as an eating style that fosters a positive attitude towards food, the body, and physical activity. A systematic review of the literature was undertaken to examine intuitive eating in relation to disordered eating, body image, emotional functioning, and other psychosocial correlates in adult women. Articles were identified through Academic Search Complete, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Health Source (Nursing and Academic Edition), Medline Complete, PsycINFO, PsycARTICLES, Psychology and Behavioral Sciences Collection, PubMed and Scopus. Eligible studies were those that examined women aged 18 years and older, measured intuitive eating, and assessed a psychosocial correlate of intuitive eating. Twenty-four cross-sectional studies, published between 2006 and September 2015, met eligibility criteria. Intuitive eating was associated with less disordered eating, a more positive body image, greater emotional functioning, and a number of other psychosocial correlates that have been examined less extensively. However, given that all studies used cross-sectional designs, no conclusions regarding the direction of the relationship between intuitive eating and psychosocial correlates can be drawn. Participants in the majority of studies were university students in the United States so findings cannot be generalised to the wider population of female adults. Prospective studies are now needed to verify these cross-sectional findings, and show if intuitive eating may reduce disordered eating and body image concerns, and promote women's psychological health and well-being.

Is level of intuitive eating associated with plate size effects?

OBJECTIVE

Intuitive eating is an eating approach that emphasizes increased focus on internal hunger and fullness cues to regulate eating behavior; thus, successful intuitive eating should curb the influence of environmental factors such as plate and portion size on consumption. The current study examined whether self-reported levels of intuitive eating moderated the influence of portion size on college students' food consumption during an afternoon meal of pasta and tomato sauce.

METHOD

Participants (N=137, 63.5% female) were randomly assigned to either a large plate (12-inch) or small plate (8-inch) external cue condition. All participants fasted for four daytime hours, completed the Intuitive Eating Scale, and then were asked to rate a meal of pasta and tomato sauce on different dimensions of taste. Participants were told that they could eat as much pasta as they would like.

RESULTS

Higher levels of intuitive eating were associated with greater food consumption. At the mean level of intuitive eating, participants ate more pasta in the large plate condition. Furthermore, the influence of plate size on food consumption increased as levels of intuitive eating increased.

DISCUSSION

Individuals who report high levels of intuitive eating may be more likely to eat an objectively larger amount of food in a permissive food environment, and may have implications for eating approaches that promote eating in response to internal hunger and fullness cues.

Interoception and stress

Afferent neural signals are continuously transmitted from visceral organs to the brain. Interoception refers to the processing of visceral-afferent neural signals by the central nervous system, which can finally result in the conscious perception of bodily processes. Interoception can, therefore, be described as a prominent example of information processing on the ascending branch of the brain–body axis. Stress responses involve a complex neuro-behavioral cascade, which is elicited when the organism is confronted with a potentially harmful stimulus. As this stress cascade comprises a range of neural and endocrine pathways, stress can be conceptualized as a communication process on the descending branch of the brain–body axis. Interoception and stress are, therefore, associated via the bi-directional transmission of information on the brain–body axis. It could be argued that excessive and/or enduring activation (e.g., by acute or chronic stress) of neural circuits, which are responsible for successful communication on the brain–body axis, induces malfunction and dysregulation of these information processes. As a consequence, interoceptive signal processing may be altered, resulting in physical symptoms contributing to the development and/or maintenance of body-related mental disorders, which are associated with stress. In the current paper, we summarize findings on psychobiological processes underlying acute and chronic stress and their interaction with interoception. While focusing on the role of the physiological stress axes (hypothalamic-pituitary-adrenocortical axis and autonomic nervous system), psychological factors in acute and chronic stress are also discussed. We propose a positive feedback model involving stress (in particular early life or chronic stress, as well as major adverse events), the dysregulation of physiological stress axes, altered perception of bodily sensations, and the generation of physical symptoms, which may in turn facilitate stress.

Maternal intuitive eating as a moderator of the association between concern about child weight and restrictive child feeding

Mothers who are concerned about their young child's weight are more likely to use restrictive feeding, which has been associated with increased food seeking behaviors, emotional eating, and overeating in young children across multiple prospective and experimental studies. In the present study, we examined whether mothers' intuitive eating behaviors would moderate the association between their concern about their child's weight and their use of restrictive feeding. In a sample of 180 mothers of young children, two maternal intuitive eating behaviors (i.e., eating for physical reasons, trust in hunger and satiety cues) moderated this association after controlling for maternal age, body mass index, years of education, race/ethnicity, awareness of hunger and satiety cues and perceptions of child weight. More specifically, concern about child weight was unrelated to restrictive feeding for mothers with higher levels of eating for physical reasons and trust in hunger and satiety cues. However, concern about child weight was positively related to restrictive feeding among mothers with lower or average levels of eating for physical reasons and trust in hunger and satiety cues. These findings indicate that it may be important address maternal intuitive eating within interventions designed to improve self-regulated eating in children, as mothers who attend these interventions tend to be highly concerned about their child's weight and, if also low in intuitive eating, may be at risk for using restrictive feeding behaviors that interfere with children's self-regulated eating.

The Contributions of Interoceptive Awareness to Cognitive and Affective Facets of Body Experience

Experience of one’s own body relies on signals arising within the body as well as on exteroceptive information, and on appraisal of cognitive and affective aspects of these signals. The present study investigated the impact of sensitivity to internal signals, that is, interoceptive awareness, on interindividual differences in cognitive and emotional aspects of body experience. Subjects with accurate (n = 30) versus poor (n = 30) interoceptive awareness, classified via a heartbeat perception task, completed the Body Consciousness Questionnaire and the Body Appraisal Inventory. Possible effects of emotional state on body experience were controlled for using measures of mood and anxiety. While the groups did not differ in their emotional state, individuals with accurate cardiac interoceptive awareness exhibited higher subjective sensitivity to bodily sensations and a more positive body image, characterized by stronger body-related self-confidence, greater satisfaction with physical appearance, greater perceived bodily self-control, as well as reduced hypochondriacal concerns, sexual discontent, and shame. The present findings extend earlier research on the importance of perception of physical cues for emotion, cognition, and behavior regulation. Our results underline the contribution of interoceptive information to body experience, where interindividual differences in the accessibility of such information modulate cognitive and affective facets of body image.

Psychological Flexibility and Mindfulness Explain Intuitive Eating in Overweight Adults

The current study investigated whether mindfulness and psychological flexibility, independently and together, explain intuitive eating. The participants were overweight or obese persons ( N = 306) reporting symptoms of perceived stress and enrolled in a psychological lifestyle intervention study. Participants completed self-report measures of psychological flexibility; mindfulness including the subscales observe, describe, act with awareness, non-react, and non-judgment; and intuitive eating including the subscales unconditional permission to eat, eating for physical reasons, and reliance on hunger/satiety cues. Psychological flexibility and mindfulness were positively associated with intuitive eating factors. The results suggest that mindfulness and psychological flexibility are related constructs that not only account for some of the same variance in intuitive eating, but they also account for significant unique variances in intuitive eating. The present results indicate that non-judgment can explain the relationship between general psychological flexibility and unconditional permission to eat as well as eating for physical reasons. However, mindfulness skills— acting with awareness, observing, and non-reacting—explained reliance on hunger/satiety cues independently from general psychological flexibility. These findings suggest that mindfulness and psychological flexibility are interrelated but not redundant constructs and that both may be important for understanding regulation processes underlying eating behavior.

Dreams of the Rarebit Fiend: food and diet as instigators of bizarre and disturbing dreams

In the early 1900s, the Dream of the Rarebit Fiend comic strip conveyed how the spicy cheese dish Welsh rarebit leads to bizarre and disturbing dreams. Today, the perception that foods disturb dreaming persists. But apart from case studies, some exploratory surveys, and a few lab studies on how hunger affects dreaming, there is little empirical evidence addressing this topic. The present study examines three aspects of the food/dreaming relationship; it attempts to: (1) assess the prevalence of the perception of food-dependent dreaming and the types of foods most commonly blamed; (2) determine if perceived food-dependent dreaming is associated with dietary, sleep or motivational factors; and (3) explore whether these factors, independent of food/dreaming perceptions, are associated with reports of vivid and disturbing dreams. Three hundred and ninety six students completed questionnaires evaluating sleep, dreams, and dietary habits and motivations. Items queried whether they had noticed if foods produced bizarre or disturbing dreams and if eating late at night influenced their dreams. The perception of food-dependent dreaming had a prevalence of 17.8%; with dairy products being the most frequently blamed food category (39-44%). Those who perceived food-dependent dreaming differed from others by reporting more frequent and disturbing dreams, poorer sleep, higher coffee intake, and lower Intuitive Eating Scale scores. Reports of disturbing dreams were associated with a pathological constellation of measures that includes poorer sleep, binge-eating, and eating for emotional reasons. Reports of vivid dreams were associated with measures indicative of wellness: better sleep, a healthier diet, and longer times between meals (fasting). Results clarify the relationship between food and dreaming and suggest four explanations for the perception of food-dependent dreaming: (1) food specific effects; (2) food-induced distress; (3) folklore influences, and (4) causal misattributions. Research and clinical implications are discussed.

Differential changes in self-reported aspects of interoceptive awareness through 3 months of contemplative training

Interoceptive body awareness (IA) is crucial for psychological well-being and plays an important role in many contemplative traditions. However, until recently, standardized self-report measures of IA were scarce, not comprehensive, and the effects of interoceptive training on such measures were largely unknown. The Multidimensional Assessment of Interoceptive Awareness (MAIA) questionnaire measures IA with eight different scales. In the current study, we investigated whether and how these different aspects of IA are influenced by a 3-months contemplative intervention in the context of the ReSource project, in which 148 subjects engaged in daily practices of "Body Scan" and "Breath Meditation." We developed a German version of the MAIA and tested it in a large and diverse sample (n = 1,076). Internal consistencies were similar to the English version (0.56-0.89), retest reliability was high (rs: 0.66-0.79), and the MAIA showed good convergent and discriminant validity. Importantly, interoceptive training improved five out of eight aspects of IA, compared to a retest control group. Participants with low IA scores at baseline showed the biggest changes. Whereas practice duration only weakly predicted individual differences in change, self-reported liking of the practices and degree of integration into daily life predicted changes on most scales. Interestingly, the magnitude of observed changes varied across scales. The strongest changes were observed for the regulatory aspects of IA, that is, how the body is used for self-regulation in daily life. No significant changes were observed for the Noticing aspect (becoming aware of bodily changes), which is the aspect that is predominantly assessed in other IA measures. This differential pattern underscores the importance to assess IA multi-dimensionally, particularly when interested in enhancement of IA through contemplative practice or other mind-body interventions.

Interoceptive sensitivity, body weight and eating behavior in children: a prospective study

Previous research indicates that interindividual differences in the ability to perceive one's own bodily signals (interoceptive sensitivity, IS) are associated with disordered eating behavior and weight problems. But representative and prospective data in children are lacking and therefore, the exact nature of these observed associations remains unclear. Data on IS measured by heartbeat perception ability in 1657 children between 6 and 11 years of age were collected on the basis of two measurement points with a year distance in time. Stability of the construct and its prospective association with different food approach behaviors [assessed via parent questionnaires (Children's Eating Behavior Questionnaire and Dutch Eating Behavior Questionnaire)] as well as with weight status were analyzed via structural equation modeling. Main results were that only in overweight children external and emotional eating behavior were predictive for later IS, whereas no such relation was found in normal weight children. There was no direct relation between IS and body mass index. For the first time, we could show that eating behavior and IS in middle childhood are prospectively related to each other. But surprisingly, our data indicate that altered interoceptive processes rather follow than precede non-adaptive eating behavior patterns in overweight children. This suggests a possible crucial role of faulty learning mechanisms in eating behavior early in life, undermining the later confidence in one's body.

Attenuated interoceptive sensitivity in overweight and obese individuals

OBJECTIVE

Perceiving internal signals of hunger and satiety is related to the regulation of food intake. Recent data suggest that interoception (perception of bodily signals) and interoceptive sensitivity (sensitivity for internal signals) might be a crucial variable for the regulation of behavior associated with feelings of satiety. It is yet unclear whether interoceptive sensitivity is altered in overweight and obese participants.

DESIGN AND METHODS

We therefore examined interoceptive sensitivity among 75 overweight and obese women and men using a heartbeat detection task and compared them to normal weight controls. We hypothesized that overweight and obesity would be related to attenuated interoceptive sensitivity.

RESULTS

Interoceptive sensitivity was higher in normal weight participants as compared to overweight and obese participants. Additionally, we found a negative correlation coefficient between the BMI and interoceptive sensitivity in the overweight and obese group only.

CONCLUSIONS

In accordance with our hypotheses, we found evidence for reduced interoceptive sensitivity in overweight and obese individuals. Interoceptive sensitivity presumably interacts with the regulation of food intake in everyday life in part by facilitating the detection of bodily changes accompanying satiety. Overweight and obese individuals might experience greater difficulties in accurately detecting such signals due to reduced interoceptive sensitivity.

Striking discrepancy of anomalous body experiences with normal interoceptive accuracy in depersonalization-derealization disorder

Background

Disembodiment is a core feature of depersonalization disorder (DPD). Given the narratives of DPD patients about their disembodiment and emotional numbing and neurobiological findings of an inhibition of insular activity, DPD may be considered as a mental disorder with specific impairments of interoceptive awareness and body perception.

Methods

We investigated cardioceptive accuracy (CA) of DPD patients (n = 24) as compared to healthy controls (n = 26) with two different heartbeat detection tasks (“Schandry heartbeat counting task” and “Whitehead heartbeat discrimination task”). Self-rated clearness of body perception was measured by questionnaire.

Results

Contrary to our hypothesis, DPD patients performed similarly to healthy controls on the two different heartbeat detection tasks, and they had equal scores regarding their self-rated clearness of body perception. There was no correlation of the severity of “anomalous body experiences” and depersonalization with measures of interoceptive accuracy. Only among healthy controls CA in the Schandry task was positively correlated with self-rated clearness of body perception. Depersonalization was unrelated to severity of depression or anxiety, while depression and anxiety were highly correlated. Anxiety and depression did not modify the associations of depersonalization with interoceptive accuracy.

Conclusions

Our main findings highlight a striking discrepancy of normal interoception with overwhelming experiences of disembodiment in DPD. This may reflect difficulties of DPD patients to integrate their visceral and bodily perceptions into a sense of their selves. This problem may be considered an important target for psychotherapeutic treatment approaches.