Too hot to handle: Mood states moderate implicit approach vs. avoidance tendencies toward food cues in patients with obesity and active binge eating disorder

The prognostic role of food addiction for weight loss treatment outcomes in individuals with overweight and obesity: A systematic review and meta-analysis

Food addiction (FA) could be a potential prognostic factor of weight loss intervention outcomes. This systematic review with meta-analysis aimed to (1) estimate this prognostic effect of FA diagnosis and symptom count in individuals with overweight or obesity and (2) explore potential sources of heterogeneity based on properties of the weight loss intervention, study, and sample (e.g., age, gender, ethnicity). We searched PubMed, PsycINFO, and Web of Science for studies reporting on associations between pre-intervention FA (assessed with the Yale Food Addiction Scale) and weight outcomes after weight loss intervention in individuals with overweight or obesity without a medically diagnosed eating disorder. Twenty-five studies met inclusion criteria, including 4904 individuals (71% women, Mage = 41 years, BMI = 40.82 kg/m2), k = 18 correlations of weight loss with FA symptom count, and k = 21 mean differences between FA diagnosis groups. Pooled estimates of random-effects meta-analyses found limited support for a detrimental effect of FA symptom count and diagnosis on weight loss intervention outcomes. Negative associations with FA increased for behavioral weight loss interventions and among more ethnically diverse samples. More research on the interaction of FA with pre-existing mental health problems and environmental factors is needed.

Investigating the structure of disordered eating symptoms in adult men: A network analysis

OBJECTIVE

Eating disorders (EDs) increasingly emerge as a health risk in men, but there is concern that men's symptoms go unnoticed due to stereotypical perceptions and gender-related differences in symptom presentation. Novel assessments focused particularly on attitudes and behaviours towards increasing muscle size and definition. Using network analysis, this study aimed to corroborate and extend previous findings on disordered eating presentation in men by examining the role of muscularity concerns among an extended range of disordered eating symptoms.

METHOD

N = 294 adult men (18 years or older) completed muscularity-related and disordered eating assessments, among which we included assessments for orthorexic eating and Avoidant/Restrictive Food Intake Disorder for the first time. We selected symptoms empirically, estimated a regularised network, identified symptom communities, evaluated network loadings and bridge centrality estimates, and compared network structures between different groups of participants.

RESULTS

We identified five symptom communities related to muscularity-related concerns, features of core ED psychopathology, and selective eating. Symptoms regarding ruminating about healthy eating, guilt for unhealthy eating, weight overvaluation, concerns about muscularity, and selective eating emerged as highly central.

DISCUSSION

The results largely corroborate previous observations but suggest that muscle-building behaviours are part of a broader cluster of male body shaping and rule-based dieting behaviours.

Feeling good, approaching the positive

Introduction

Approach and avoidance behaviors have been extensively studied in cognitive science as a fundamental aspect of human motivation and decision-making. The Approach-Avoidance Bias (AAB) refers to the tendency to approach positive stimuli faster than negative stimuli and to avoid negative stimuli faster than positive ones. Affect and arousal in involved individuals are assumed to play a crucial role in the AAB but many questions in that regard remain open. With this in mind, the present study aimed to examine the impact of positive and negative mood on the AAB.

Method

To achieve this goal, we conducted an experiment where participants watched either positive or negative videos prior to performing an approach-avoidance task.

Results

We have not been able to confirm our preregistered hypothesis that mood induction moderates the AAB. Instead, our results suggest that an AAB can be robustly shown after both the positive and the negative intervention. Positive Affect Negative Affect Schedule (PANAS) results show that the participants' affective state was influenced by the mood intervention only in the form of increased emotional intensity. Participants did not self-report a change in mood valence that corresponds to the valence of the video primes. However, the behavioral data shows that after watching a positive video, participants are faster in approaching positive stimuli than negative stimuli. At the same time, we do not find a similar effect after the negative intervention.

Discussion

These findings suggest that positive and negative affect might play an important role in shaping the AAB that is modulated by stimulus valence. This provides new potential insights into the underlying mechanisms of human motivation and decision-making. Specifically, we argue for potential differences between attention and reaction toward a valenced stimulus.

Dissecting implicit food-related behaviors in Binge Eating Disorder and obesity: insights from a mobile approach-avoidance framework

Introduction

Bulimic episodes experienced by patients with Binge Eating Disorder (BED) might be sustained by an enhanced behavioral propensity to approach food stimuli.

Methods

To test this hypothesis, automatic approach avoidance tendencies toward high-calorie foods (HCF), low-calorie foods (LCF), and neutral objects were assessed in a group of 23 patients with BED, and their performance was compared to the one of 17 patients with obesity without BED and a group of 32 normal weight participants. All participants performed a mobile approach-avoidance task in which they were required to approach and avoid different stimuli by respectively pulling their phone toward themselves or pushing it away. Reaction times were analyzed.

Results

Results showed a significant three-way interaction between group, type of movement and stimulus. Post-hoc analyses revealed that all the groups displayed an approach bias toward HCF. Patients with BED and healthy controls also displayed an approach bias toward LCF, a bias that was absent in obese individuals without BED. Moreover, patients with BED were faster in approaching food stimuli, both HCF and LCF, compared to healthy controls.

Discussion

These behavioral tendencies are quite consistent with the real-life attitudes of both BED patients and patients with obesity and might contribute to the maintenance of unhealthy eating habits such as binging in patients with BED and high-calorie diets in patients with obesity.

Testing the effectiveness of a mobile approach avoidance intervention and measuring approach biases in an ecological momentary assessment context: study protocol for a randomised-controlled trial

INTRODUCTION

Unhealthy eating behaviour is a major contributor to obesity and related diseases and is associated with a behavioural bias to approach rather than avoid desired foods, as measured with reaction time tasks. Approach-avoidance interventions (AAIs) have been proposed as a way to modify food evaluations and help people to eat in accordance with their dietary goals. Mobile implementations of AAI might be easily accessible, low threshold interventions, but their effectiveness has not been established yet.

METHODS AND ANALYSIS

Participants who aim to change their eating behaviour are randomised to intervention or control groups. They complete six sessions of a smartphone-based AAI, in which they push (ie, avoid) or pull (ie, approach) personalised food images. Intervention group participants always avoid foods that they personally want to eat less often and approach foods that they personally want to eat more often. In the control group, images are paired equally often with both response directions. To evaluate contextual and dynamic intervention effects, ecological momentary assessment (EMA) is measured throughout, with questions about food intake, hunger, stress, emotions, eating intentions, food craving and impulsivity twice a day. Additional EMA preintervention and postintervention measures are administered before and after the intervention phase (4 days each) with a 1-day follow-up EMA 4 weeks after the intervention. Multilevel models will examine the temporal covariance between approach bias and self-reported variables as well as short-term and long-term intervention effects on approach bias, food intake and craving.

ETHICS AND DISSEMINATION

The study was approved by the Ethics Committee of the University of Salzburg. Results will be published in peer-reviewed scientific journals and presented at scientific conferences.

TRIAL REGISTRATION NUMBER

German Clinical Trials Register DRKS, registration number DRKS00030780.

Gender differences in individuals with obesity and binge eating disorder: A retrospective comparison of phenotypical features and treatment outcomes

OBJECTIVE

Phenotypical comparisons between individuals with obesity without binge eating disorder (OB) and individuals with obesity and comorbid binge eating disorder (OB + BED) are subject to ongoing investigations. At the same time, gender-related differences have rarely been explored, raising the question whether men and women with OB and OB + BED may require differently tailored treatments.

METHOD

We retrospectively compared pre- versus post-treatment data in a matched sample of n = 180 men and n = 180 women with OB or OB + BED who received inpatient treatment.

RESULTS

We found that men displayed higher weight loss than women independent of diagnostic group. In addition, men with OB + BED showed higher weight loss than men with OB after 7 weeks of treatment.

CONCLUSIONS

The present findings add to an emerging yet overall still sparse body of studies comparing phenotypical features and treatment outcomes in men and women with OB and OB + BED; implications for further research are discussed.

CLINICAL TRIAL REGISTRATION

The study was prospectively registered with the German Clinical Trial Register as part of application DRKS00028441.

A Program for the Comprehensive Cognitive Training of Excess Weight (TRAINEP): The Study Protocol for A Randomized, Controlled Trial

Background: The available treatments for people with excess weight have shown small effects. Cognitive training has shown promising results, but most of the research focused on normal-weight university students and reported immediate results after a single training session. This parallel group, randomized, controlled trial aims to study the efficacy of a program for the comprehensive cognitive treatment of excess weight. Methods and Analysis: Participants will be 150 people with excess weight recruited through social media, who will be randomized into three groups: cognitive intervention, sham cognitive intervention, and treatment as usual. All assessment and intervention sessions will be online in groups of 5–6 participants. The three groups will attend a motivational interviewing session, and they will receive individualized diet and physical exercise guidelines throughout the program. The cognitive training will consist of four weekly sessions of approximately 60–90 min, each based on approach–avoidance bias training, inhibitory control training, implementation of intentions, and episodic future thinking, respectively. The main outcome measure will be a change in Body Mass Index (kg/m2). Secondary outcomes include changes in cognitive measures, eating and physical exercise behaviors, and anthropometric measures. Assessments will be conducted up to 6 months after the end of the program. In addition, data on the use of the health system will be collected to analyze the cost-effectiveness and the cost-utility of training. Linear mixed models will be used for statistical analysis. Findings of this study will expand the available evidence on cognitive interventions to reduce excess weight.

Two of a Kind? Mapping the Psychopathological Space between Obesity with and without Binge Eating Disorder

(1) Background: Obesity (OB) is a frequent co-morbidity in Binge Eating Disorder (BED), suggesting that both conditions share phenotypical features along a spectrum of eating-related behaviors. However, the evidence is inconsistent. This study aimed to comprehensively compare OB-BED patients against OB individuals without BED and healthy, normal-weight controls in general psychopathological features, eating-related phenotypes, and early life experiences. (2) Methods: OB-BED patients (n = 37), OB individuals (n = 50), and controls (n = 44) completed a battery of standardized questionnaires. Responses were analyzed using univariate comparisons and dimensionality reduction techniques (linear discriminant analysis, LDA). (3) Results: OB-BED patients showed the highest scores across assessments (e.g., depression, emotional and stress eating, food cravings, food addiction). OB-BED patients did not differ from OB individuals in terms of childhood traumatization or attachment styles. The LDA revealed a two-dimensional solution that distinguished controls from OB and OB-BED in terms of increasing problematic eating behaviors and attitudes, depression, and childhood adversities, as well as OB-BED from OB groups in terms of emotional eating tendencies and self-regulation impairments. (4) Conclusions: Findings support the idea of a shared spectrum of eating-related disorders but also highlight important distinctions relevant to identifying and treating BED in obese patients.