Attentional bias to unhealthy food in individuals with severe obesity and binge eating

Attention to food stimuli in binge eating disorder: Electrophysiological evidence

Attentional biases towards food play an important role in the pathology of binge eating disorder (BED). Later stage electrophysiological potentials (P300, late positive potential) present promising markers of motivated attention with high temporal, albeit low spatial resolution. Complementing this, the N2pc is an earlier-latency component providing the possibility of more directly analyzing visuospatial attention. Therefore, we tested a group with BED (N = 60), as well as an overweight (OW; N = 28) and normal weight (NW; N = 30) group without BED in a Go/No-Go paradigm using food and nonfood distractor images. Only the OW group in exclusively the Go trials displayed a stronger spatial attention allocation towards nonfood distractors as evidenced by an increased N2pc amplitude. In the P300's time window, the OW group displayed no attentional bias towards food and the NW group only did so in the absence of a target. Solely the BED group allocated more motivated attention towards food distractors both in Go and No-Go trials. In the following late positive potential (LPP), the OW group exhibited a general attentional bias towards food distractors, while the BED group only did so in the absence of a target. These results are discussed in light of the incentive sensitization theory and a potential early attentional suppression of potent distractors.

Modifying biased attention towards food stimuli in binge eating disorder: A multi-session training study

Individuals with binge eating disorder (BED) exhibit a biased attention towards food stimuli. Against this backdrop, the present study with pre-registered design (ID: DRKS00012984) tested whether (a) a training designed to reduce attentional food processing indeed modifies this bias, (b) this reduction is evident in several measures of food-related attention and (c) this is associated with reductions in craving, binge frequency over the past 28 days and calories eaten in a laboratory based bogus taste test. Individuals with BED were randomly allocated to four sessions of either an attentional bias modification training (ABMT; n = 39) or a comparable no-modification control training (CT; n = 27). In all measures assessed via eye-tracking - dwell time bias, dwell time bias variability and first fixation bias - food-related bias decreased in the ABMT relative to the CT. Against our hypothesis, no differential between-group effects were found for reaction time (RT) bias and its variability as well as for calories consumed in a bogus taste test. By contrast, reductions in binge frequency and subjective craving were found for both groups. Taken together, the tendency to preferentially process food seems a modifiable phenomenon in individuals with BED. However, modifying this selective viewing pattern does not seem a prerequisite for a successful reduction of binge frequency.

Harsh, unpredictable childhood environments are associated with inferior frontal gyrus connectivity and binge eating tendencies in late adolescents

Harsh, unpredictable childhood environments (HUCE) are associated with obesity older in life, but knowledge of how HUCE affect binge eating tendencies is lacking. Five hundred and one late adolescents aged 16-22 were recruited to finish resting state functional magnetic resonance imaging scan, behavioral measures including retrospective recall of childhood environmental harshness and unpredictability, binge eating tendencies and demographics. Three hundred and seventy-six of participants further completed the computerized visual probe task designed to evaluate attentional engagement towards high and low calorie food. As right inferior frontal gyrus (IFG) was the key nodes that related to both early life adversity and binge eating tendencies, it was treated as the interest region in the dynamic functional connectivity analyses. Results found that HUCE are associated with significant but modest decreases in connectivity of right inferior frontal gyrus (IFG)- bilateral medial frontal gyrus, right IFG - bilateral inferior parietal lobule (IPL), and right IFG - left superior frontal gyrus connectivity, as well as attentional engagement to high-calorie food and binge eating tendencies. A machine-learning method named linear support vector regression (SVR) and leave one out cross-validation (LOOCV) procedure used to examine the robustness of the brain-behavior relationship further confirm the findings. Mediation analyses suggested that right IFG - left IPL connectivity mediates the association of HUCE and binge eating tendencies. Findings suggest right IFG - left IPL connectivity may serve as a crucial neurobiological underpinning of HUCE to regulate binge eating behaviors. As such, these results contribute to a novel perspective and hypotheses in elucidating developmental neuro-mechanisms related to binge eating.

Effect of body-related information on food attentional bias in women with body weight dissatisfaction

Women with body weight dissatisfaction (BWD) have long-term negative assessments of their body weight, which are often associated with poor eating behavior. In this study, we investigated the effect of body-related information on the food cue processing and attention of women with BWD. Sixty-eight women were recruited and assigned to either a BWD (NPSS-F > 2) (n = 32) or a no body weight dissatisfaction (NBWD) group (NPSS-F < 1) (n = 36). We measured attentional bias to food cues (high- and low-calorie) with a food probe task after exposure to body-related information and recorded eye tracking data. Body-related images were presented prior to a pair of stimulus images (food-neutral or neutral-neutral). Body-related information and food type were repeated measure factors in our study. Our results showed that the first fixation duration bias for high-calorie foods was significantly longer than for low-calorie foods after exposure to overweight cues in the BWD group. Compared with the NBWD group, the BWD group showed longer first fixation duration bias for high-calorie foods after exposure to overweight cues. The direction for high-calorie foods was significantly more often than that for low-calorie foods in the BWD group after exposure to body-related information. Our findings suggest that compared to women with NBWD, women with BWD may be more susceptible to body-related information, resulting in increased attention to high-calorie foods.

Pavlovian-instrumental transfer effects in individuals with binge eating

BACKGROUND

The food addiction model of binge-eating postulates that hyperpalatable food can sensitize the reward processing system and lead to elevated cue-elicited motivational biases towards food, which eventually become habitual and compulsive. However, previous research on food reward conditioning in individuals with binge-eating is scarce. The present study examined the Pavlovian-instrumental transfer (PIT) effects in individuals with recurrent binge-eating. It was hypothesized that hyperpalatable food would elicit specific transfer effects, i.e., biased responding for the signaled food even after satiation on that food, and this effect would be stronger in individuals with binge-eating compared to healthy controls.

METHODS

Fifty-one adults with recurrent binge-eating and 50 weight-matched healthy controls (mean age: 23.95 [SD = 5.62]; % female = 76.2%) completed the PIT paradigm with food rewards. Participants also completed measures of hunger, mood, impulsivity, response disinhibition, and working memory. Mixed ANOVAs were conducted to examine transfer effects and if they differed between individuals with binge-eating and those without.

RESULTS

The group by cue interaction effect was not significant, suggesting that the specific transfer effect did not differ between groups. The main effect of cue was significant, indicating that the outcome-specific cue biased instrumental responding towards the signaled hyperpalatable food. However, the biased instrumental responding was attributable to suppressed responding in the presence of the cue predicting no reward, rather than enhanced responding in the presence of the specific food-predicting cues.

CONCLUSIONS

The present findings did not support the hypothesis that individuals with binge-eating would be more vulnerable to specific transfer effects elicited by hyperpalatable food, as measured by the PIT paradigm.

Behavioural biases in the interaction with food objects in virtual reality and its clinical implication for binge eating disorder

Cognitive processes play a central role in the development, maintenance and remission in mental disorders, like in Binge Eating Disorder (BED). Insights into cognitive mechanisms reflected by embodied interaction with food and its connections to clinically relevant psychopathology offer new possibilities for translational diagnostics and interventions. We longitudinally investigated the manual interaction with food in a virtual reality (VR) in 31 patients with BED. Patients were assessed at baseline before participating in a randomized-controlled trial (RCT) investigating a computer-based inhibitory control training programme enhanced by transcranial direct current stimulation (tDCS) and at a 6-week follow-up. At both assessments, an experimental VR paradigm was conducted and patients were characterized concerning eating disorder psychopathology, eating behaviour, general impulsivity and food craving. In the experimental task, one of two simultaneously presented objects (food vs. office tools) had to be collected. Food was recognized faster than office tools and subsequent approach behaviour was initiated faster, whereas thereafter, food was collected slower than office tools. Exploratory, we could not find a modulatory effect of applied tDCS on the interaction with food. No relationship between behavioural biases and sample characterizations could be detected. Two different stages in the manual interaction with food were found: a faster first stage that comprises recognition and movement initiation and a slower second stage that comprises controlled handling and may reflect aversive motivational processes. As the behavioural patterns do not change with an ameliorated BED-psychopathology at the second assessment, the task seems insensitive in detecting translational interconnections between behavioural biases and BED-characteristics.Level of evidence: Level I, experimental study.

Spatial attentional biases toward height-related words in young males with physical stature dissatisfaction

By recording event-related potentials (ERPs) during a dot-probe task, the present study examined the neural dynamics of attentional bias toward height-related words among height dissatisfied males. Sixty male participants screened by Negative Physical Self Scale-Stature Concerns subscale (NPS-S) were assigned into a high height dissatisfaction (HHD) group and a low height dissatisfaction (LHD) group. The results showed that tall-related versus neutral words elicited larger N2pc for both HHD and LHD groups, whereas short-related versus neutral words elicited larger N2pc only for the HHD group. Additionally, an evident Pd was elicited by tall-related words for the HHD group, but not for the LHD group. Taken together, these findings revealed attentional biases toward height-related information for HHD individuals on a neural level. Specifically, HHD individuals showed an enhanced spatial attention oriented toward both tall-related and short-related words, and then, the allocated attention to the tall-related words was terminated by an active suppression mechanism.

Larger dlPFC and vmPFC grey matter volumes are associated with high adherence to the Mediterranean diet: A cross-sectional study in older adults

Dietary self-control is associated with inter-individual differences in neuroanatomy. Yet, whether such inter-individual differences are also associated with healthier dietary patterns is yet to be determined. In this cross-sectional study, a total of 100 northern Portuguese older community-dwellers were assessed with regards to i) the adherence to a healthy dietary eating pattern - the Mediterranean diet (MedDiet), and ii) grey matter density (GMD) of brain regions associated with valuation and dietary self-regulation, the ventromedial (vmPFC) and dorsolateral prefrontal cortex (dlPFC), through voxel-based morphometry. Healthy food choices were ascertained through the Mediterranean Diet Adherence Screener (MEDAS) where higher scores indicated greater adherence to the MedDiet. Voxel-based morphometry showed that greater grey matter density in the dlPFC and vmPFC associated with a higher adherence to the MedDiet. These results replicate previous links between dietary decision-making measured under laboratory conditions and the neuroanatomy of the brain's valuation and self-control system. Importantly, they shed new light on the potential relevance of inter-individual differences in the neuroanatomy of these two brain regions for adhering to healthier dietary patterns in everyday life.

Conscious and pre-conscious attentional bias to food images in patients subjected to Roux-en-Y gastric bypass

Attentional bias (AB) to food after bariatric surgery might be a cognitive marker for weight regain. The visual probe task (VPT) is commonly used to capture AB at automatic, pre-conscious, and conscious orientation of attention. The aim of this study was to investigate how the preoperative BMI of patients submitted to Roux-en-Y gastric bypass (RYGB) impacts AB to food. We assessed patients who had preoperative BMI>50 (n = 28) or preoperative BMI<50 (n = 31) months after the RYGB procedure. Participants underwent clinical, psychological, and VPT evaluations. In VPT, pairs of food and matching non-food images were shown for 100 ms, 500 ms or 2000 ms and AB for food was assessed for each exposure time. A significant AB to food was observed at 2000 ms for all patients in this study, suggesting that the overall sample were consciously orienting their attention toward food cues after surgery, a finding that might be relevant for understanding weight control. When groups with preoperative BMI higher and lower than 50 kg/m2 were compared, a significant difference on AB to food stimuli at 500 ms was observed, controlling for excess weight lost since surgery and postoperative time. Subjects with preoperative BMI>50 had a positive and reliable AB to food while subjects with preoperative BMI<50 had a negative AB. This suggests that food stimuli have a higher incentive salience even after surgery for those with BMI>50, which might explain why subjects with higher preoperative weight have higher risks for weight regain. These results may indicate that RYGB can impact incentive salience for food cues in a differential manner, increasing conscious AB in all patients and decreasing pre-conscious AB only in those with BMI<50 kg/m2.

Exploring Mindfulness and Mindful Eating and Visual Attention Towards Food Cues: Preliminary Findings

Continual exposure to energy dense foods is suggested to promote overeating and obesity. The aim of the present research was to explore whether or not mindfulness could reduce visual attention towards food cues. In two laboratory studies, participants with a normal weight range completed an eye-tracking paradigm, and their eye-movements were recorded. In study 1, participants were exposed to either mindfulness meditation or a control condition, and their eye-movements towards low energy density (LED) vs high energy density (HED) food cues were measured. In study 2, participants were assigned to a mindful eating condition using a Mindful Construal Diary (MCD) or a control condition, and their eye-movements towards LED or HED food vs. non-food cues were recorded. In study 1, participants in the mindfulness meditation condition had greater attention duration towards LED food cues, whilst those in the control condition exhibited greater attention duration towards HED food cues. In study 2, there were no significant differences in the maintenance of attentional biases towards food cues between the two conditions. Mindfulness meditation may be beneficial in increasing attention towards LED food cues. Future research should further explore the effect of mindfulness and mindful eating on visual attention towards food cues with people who suffer from excess weight or have obesity, and also within naturalistic settings.

Food Captures Attention, but Not the Eyes: An Eye-Tracking Study on Mindset and BMI’s Impact on Attentional Capture by High-Caloric Visual Food Stimuli

Obesity is a worldwide pandemic and theories propose that attentional bias (AB) for food triggers craving and overeating, especially for people with obesity. However, empirical evidence is inconsistent, which may be due to methodological diversity and the double-sided nature of high-caloric palatable foods. That is, these foods simultaneously have a high hedonic and a low health value. So, depending on context and/or emotional state, people’s mindset while viewing foods may alternate between hedonic (taste) and health (calories) values, possibly affecting AB for food in opposite directions. This study tests how mindset and BMI (Body Mass Index) influences AB and food intake. We expect greater AB for food and more food intake in the hedonic compared to the health mindset, especially for people with obesity. Mindsets were induced using short video-clips in two sessions in counterbalanced order. Participants (35 with a healthy-weight-category BMI, 31 with obesity) performed a modified Additional Singleton paradigm where they searched for a neutral target among neutral fillers. On 90% of the trials, either a food or a neutral distractor appeared. Response latencies to the target and eye-movements to the distractor were recorded. Dependent variables included: response latencies, and eye-movement variables on the distractor: fixations (%), 1st fixation duration, dwell-time. Food intake was assessed in a bogus taste test. No significant effects emerged from the eye-movements analysis, whereas the analysis of response latencies showed an AB for food, not significantly moderated by BMI or mindset. Food intake was affected by mindset partly as expected, as participants ate more in the hedonic than in the health mindset when the hedonic mindset was induced in the second session. One AB measure (fixations) correlated positively with food intake. Finally, food captured attention – but not the eyes – and mindset affects food intake partly as expected.

Brain responses to anticipatory cues and milkshake taste in obesity, and their relationship to bariatric surgery outcome

There is substantial variability in percent total weight loss (%TWL) following bariatric surgery. Functional brain imaging may explain more variance in post-surgical weight loss than psychological or metabolic information. Here we examined the neuronal responses during anticipatory cues and receipt of drops of milkshake in 52 pre-bariatric surgery men and women with severe obesity (OW, BMI = 35-60 kg/m2) (23 sleeve gastrectomy (SG), 24 Roux-en-Y gastric bypass (RYGB), 3 laparoscopic adjustable gastric banding (LAGB), 2 did not undergo surgery) and 21 healthy-weight (HW) controls (BMI = 19-27 kg/m2). One-year post-surgery weight loss ranged from 3.1 to 44.0 TWL%. Compared to HW, OW had a stronger response to milkshake cues (compared to water) in frontal and motor, somatosensory, occipital, and cerebellar regions. Responses to milkshake taste receipt (compared to water) differed from HW in frontal, motor, and supramarginal regions where OW showed more similar response to water. One year post-surgery, responses to high-fat milkshake cues normalized in frontal, motor, and somatosensory regions. This change in brain response was related to scores on a composite health index. We found no correlation between baseline response to milkshake cues or tastes and%TWL at 1-yr post-surgery. In RYGB participants only, a stronger response to low-fat milkshake and water cues (compared to high-fat) in supramarginal and cuneal regions respectively was associated with more weight loss. A stronger cerebellar response to high-fat vs low-fat milkshake receipt was also associated with more weight loss. We confirm differential responses to anticipatory milkshake cues in participants with severe obesity and HW in the largest adult cohort to date. Our brain wide results emphasizes the need to look beyond reward and cognitive control regions. Despite the lack of a correlation with post-surgical weight loss in the entire surgical group, participants who underwent RYGB showed predictive power in several regions and contrasts. Our findings may help in understanding the neuronal mechanisms associated with obesity.

The transdiagnostic role of food craving: An application of substance use models

Food craving is a transdiagnostic process underlying clinically significant disordered eating behaviors and eating disorder diagnoses. However, the lack of literature examining the role of food craving as it relates to the full spectrum of disordered eating behaviors, including restrictive eating and compensatory behaviors, may be due to the traditional definition of food craving as the desire to consume particular foods. Applying motivational models of substance use craving to food craving may help to explain inconsistencies within existing literature. Three motivational models of craving from the substance use literature may be particularly applicable to (1) provide a clear definition of food craving as a motivational process, (2) understand the role of that motivational process as it underlies the full spectrum of disordered eating behavioral patterns, (3) provide insight for the most appropriate ways in which to accurately assess food craving, and (4) establish ways in which food craving may represent a useful motivational process to target in eating disorder treatments. This narrative review describes three models of substance use craving and provides suggestions for utilizing motivational models to understand the transdiagnostic role of food craving as it relates to the full spectrum of disordered eating behaviors in both research and clinical work.

Diminished insulin sensitivity is associated with altered brain activation to food cues and with risk for obesity - Implications for individuals born small for gestational age

While classically linked to memory, the hippocampus is also a feeding behavior modulator due to its multiple interconnected pathways with other brain regions and expression of receptors for metabolic hormones. Here we tested whether variations in insulin sensitivity would be correlated with differential brain activation following exposure to palatable food cues, as well as with variations in implicit food memory in a cohort of healthy adolescents, some of whom were born small for gestational age (SGA). Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) was positively correlated with activation in the cuneus, and negatively correlated with activation in the middle frontal lobe, superior frontal gyrus and precuneus when presented with palatable food images versus non-food images in healthy adolescents. Additionally, HOMA-IR and insulinemia were higher in participants with impaired food memory. SGA individuals had higher snack caloric density and greater chance for impaired food memory. There was also an interaction between the HOMA-IR and birth weight ratio influencing external eating behavior. We suggest that diminished insulin sensitivity correlates with activation in visual attention areas and inactivation in inhibitory control areas in healthy adolescents. Insulin resistance also associated with less consistency in implicit memory for a consumed meal, which may suggest lower ability to establish a dietary pattern, and can contribute to obesity. Differences in feeding behavior in SGA individuals were associated with insulin sensitivity and hippocampal alterations, suggesting that cognition and hormonal regulation are important components involved in their food intake modifications throughout life.

Extending Expectancy Theory to Food Intake: Effect of a Simulated Fast-Food Restaurant on Highly and Minimally Processed Food Expectancies

Unhealthy diets are widespread and linked to a number of detrimental clinical outcomes. The current preregistered experiment extended Expectancy Theory into the study of food intake; specifically, we tested whether a fast-food restaurant affects food expectancies, or the emotions one expects to feel while eating highly (e.g., pizza) and minimally (e.g., carrots) processed foods. Participants (N = 200, M age = 18.79) entered a simulated fast-food restaurant or a neutral space, completed questionnaires, and engaged in a 'bogus' taste test. The simulated fast-food restaurant increased positive highly-processed food expectancies (d = 0.29). Palatable eating coping motives scores did not moderate the effect; however, this clinically-relevant pattern of eating behavior was associated with greater positive highly-processed food expectancies. In addition, there was an indirect effect of the fast-food restaurant on ad libitum food intake through positive highly-processed food expectancies. Reducing positive highly-processed food expectancies may improve diet, which may broadly impact health.

Loss of control over eating: A systematic review of task based research into impulsive and compulsive processes in binge eating

Recurring episodes of excessive food intake in binge eating disorder can be understood through the lens of behavioral control systems: patients repeat maladaptive behaviors against their explicit intent. Self-report measures show enhanced impulsivity and compulsivity in binge eating (BE) but are agnostic as to the processes that might lead to impulsive and compulsive behavior in the moment. Task-based neurocognitive investigations can tap into those processes. In this systematic review, we synthesize neurocognitive research on behavioral impulsivity and compulsivity in BE in humans and animals, published between 2010-2020. Findings on impulsivity are heterogeneous. Findings on compulsivity are sparse but comparatively consistent, indicating an imbalance of goal-directed and habitual control as well as deficits in reversal learning. We urge researchers to address heterogeneity related to mood states and the temporal dynamics of symptoms, to systematically differentiate contributions of body weight and BE, and to ascertain the validity and reliability of tasks. Moreover, we propose to further scrutinize the compulsivity findings to unravel the computational mechanisms of a potential reinforcement learning deficit.

Implicit bias to food and body cues in eating disorders: a systematic review

BACKGROUND

Rigid, restrictive eating patterns, fear of gaining weight, body image concerns, but also binge eating episodes with loss of control leading to overweight, at times followed by compensatory measures to control weight, are typical symptoms in eating disorders (EDs). The regulation of food intake in EDs may underlie explicit processes that require cognitive insight and conscious control or be steered by implicit mechanisms that are mostly automatic, rapid, and associated with affective-rather than cognitive-processing. While introspection is not capable of assessing implicit responses, so-called indirect experimental tasks can assess implicit responses underlying a specific behavior by-passing the participant's consciousness. Here, we aimed to present the current evidence regarding studies on implicit biases to food and body cues in patients with EDs.

METHODS

We performed a systematic review (PRISMA guidelines). We included controlled studies performed in clinical ED cohorts (vs. healthy control subjects or another control condition, e.g., restrictive vs. binge/purge AN) and using at least one indirect assessment method of interest.

RESULTS

Out of 115 screened publications, we identified 29 studies fulfilling the eligibility criteria, and present a synthesis of the essential findings and future directions.

CONCLUSION

In this emerging field of research, the present work provides cornerstones of evidence highlighting aspects of implicit regulation in eating disorders. Applying both direct (e.g., self-reports) and indirect measures for the assessment of both explicit and implicit responses is necessary for a comprehensive investigation of the interplay between these different regulatory mechanisms and eating behavior. Targeted training of implicit reactions is already in use and represents a useful future tool as an add-on to standard psychotherapeutic treatments in the battle against eating disorders.

EVIDENCE LEVEL

1 (systematic review).

Disordered eating following bariatric surgery: a review of measurement and conceptual considerations

Eating disorders are associated with significant medical morbidity and mortality and serious psychological impairment. Individuals seeking bariatric surgery represent a high-risk group for evidencing disordered eating and eating disorders, with some patients experiencing the persistence or onset of disordered eating postsurgery. This review synthesizes the available literature on problematic or disordered eating in the bariatric field, followed by a review of measurement and conceptual considerations related to the use of eating disorder assessment tools within the bariatric population.

Attentional Bias, Alcohol Craving, and Anxiety Implications of the Virtual Reality Cue-Exposure Therapy in Severe Alcohol Use Disorder: A Case Report

Aims: Attentional bias (AB), alcohol craving, and anxiety have important implications in the development and maintenance of alcohol use disorder (AUD). The current study aims to test the effectiveness of a Virtual Reality Cue-Exposure Therapy (VR-CET) to reduce levels of alcohol craving and anxiety and prompt changes in AB toward alcohol content. Method: A 49-year-old male participated in this study, diagnosed with severe AUD, who also used tobacco and illicit substances on an occasional basis and who made several failed attempts to cease substance misuse. The protocol consisted of six VR-CET booster sessions and two assessment sessions (pre- and post-VR-CET) over the course of 5 weeks. The VR-CET program consisted of booster therapy sessions based on virtual reality (VR) exposure to preferred alcohol-related cues and contexts. The initial and final assessment sessions were focused on exploring AB, alcohol craving, and anxiety using paper-and-pencil instruments and the eye-tracking (ET) and VR technologies at different time points. Results: Pre and post assessment sessions indicated falls on the scores of all instruments assessing alcohol craving, anxiety, and AB. Conclusions: This case report, part of a larger project, demonstrates the effectiveness of the VR-CET booster sessions in AUD. In the post-treatment measurements, a variety of instruments showed a change in the AB pattern and an improvement in craving and anxiety responses. As a result of the systematic desensitization, virtual exposure gradually reduced the responses to significant alcohol-related cues and contexts. The implications for AB, anxiety and craving are discussed.

Attentional Bias to High-Calorie Food in Binge Eaters With High Shape/Weight Concern

Individuals with high shape/weight concern (SWC) place disproportionate emphasis on shape and weight in evaluating their self-worth, making them more vulnerable to body-related cues. Binge eaters (BE), who are obsessed with devouring high-calorie foods, would show severe symptomatology, especially when they have clinically high SWC. The present study attempted to elucidate how SWC influences binging based on attentional patterns toward high-calorie food cues. A total of 120 participants were selected and divided into four groups: (1) BE with high SWC, (2) BE with low SWC, (3) healthy controls (HC) with high SWC, and (4) HC with low SWC. BE and SWC status were respectively determined using the Eating Disorder Diagnostic Scale (DSM-5) and the Eating Disorder Examination Questionnaire. All participants completed the same free-viewing task, measuring initial fixation latency and total fixation duration. BE with high SWC showed attentional bias toward high-calorie food cues in terms of significantly faster initial fixation latency and longer total fixation duration, whereas BE with low SWC and the HC groups did not show any differences. The results revealed that SWC level makes unique contributions to BE's initial orienting bias toward and difficulty disengaging from high-calorie food cues. This may indicate that BE with high SWC merely worry about eating high-calorie food in a cognitive way, but not controlling actual binging behavior. The current study of attentional bias elucidated the role of SWC as a potential maintenance factor of being concerned and binging in BE.

Food Marketing in an Obesogenic Environment: a Narrative Overview of the Potential of Healthy Food Promotion to Children and Adults

Purpose of Review

There is abundant evidence that food marketing influences children’s and adults’ food preferences and consumption. As such, exposure to unhealthy food marketing is a widely acknowledged risk factor contributing to the development of overweight and obesity. Less is known about the effects of healthy food promotion on people’s dietary behavior. This narrative review describes research from the past 5 years focused on the effects of healthy food marketing on children’s and adults’ food preferences and dietary intake. Our aim is to gain insight into the potential effects and mechanistic underpinnings of healthy food promotion, thereby building on existing knowledge on underlying mechanisms of the effectiveness of unhealthy food marketing.

Recent Findings

Only a small number of studies directly examined the effects of healthy food promotion on children’s and adults’ dietary behavior. Most studies targeted children’s fruit and/or vegetable intake and used a variety of marketing techniques, ranging from television adverts to social media influencer marketing. Six out of ten studies found a positive effect of healthy food promotion, indicating that healthy food marketing has the potential to influence dietary behavior.

Summary

Food marketing is highly effective in stimulating and reinforcing food consumption, in particular for energy-dense foods. Further investigation and experimentation into the efficiency and effectiveness of healthy food promotion are needed to determine how marketing techniques could be used to improve dietary behavior. The healthy food promotion model provides a framework for future research in this area.

Short-Term Prosocial Video Game Exposure Influences Attentional Bias Toward Prosocial Stimuli

Research has shown that violent video games induce attentional bias toward aggressive information. However, the effects of prosocial video games on selective attention are poorly understood. This study investigated attentional bias toward prosocial stimuli at different presentation durations (i.e., 100, 500, and 1,250 milliseconds [ms]) after short-term prosocial video game exposure. Sixty males (mean age: 20.26 years; range: 19-23 years) participated in this study. Half of them played a prosocial video game for 30 minutes, whereas others played a neutral one. A spatial cueing paradigm was then used to investigate attentional bias. Results showed that there was both attention orientation and difficulty in attention disengagement toward prosocial stimuli when the presentation lasted 100 ms in the prosocial game group, but not in the neutral group. There was no group difference at 500 or 1,250 ms, suggesting that the attentional bias toward prosocial information might occur at the early stages of cognitive processing. These results provided initial evidence of the influence of prosocial video games on cognitive processing and advanced our understanding of related theories.

Exploring Changes in Event-Related Potentials After a Feasibility Trial of Inhibitory Training for Bulimia Nervosa and Binge Eating Disorder

In a feasibility trial comparing two forms of combined inhibitory control training and goal planning (i.e., food-specific and general) among patients with bulimia nervosa (BN) and binge eating disorder (BED), we found evidence of symptomatic benefit, with stronger effects among participants receiving a food-specific intervention. The aim of the present study was to examine changes in behavioral outcomes and event-related potentials (ERPs; N2 and P3 amplitudes) from baseline to post-intervention that might suggest the mechanisms underpinning these effects. Fifty-five participants completed go/no-go tasks during two electroencephalography (EEG) sessions, at baseline and post-intervention. The go/no-go task included "go" cues to low energy-dense foods and non-foods, and "no-go" cues to high energy-dense foods and non-foods. Datasets with poor signal quality and/or outliers were excluded, leaving 48 participants (N = 24 BN; N = 24 BED) in the analyses. Participants allocated to the food-specific, compared to the general intervention group, showed significantly greater reductions in reaction time to low energy-dense foods, compared to non-foods, by post-intervention. Commission errors significantly increased from baseline to post-intervention, regardless of stimulus type (food vs. non-food) and intervention group (food-specific vs. general). There were no significant changes in omission errors. P3 amplitudes to "no-go" cues marginally, but non-significantly, decreased by post-intervention, but there was no significant interaction with stimulus type (high energy-dense food vs. non-food) or intervention group (food-specific vs. general). There were no significant changes in N2 amplitudes to "no-go" cues, N2 amplitudes to "go" cues, or P3 amplitudes to "go" cues from baseline to post-intervention. Training effects were only marginally captured by these event-related potentials. We discuss limitations to the task paradigm, including its two-choice nature, ease of completion, and validity, and give recommendations for future research exploring ERPs using inhibitory control paradigms.

Development and preliminary validation of the Anticipated Effects of Food Scale

Expectancy theory has been widely applied in substance use research but has received less attention in eating behavior research. Measuring food expectancies, or the anticipated outcomes of eating specific foods, holds theoretical and practical promise for investigations into nonhomeostatic eating behavior. The current study developed and assessed the psychometric properties of a novel measure of positively and negatively valenced highly (e.g., sweets, salty snacks, fast foods, sugary drinks) and minimally (e.g., fruits, vegetables) processed food expectancies. The Anticipated Effects of Food Scale (AEFS) was adapted from a self-report of alcohol expectancies, piloted for item generation/retention and readability, and preliminarily validated in an adult sample (N = 247; Mage = 36.84; 53.3% male; 74.5% White). Consistent with the substance expectancies literature, AEFS positive highly processed food expectancies were associated with greater added sugars intake, r = .17, p = .009, and food addiction symptoms, r = .56, p < .001. Of note, AEFS negative minimally processed food expectancies were robustly associated with food addiction symptoms, r = .81, p < .001, and, together with AEFS positive highly processed food expectancies, explained 67% of the variance in food addiction symptoms. Furthermore, AEFS food expectancies demonstrated incremental validity with food addiction symptoms above and beyond general eating expectancies. The AEFS seems to be a psychometrically sound measure and can be used to investigate cognitive-affective mechanisms implicated in highly processed food intake and food addiction. Moreover, the present results provide new insight into potential food expectancy challenge intervention approaches for preventing nonhomeostatic eating behavior. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Food-Related Attentional Bias in Individuals with Normal Weight and Overweight: A Study with a Flicker Task

The primary purpose of the present study was to investigate attentional biases for food-related stimuli in individuals with overweight and normal weight using a flicker paradigm. Specifically, it was tested whether attention allocation processes differ between individuals with overweight and normal weight using transient changes of food-related and neutral pictures. Change detection latencies in objects of central interest (CI) or objects of marginal interest (MI) were measured as an index of attention allocation in a sample of fifty-three students with overweight/obesity and sixty students with normal weight during a flicker paradigm with neutral, hypercaloric and hypocaloric food pictures. Both groups of participants showed an attentional bias for food-related pictures as compared to neutral pictures. However, the bias was larger in individuals with overweight than in individuals with normal weight when changes were of marginal interest, suggesting a stronger avoidance of the food-related picture. This study showed that food-related stimuli influence attention allocation processes in both participants with overweight and normal weight. In particular, as compared to individuals with normal weight, those with overweight seem to be characterised by a stronger attentional avoidance of (or smaller attention maintenance on) food-related stimuli that could be considered as a voluntary strategy to resist food consumption.

Food Addiction: Implications for the Diagnosis and Treatment of Overeating

With the obesity epidemic being largely attributed to overeating, much research has been aimed at understanding the psychological causes of overeating and using this knowledge to develop targeted interventions. Here, we review this literature under a model of food addiction and present evidence according to the fifth edition of the Diagnostic and Statistical Manual (DSM-5) criteria for substance use disorders. We review several innovative treatments related to a food addiction model ranging from cognitive intervention tasks to neuromodulation techniques. We conclude that there is evidence to suggest that, for some individuals, food can induce addictive-type behaviours similar to those seen with other addictive substances. However, with several DSM-5 criteria having limited application to overeating, the term 'food addiction' is likely to apply only in a minority of cases. Nevertheless, research investigating the underlying psychological causes of overeating within the context of food addiction has led to some novel and potentially effective interventions. Understanding the similarities and differences between the addictive characteristics of food and illicit substances should prove fruitful in further developing these interventions.

Food cue reactivity in food addiction: A functional magnetic resonance imaging study

BACKGROUND

While neuroimaging studies have revealed that reward dysfunction may similarly contribute to obesity and addiction, no prior studies have examined neural responses in individuals who meet the "clinical" food addiction phenotype.

METHODS

Women (n = 44) with overweight and obesity, nearly half of whom (n = 20) met criteria for moderate-to-severe Yale Food Addiction Scale 2.0 (YFAS 2.0) food addiction, participated in a functional magnetic resonance imaging cue reactivity task. Participants viewed images of highly processed foods, minimally processed foods, and household objects while thinking about how much they wanted each item. Differences in neural responses by YFAS 2.0 food addiction to highly processed and minimally processed food cues were investigated.

RESULTS

There was a significant interaction between participant group and neural response in the right superior frontal gyrus to highly versus minimally processed food cues (r = 0.57). Individuals with YFAS 2.0 food addiction exhibited modest, elevated responses in the superior frontal gyrus for highly processed food images and more robust, decreased activations for minimally processed food cues, whereas participants in the control group showed the opposite responses in this region. Across all participants, the household items elicited greater activation than the food cues in regions associated with interoceptive awareness and visuospatial attention (e.g., insula, inferior frontal gyrus, inferior parietal lobe).

CONCLUSIONS

Women with overweight or obesity and YFAS 2.0 food addiction, compared to those with only overweight or obesity, exhibited differential responses to highly and minimally processed food cues in a region previously associated with cue-induced craving in persons with a substance-use disorder. Overall, the present work provides further support for the utility of the food addiction phenotype within overweight and obesity.

The Attentional Bias in Current and Former Smokers

Attentional bias has been defined as the propensity of a person to allocate selective attention automatically to salient cues (Field and Powell, 2007). In the case of smoking, this bias implies that smokers are implicitly attracted by smoking-related stimuli, which produce behavioral, memory, and emotional effects (Volkow et al., 2006; Giardini et al., 2009). In more detail, scientific evidence pointed out that smoking is strongly supported by attentional bias that activates craving and urgency to smoke a cigarette. However, poor and conflicting data are available regarding the role of this cognitive bias on former smokers. The main aim of this study is to explore the occurrence of the attentional bias on of both current and former smokers, also with the aim to identify associations with behavioral, psychological and cognitive characteristic of participants. We collected data on 245 current, volunteers (male 50.6%; female 49.4%) aged 54.81 (SD = 14.352, range = 18–63), divided in current smokers (98), former smokers (102) and non-smokers (45). A combination of neuropsychology tests (Emotional Smoke Stroop Task and Go/no-Go task), and standardized questionnaires [Behavioral Inhibition System-Behavioral Approach System (BIS-BAS), Fagerström Test for Nicotine Dependence (FTND), Barratt Impulsiveness Scale, Motivational questionnaire] were used to assess the attentional bias, psychological variables, and smoking-related characteristics. Responses at the Emotional Smoke Stroop task revealed that current and former smokers are actually slower than non-smokers are when facing smoking cues, while performances at other Stroop conditions and at the Go/no-Go task are not statistically different. These results confirmed the occurrence of the attentional bias in current smokers, and above all points out that the same effect is present in former smokers. We found only small and selective correlations between attentional bias and psychological variables (e.g., impulsiveness and inhibition). In particular, impulsivity is not directly associated with the AB intensity. Also, smoking characteristics (e.g., years of smoking and dependence level) and the length of the period of abstinence do not seem to modulate implicit cognition of smoking cue. Our data support the idea that the attentional bias may be considered relevant in sustaining smoking and favoring relapse.

Neural responses to food stimuli among individuals with eating and weight disorders: a systematic review of event-related potentials

A systematic review was conducted to investigate event-related potentials (ERPs) in response to food and non-food stimuli among individuals with eating and weight disorders. Limiting the search to studies that have analysed ERPs relating to motivated attention and inhibitory control, 19 research papers were extracted from a systematic search in PubMed, Ovid, and Web of Science (2000-2018). An enhanced attentional bias towards food over non-food images (as indexed by P3(00) and LPP amplitudes) was evident for all populations. Individuals with binge eating disorder showed an enhanced attentional response to food cues compared to healthy controls. Inhibitory control-related ERP components (N2(00) and P3a) increased during food-specific no-go trials, but did not differentiate overweight from 'healthy' weight groups. The N2 amplitude to food pictures were positively correlated with caloric intake and food craving among individuals with obesity and binge eating disorder, respectively, while P3(00) was sensitive to hunger levels among overweight and obese females. The heterogeneity of stimuli/paradigms adopted, component timescales extracted, ERPs analysed, and data presented has challenged this review's ability to produce a robust synthesis of results. Some recommendations for future research are discussed.

What drives prioritized visual processing? A motivational relevance account

Emotion is fundamental to our being, and an essential aspect guiding behavior when rapid responding is required. This includes whether we approach or avoid a stimulus, and the accompanying physiological responses. A common tenet is that threat-related content drives stimulus processing and biases visual attention, so that rapid responding can be initiated. In this paper, it will be argued instead that prioritization of threatening stimuli should be encompassed within a motivational relevance framework. To more fully understand what is, or is not, prioritized for visual processing one must, however, additionally consider: (i) stimulus ambiguity and perceptual saliency; (ii) task demands, including both perceptual load and cognitive load; and (iii) endogenous/affective states of the individual. Combined with motivational relevance, this then leads to a multifactorial approach to understanding the drivers of prioritized visual processing. This accords with current recognition that the brain basis allowing for visual prioritization is also multifactorial, including transient, dynamic and overlapping networks. Taken together, the paper provides a reconceptualization of how "emotional" information prioritizes visual processing.

Attentional Bias, "Cool" and "Hot" Executive Functions in Obese Patients: Roles of Body Mass Index, Binge Eating, and Eating Style

PURPOSE/BACKGROUND

Obesity is recognized as an important risk factor for many chronic diseases and is a major health issue. The current study examined attentional bias to food and the "cool" (inhibitory control and mental flexibility) and "hot" (affective decision making) executive functions (EFs) in obese patients preparing for bariatric surgery. In addition to body mass index (BMI), this study examined the impact of the binge-eating tendency and eating styles.

METHODS

The study population comprised 21 morbidly obese patients preparing to undergo bariatric surgery (BMI ≥30 kg/m) and 21 normal-weight controls (24 kg/m > BMI ≥ 18.5 kg/m). The Visual Probe Task was adopted to examine attentional bias toward food-related cues. The Stop-Signal Task and the Color Trails Test were used to assess inhibitory control and mental flexibility, respectively. The Iowa Gambling Task was administered to assess the affective decision making.

RESULTS

(1) The obese patients showed poorer performances on cool EFs (for Color Trails Test, P = 0.016, ηp = 0.136; for Stop-Signal Task, P = 0.049, ηp = 0.093) and hot EF (for Iowa Gambling Task, normal controls showed progressed performance, P = 0.012, ηp = 0.077, but obese patients did not show this progress, P = 0.111, ηp = 0.089) compared with the normal controls; (2) participants with low binge-eating tendency had larger attentional biases at 2000 milliseconds than at 200 milliseconds on food-related cues (P = 0.003, ηp = 0.363); and (3) low-restrained participants exhibited attentional bias toward the low-calorie food cues, compared with the high-restrained group (P = 0.009, ηp = 0.158).

CONCLUSIONS

The current study contributes to the development of a different therapeutic focus on obese patients and binge eaters.

The Cognitive Drivers of Compulsive Eating Behavior

Compulsivity is a central feature of obsessive-compulsive and addictive disorders, which share considerable overlap with excessive eating in terms of repetitive behavior despite negative consequences. Excessive eating behavior is characteristic of several eating-related conditions, including eating disorders [bulimia nervosa (BN), binge eating disorder (BED)], obesity, and food addiction (FA). Compulsivity is proposed to be driven by four distinct cognitive components, namely, contingency-related cognitive flexibility, task/attentional set-shifting, attentional bias/disengagement and habit learning. However, it is unclear whether repetitive behavior in eating-related conditions is underpinned by deficits in these cognitive components. The current mini-review synthesizes the available evidence for performance on compulsivity-related cognitive tasks for each cognitive domain among populations with excessive eating behavior. In three of the four cognitive domains, i.e., set-shifting, attentional bias and habit learning, findings were mixed. Evidence more strongly pointed towards impaired contingency-related cognitive flexibility only in obesity and attentional bias/disengagement deficits only in obesity and BED. Overall, the findings of the reviewed studies support the idea that compulsivity-related cognitive deficits are common across a spectrum of eating-related conditions, although evidence was inconsistent or lacking for some disorders. We discuss the theoretical and practical importance of these results, and their implications for our understanding of compulsivity in eating-related conditions.

A systematic review of attentional biases in disorders involving binge eating

OBJECTIVE

Attentional bias (AB) may be one mechanism contributing to the development and/or maintenance of disordered eating. AB has traditionally been measured using reaction time in response to a stimulus. Novel methods for AB measurement include eye tracking to measure visual fixation on a stimulus, and electroencephalography to measure brain activation in response to a stimulus. This systematic review summarizes, critiques, and integrates data on AB gathered using the above-mentioned methods in those with binge eating behaviors, including binge eating, loss of control eating, and bulimia nervosa.

METHOD

Literature searches on PubMed and PsycInfo were conducted using combinations of terms related to binge eating and biobehavioral AB paradigms. Studies using AB paradigms with three categories of stimuli were included: food, weight/shape, and threat. For studies reporting means and standard deviations of group bias scores, Hedges' g effect sizes for group differences in AB were calculated.

RESULTS

Fifty articles met inclusion criteria and were reviewed. Individuals who binge eat in the absence of compensatory behaviors show an increased AB to food cues, but few studies have examined such individuals' AB toward weight/shape and threatening stimuli. Individuals with bulimia nervosa consistently show an increased AB to shape/weight cues and socially threatening stimuli, but findings for AB to food cues are mixed.

DISCUSSION

While there are important research gaps, preliminary evidence suggests that the combination of AB to disorder-specific cues (i.e., food and weight/shape) and AB toward threat may be a potent contributor to binge eating. This conclusion underscores previous findings on the interaction between negative affect and AB to disorder-specific cues. Recommendations for future research are provided.

Explicit and Implicit Approach vs. Avoidance Tendencies towards High vs. Low Calorie Food Cues in Patients with Obesity and Active Binge Eating Disorder

Patients with binge eating disorder (BED) suffer from regular food binges with loss of control. This may be due to dysfunctional approach vs. avoidance tendencies towards food in BED. We applied an approach-avoidance task (AAT), in which n = 24 patients with obesity and active BED (OB-BED), n = 32 patients with obesity without current BED (OB), and n = 25 healthy controls (CO) either approached (“pulled”) or avoided (“pushed”) high (HC) vs. low calorie (LC) food pictures. We tested the hypothesis that OB-BED patients would show an approach bias (measured as different response times RT) towards HC food compared to the other groups. While there was no main effect for group or direction of movement, a significant main effect for calorie (p < 0.001; RT for HC significantly slower than for LC) was found. Repeated measures ANOVA (rm-ANOVA) for comparison of OB-BED vs. OB vs. CO revealed a significant three-fold interaction group × direction × calorie (p = 0.02). Against our hypothesis, the OB-BED group showed an avoidance bias for LC. In explicit ratings, OB-BED reported a significantly reduced urge to consume LC food compared to the OB group. Similar to OB-BED, CO also showed an avoidance bias for LC. The implications of our results are discussed and future directions in this field of research are presented.

Cognitive Food Processing in Binge-Eating Disorder: An Eye-Tracking Study

Studies indicate an attentional bias towards food in binge-eating disorder (BED); however, more evidence on attentional engagement and disengagement and processing of multiple attention-competing stimuli is needed. This study aimed to examine visual attention to food and non-food stimuli in BED. In n = 23 participants with full-syndrome and subsyndromal BED and n = 23 individually matched healthy controls, eye-tracking was used to assess attention to food and non-food stimuli during a free exploration paradigm and a visual search task. In the free exploration paradigm, groups did not differ in their initial fixation position. While both groups fixated non-food stimuli significantly longer than food stimuli, the BED group allocated significantly more attention towards food than controls. In the visual search task, groups did not differ in detection times. However, a significant detection bias for food was found in full-syndrome BED, but not in controls. An increased initial attention towards food was related to greater BED symptomatology and lower body mass index (BMI) only in full-syndrome BED, while a greater maintained attention to food was associated with lower BMI in controls. The results suggest food-biased visual attentional processing in adults with BED. Further studies should clarify the implications of attentional processes for the etiology and maintenance of BED.

Adverse effects of consuming high fat–sugar diets on cognition: implications for understanding obesity

There is increasing evidence for important roles of key cognitive processes, including attention, memory and learning, in the short-term decision making about eating. There is parallel evidence that people who are overweight or obese tend to perform worse on a variety of cognitive tasks. In this review, the evidence for these two ideas is summarised and then the idea that overconsumption of Western-style high-fat (HF)–high-sugar diets may underlie the association between obesity and poorer cognitive performance is explored. In particular, evidence in animals and human subjects that repeated consumption of HF or HF and sugar (HFS) diets leads to specific impairments in the functioning of the hippocampus, which underpin the consequent changes in cognition is summarised. These findings lead into the vicious cycle model (VCM), which suggests that these cognitive changes have knock-on negative effects for future appetite control, and evidence that altered hippocampal function is also associated with impaired appetite control is explored. The review concludes that there is consistent evidence in the animal literature and emerging evidence from human studies that supports this VCM. It is also noted, however, that to date studies lack the nutritional specificity needed to be able to translate these basic research findings into clear nutritional effects, and concludes that there is an urgent need for additional research to clarify the precise nature of the apparent effects of consuming HFS diets on cognition.