Decision-Making Deficits and Overeating: A Risk Model for Obesity

Obesity and its relationship to addictions: is overeating a form of addictive behavior?

Obesity is a major public health problem and notoriously difficult to treat. There are many parallels between obesity/overeating and addictions to alcohol and drugs. This paper discusses similarities between obesity and addictive disorders, including common personality characteristics, disruptive behavior syndromes, and brain mechanisms. Although there are important differences between overeating and other addictive behaviors, an addiction model of overeating may effectively inform prevention and treatment of obesity.

Overeating Behavior and Striatal Dopamine with 6-[F]-Fluoro-L-m-Tyrosine PET

Eating behavior may be affected by dopamine synthesis capacity. In this study, 6-[(18)F]-fluoro-L-m-tyrosine (FMT) positron emission tomography (PET) uptake in striatal subregions was correlated with BMI (kg/m(2)) and an estimate of the frequency of prior weight loss attempts in 15 healthy subjects. BMI was negatively correlated with FMT uptake in the dorsal caudate. Although the association between BMI and FMT uptake in the dorsal caudate was not significant upon correction for age and sex, the association fell within the range of a statistical trend. Weight loss attempts divided by years trying was also negatively correlated with FMT uptake in the dorsal putamen (P = .05). These results suggest an association between low dorsal striatal presynaptic dopamine synthesis capacity and overeating behavior.

Managing the pandemic of obesity: siding with the fox or the hedgehog?

Obesity is a major public health problem of pandemic proportion. Despite its high prevalence and widespread distribution (consistent with a common underlying etiology), clinical psychologists and primary care physicians routinely approach the problem with individualized but often ineffective treatments like psychotherapy and pharmacotherapy, or propose alterations to specific components of the 'toxic environment', cultural influences, and psychosocial factors purported to cause overeating. This paper presents an alternative perspective and proposes a potential framework for assisting health professionals in developing rational approaches to education about and preventive treatment of obesity based on the role of factors in early life that contribute to personality and behavior and which over time lead to obesity and its maintenance.

Immediate pleasures and future consequences. A neuropsychological study of binge eating and obesity

Longitudinal data indicate that our capacity for adaptive self-regulation is a relatively stable predisposition that appears in childhood and predicts future life successes. In 2004, we published the first study demonstrating decision-making deficits in overweight/obese adult women. The present study is an extension of these findings. We assessed obese women with (n=65) and without (n=73) binge-eating disorder (BED), and a group (n=71) of normal-weight women, on two neuropsychological tests: the Iowa Gambling Task and a Delay Discounting measure. The BED and obese groups had worse performance scores on both tasks compared to normal controls, but did not differ from each other. These findings suggest that adaptive decision-making and the ability to delay gratification may influence our eating behaviours, particularly in a food environment where effortful control of energy intake is essential for the maintenance of a healthy body weight. There were also group differences in education level with fewer BED and obese individuals having a post-secondary degree, in accord with established links between socioeconomic status and body weight. Interestingly, when education level was added to the models, those with a higher education performed better on both tasks, and the group differences were not significant.

Decision-making impairments in women with binge eating disorder

Even though eating is frequently driven by overindulgence and reward rather than by energy balance, few studies so far have analyzed decision-making processes and disturbances in feedback processing in women with binge eating disorder (BED). In an experimental study, 17 women with BED (DSM-IV) and 18 overweight healthy controls (HC) were compared in the game of dice task (GDT). This task assesses decision-making under risk with explicit rules for gains and losses. Additionally, differences in dispositional activation of the behavior inhibition and behavior approach system as well as cognitive flexibility were measured. Main results revealed that women with BED make risky decisions significantly more often than HC. Moreover, they show impaired capacities to advantageously utilize feedback processing. Even though these deficits were not related to disease-specific variables, they may be important for the daily decision-making behavior of women with BED, thus being relevant as a maintenance factor for the disorder.

Percent body fat is related to delay and probability discounting for food in humans

This study describes delay and probability discounting patterns for hypothetical food and money in relation to percent body fat (PBF). Sixty university students completed four computerized discounting tasks in which they were asked to make a series of hypothetical decisions between (a) 10 dollars after one of several different delays (1, 2, 30, 180, and 365 days) or a smaller amount of money available immediately; (b) 10 bites of food after one of several delays (1, 2, 5, 10, and 20h) or a smaller number of bites available immediately; (c) $10 at one of several probabilities (0.9, 0.75, 0.5, 0.25, 0.1) or a smaller amount of money to be received for sure; and (d) 10 bites of food at one of several probabilities (0.9, 0.75, 0.5, 0.25, 0.1) or a smaller number of bites to be received for sure. Median indifference points for all participants across each task were well described using the hyperbolic discounting function. Results suggest that percent body fat predicted discounting for hypothetical food, but not money, using regression analyses with the entire sample and when comparing individuals in the high and low quartiles for PBF. None of the other dietary variables (body mass index, subjective hunger, and time since last meal or snack) were related to discounting patterns. This suggests that individuals with high PBF may exhibit heightened sensitivities to delay and probability when making decisions about food.

Cognitive function and overweight in preschool children

The authors assessed the association between cognitive function and incidence and maintenance of overweight in preschool children. A population-based birth cohort was established in Menorca, Spain, between 1997 and 1999 (n = 482). Body mass index (weight (kg)/height (m)(2)) was measured at ages 4 years and 6 years (n = 421). At age 4 years, children were assessed for cognitive function (McCarthy Scales of Children's Abilities) (n = 395). After multivariable adjustment for a wide range of factors, including maternal education and body mass index, children with higher general cognition at age 4 years had a lower likelihood of being overweight (odds ratio = 0.47, 95% confidence interval (CI): 0.25, 0.88) at age 6 years. Children with higher general cognition at age 4 years had a lower likelihood of maintaining an unhealthy weight status (being at risk of overweight or overweight) between ages 4 years and 6 years, as well as worsening weight status over time, than children who maintained a healthy weight (odds ratios were 0.78 (95% CI: 0.54, 1.14) and 0.77 (95% CI: 0.51, 1.14), respectively). When specific dimensions of cognitive function were assessed, associations were mainly found for verbal and executive function areas. Children with higher cognitive function in early life might be at decreased risk of overweight later in childhood.

Affect, cognition, awareness and behavior in eating disorders. Comparison between obesity and anorexia nervosa

A kontinuummodell szerint az evészavarok elhelyezhetőek egy olyan folyamatos spektrumon, aminek az egyik végén a restriktív anorexia, a másik végén a stabil obesitas kórképe található. Számos vizsgálat bizonyítja továbbá azt, hogy a hangulati (depresszió, kóros szorongás és alexitímia), illetve a kognitív zavarok a testkép észlelésének problémájával együtt jelentkeznek az evészavarokban. Ennek ellenére az obesitast még mindig csupán testsúlykezelési problémaként tartják számon a klinikumban. Célkitűzés: Azon érzelmi, kognitív, illetve testképzavarok feltárása restriktív anorexiában és túlevés okozta stabil obesitasban, amelyek a kontinuummodell érvényességét igazolhatják, továbbá amelyek az evészavarok patológiájának közös alapját képezhetik. Módszerek: Neuropszichológiai tesztekkel vizsgáltuk a kognitív zavarokat, pszichológiai kerdőívekkel a hangulati zavart és az explicit testképértékelést, továbbá affektív priming paradigmát használtunk az implicit attitűdök feltárására. Eredmények: A neuropszichológiai tesztek figyelmi problémát mutattak ki mind anorexiában, mind obesitasban. Mind a gyerek-, mind a felnőttobesitasban megjelent a mentális rigiditás és a stratégiaváltás problémája, ami a frontális lebeny végrehajtórendszerének zavarát igazolta. Az elhízott betegek lassabban kategorizálták a szomorúságot kifejező arcokat, míg az anorexiások a mosolygós arcokat. Az elhízott csoport pozitív implicit attitűdöt, az anorexiás csoport negatív attitűdöt mutatott a túlsúlyos, de nem kövér testkép iránt. Anorexiások nem mutattak preferenciát a nagyon vékony testalak iránt. Következtetések: Az eredményeink szerint a restriktív anorexia több közös tünetet mutat a szorongásos kórképekkel, míg az elhízás a szenvedélybetegségek sajátosságait mutatta. Így a vizsgálatok nem igazolták egyértelműen a modell érvényességét.

Ability to delay gratification at age 4 years and risk of overweight at age 11 years

OBJECTIVES

To determine if limited ability to delay gratification (ATDG) at age 4 years is independently associated with an increased risk of being overweight at age 11 years and to assess confounding or moderation by child body mass index z score at 4 years, self-reported maternal expectation of child ATDG for food, and maternal weight status.

DESIGN

Longitudinal prospective study.

SETTING

Ten US sites.

PARTICIPANTS

Participants in the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development. Main Exposure Ability to delay gratification at 4 years, measured as pass or fail on a validated task.

OUTCOME MEASURES

Overweight at 11 years, defined as a body mass index greater than or equal to the 85th percentile based on measured weight and height.

RESULTS

Of 805 children, 47% failed the ATDG task. Using multiple logistic regression, children who failed the ATDG task were more likely to be overweight at 11 years (relative risk, 1.29; 95% confidence interval, 1.06-1.58), independent of income to needs ratio. Body mass index z score at 4 years and maternal expectation of child ATDG for food did not alter the association, but maternal weight status reduced the association significantly.

CONCLUSIONS

Children with limited ATDG at age 4 years were more likely to be overweight at age 11 years, but the association was at least partially explained by maternal weight status. Further understanding of the association between the child's ATDG and maternal and child weight status may lead to more effective obesity intervention and prevention programs.

"Gourmand syndrome" in a child with pharmacoresistant epilepsy

We report the case of a 10-year-old boy with pharmacoresistant epilepsy, symptomatic of a right temporoparietal hemorrhagic lesion, who displayed an eating passion as described for the gourmand syndrome (GS) in adults and discuss the role of epilepsy in GS. This patient presented with a significant change in his eating habits (abnormal preoccupation with the preparation and eating of fine-quality food) concordant with the onset of his seizure disorder, without any previous history of eating disorders or psychiatric illness. This observation corroborates the important role of the right cerebral hemisphere in disturbed eating habits, including the relatively benign GS, and, possibly rarely, in less benign eating disorders such as anorexia and obesity.

Impulsivity in Hong Kong-Chinese club-drug users

To investigate the relationship between personality, club-drug use and high-risk drug-related behaviour, 360 club-drug users and 303 non-drug users in Hong Kong were assessed on measures of two impulsivity dimensions, reward drive and rash impulsivity, and a related trait of punishment sensitivity. The most frequently used drugs were ketamine, ecstasy, and cannabis, with the majority of participants using two or more drugs on any one occasion. Club-drug users were more rash-impulsive and reward-driven, and less punishment-sensitive than non-drug users (p<0.001). Rash impulsivity, but not reward drive or punishment sensitivity, was significantly (p<0.001) associated with risky drug-related behaviour. There was no association between any personality traits and preferred drug. These findings suggest that, while those who use club drugs are generally more impulsive and less punishment-sensitive, some discrete facets of impulsivity are associated with differing patterns of drug-use behaviour.

Dieting as a case of behavioural decision making. Does self-control matter?

To be a successful dieter, one has to be able to consistently resist immediate temptations in order to achieve the bigger, but delayed rewards of weight loss, increased attractiveness and better health. These long-term benefits are by no means guaranteed as the delayed rewards are more uncertain than the immediate rewards. Several researchers have suggested that the population of restrained eaters consists of two populations: unsuccessful dieters who score high on restraint and high on disinhibition, and successful dieters who score high on restraint but low on disinhibition. The present study examines to what extent restrained eating in combination with individual differences in self-control (akin to low disinhibition) is related to successful decision making on a task that mimics the uncertainty of dieting (measured with the Iowa Gambling Task). As expected, self-control moderated the association between restraint and decision making: restrained eating was related to worse decision making when self-control was low, but to better decision making when self-control was high. This suggest that those high in restraint and high in self-control may be more successful in their dieting attempts because they are generally better at inhibiting short-term rewards in order to gain better long-term outcomes.

Pediatric obesity: parallels with addiction and treatment recommendations

Rates of pediatric obesity have increased dramatically over the past decade. This trend is especially alarming because obesity is associated with significant medical and psychosocial consequences. It may contribute to cardiovascular, metabolic, and hepatic complications, as well as to psychiatric difficulties. The development of obesity appears to be influenced by a complex array of genetic, metabolic, and neural frameworks, along with behavior, eating habits, and physical activity. Numerous parallels exist between obesity and addictive behaviors, including genetic predisposition, personality, environmental risk factors, and common neurobiological pathways in the brain. Typical treatments for pediatric obesity include behavioral interventions targeting diet or exercise. These treatments have yielded mixed results and typically have been examined in specialty clinic populations, limiting their generalizability. There are limited medication options for overweight children and adolescents, and no approved medical intervention in children younger than 16 years old. Bariatric surgery may be an option for some adolescents, but due to the risks of surgery, it is often seen as a last resort. The parallels between addiction and obesity aid in developing novel interventions for pediatric obesity. Motivational enhancement and cognitive-behavioral strategies used in addiction treatment may prove to be beneficial.

Diminishing risk-taking behavior by modulating activity in the prefrontal cortex: a direct current stimulation study

Studies have shown increased risk taking in healthy individuals after low-frequency repetitive transcranial magnetic stimulation, known to transiently suppress cortical excitability, over the right dorsolateral prefrontal cortex (DLPFC). It appears, therefore, plausible that differential modulation of DLPFC activity, increasing the right while decreasing the left, might lead to decreased risk taking, which could hold clinical relevance as excessively risky decision making is observed in clinical populations leading to deleterious consequences. The goal of the present study was to investigate whether risk-taking behaviors could be decreased using concurrent anodal transcranial direct current stimulation (tDCS) of the right DLPFC, which allows upregulation of brain activity, with cathodal tDCS of the left DLPCF, which downregulates activity. Thirty-six healthy volunteers performed the risk task while they received either anodal over the right with cathodal over the left DLPFC, anodal over the left with cathodal over the right DLPFC, or sham stimulation. We hypothesized that right anodal/left cathodal would decrease risk-taking behavior compared with left anodal/right cathodal or sham stimulation. As predicted, during right anodal/left cathodal stimulation over the DLPFC, participants chose more often the safe prospect compared with the other groups. Moreover, these participants appeared to be insensitive to the reward associated with the prospects. These findings support the notion that the interhemispheric balance of activity across the DLPFCs is critical in decision-making behaviors. Most importantly, the observed suppression of risky behaviors suggests that populations with boundless risk-taking behaviors leading to negative real-life consequences, such as individuals with addiction, might benefit from such neuromodulation-based approaches.

Is there any relationship between obesity and mental flexibility in children?

Cognitive profiles of 12 schoolboys with obesity were compared with their peers with normal weight. For the cognitive assessment five clinical tasks were selected: digit span memory, Raven's progressive matrices (intelligence), semantic verbal fluency, D2 attention endurance and Wisconsin card sorting test. We found no differences in memory, intelligence and verbal fluency between the two groups. Children with obesity performed worse on D2 and Wisconsin tests. Correlations confirmed relationships between body weight, body mass index, attention and Wisconsin measured perseveration in set-shifting. This suggests that childhood obesity involves cognitive deficits in shifting and attention abilities.

Preventing risk for obesity by promoting self-regulation and decision-making skills: pilot results from the PATHWAYS to health program (PATHWAYS)

The overall aim of the two school-based pilot studies was to evaluate whether an approach to prevention that focused on changing child impulse control, decision making, and social competence can be effective in changing attitudes toward food intake and physical activity as risk factors for obesity. The strategy used was to translate specific components of one evidence-based program for violence prevention (Promoting Alternative Thinking Strategies: PATHS) into an elementary school curriculum program for obesity prevention. Both studies demonstrated significant changes in positive attitudes toward self-regulation of appetitive behavior. In addition, Study 2 demonstrated positive changes in actual food choices and television viewing patterns. Implications are that comprehensive efforts to prevent youth risk for obesity should include as one component school-based curricula that target self-regulation and decision-making skills.

Why obese children cannot resist food: the role of impulsivity

Facing the undesirable health consequences of being obese, an important question is why some people are not able to resist eating to excess. It is theorized that increased impulsivity at least partly underlies the inability to control eating behaviour; being more impulsive is supposed to make it more difficult to resist food intake. Thirty-three obese children in a residential setting and 31 lean control children are tested. Impulsivity is measured with two behavioural measures (inhibitory control and sensitivity to reward) and questionnaires. Results show that the obese children in treatment were more sensitive to reward and showed less inhibitory control than normal weight children. In addition, the obese children with eating binges were more impulsive than the obese children without eating binges. Most interesting finding was that the children that were the least effective in inhibiting responses, lost less weight in the residential treatment program. To conclude: impulsivity is a personality characteristic that potentially has crucial consequences for the development and maintenance, as well as treatment of obesity.

Neuropsychological correlates of decision-making in ambiguous and risky situations

Decision-making situations in real life differ regarding their explicitness of positive and negative consequences as well as regarding the directness of probabilities for reward and punishment. In neuropsychological research, decisions under ambiguity and decisions under risk are differentiated. To assess decisions under ambiguity the Iowa Gambling Task (IGT) is one of the most frequently used tasks. Decisions under risk can be measured by a task that offers explicit rules for gains and losses and stable winning probabilities, as the Game of Dice Task (GDT) does. In this contribution we firstly summarize studies that investigated decision-making in various groups of patients using the IGT or the GDT. We also propose a new model of decision-making in risky situations and describe differences between decisions under ambiguity and decisions under risk from a theoretical and clinical perspective.

Food intake and reward mechanisms in patients with schizophrenia: implications for metabolic disturbances and treatment with second-generation antipsychotic agents

Obesity is highly prevalent among patients with schizophrenia and is associated with detrimental health consequences. Although excessive consumption of fast food and pharmacotherapy with such second-generation antipsychotic agents (SGAs) as clozapine and olanzapine has been implicated in the schizophrenia/obesity comorbidity, the pathophysiology of this link remains unclear. Here, we propose a mechanism based on brain reward function, a relevant etiologic factor in both schizophrenia and overeating. A comprehensive literature search on neurobiology of schizophrenia and of eating behavior was performed. The collected articles were critically reviewed and relevant data were extracted and summarized within four key areas: (1) energy homeostasis, (2) food reward and hedonics, (3) reward function in schizophrenia, and (4) metabolic effects of the SGAs. A mesolimbic hyperdopaminergic state may render motivational/incentive reward system insensitive to low salience/palatability food. This, together with poor cognitive control from hypofunctional prefrontal cortex and enhanced hedonic impact of food, owing to exaggerated opioidergic drive (clinically manifested as pain insensitivity), may underlie unhealthy eating habits in patients with schizophrenia. Treatment with SGAs purportedly improves dopamine-mediated reward aspects, but at the cost of increased appetite and worsened or at least not improved opiodergic capacity. These effects can further deteriorate eating patterns. Pathophysiological and therapeutic implications of these insights need further validation via prospective clinical trials and neuroimaging studies.

Impulsivity in obese women

In our obesogenic environment, self-control might be necessary in order to prevent overeating. Impulsivity is supposed to make it more difficult to resist the temptation to eat too much and can thereby contribute to overweight. In the present study, the hypotheses is tested that obese individuals are more impulsive. Thirty-one obese and 28 lean women, sampled from the normal population, are tested on a behavioural measure and three self-report measures of impulsivity. The obese women appeared more impulsive on the last part of the behavioural task, but not on the self-report measures. Implications of the results are discussed.

Associations among overeating, overweight, and attention deficit/hyperactivity disorder: a structural equation modelling approach

BACKGROUND

Some recent studies have reported strong links between obesity and ADHD in adults; however, to date, little work has focussed on possible behavioural mechanisms that could account for this association.

METHOD

This study used structural equation modelling (SEM) in a sample of healthy adult women to test the predictions that ADHD symptoms predict aspects of overeating, including binge eating and emotionally-induced eating, which in turn are positively correlated with Body Mass Index.

RESULTS

The SEM produced a non-significant chi-square and both the measurement model and the structural model fit the data very well.

CONCLUSIONS

Plausible mechanisms are discussed to help explain how the symptomatology of ADHD could foster different forms of overeating.

Evolved to satisfy our immediate needs: Self-control and the rewarding properties of food

Evolutionary explanations of overeating in modern society emphasize that humans have evolved to eat to their physiological limits when food is available. The present paper challenges the idea that eating is driven by the availability of food only and proposes that it is regulated by strategic anticipatory behaviour in service of the most profitable long-term scenario as well. Our alternative explanation emphasizes the interaction between the reward system that regulates the liking and wanting of food and the role of self-control, which is involved in maintaining the best outcome in the long run.

Obesity and ADHD may represent different manifestations of a common environmental oversampling syndrome: a model for revealing mechanistic overlap among cognitive, metabolic, and inflammatory disorders

Obesity and attention-deficit hyperactivity disorder (ADHD) are both increasing in prevalence. Childhood exposure to television has shown linkage to both ADHD and obesity with the former ascribed to dysfunctional cognitive hyperstimulation and the latter to altered patterns of diet and exercise. Empirical evidence has contradicted prior presumptions that the hyperactivity of ADHD would decrease the risk of obesity. Instead, obesity and ADHD demonstrate significant comorbidity. We propose that obesity and ADHD represent different manifestations of the same underlying dysfunction, a phenomenon we term environmental oversampling syndrome. Oversupply of information in the form of nutritional content and sensory content may independently predispose to both obesity and ADHD. Moreover, the pathogenic mechanisms of these conditions may overlap such that nutritional excess contributes to ADHD and cognitive hyperstimulation contributes to obesity. The overlapping effects of medications provide further evidence towards the existence of shared etiologic pathways. Metabolism and cognition may represent parallel systems of intelligence, and oversampling of content may constitute the source of parallel dysfunctions. The emerging association between psychiatric and metabolic disorders suggests a fundamental biologic link between these two systems. In addition, the immune system may represent yet another form of intelligence. The designation of syndrome X subsumes seemingly unrelated metabolic and inflammatory entities. Environmental oversampling syndrome may represent an even more inclusive concept that encompasses various metabolic, inflammatory, and behavioral conditions. Apparently disparate conditions such as insulin resistance, diabetes, hypertension, syndrome X, obesity, ADHD, depression, psychosis, sleep apnea, inflammation, autism, and schizophrenia may operate through common pathways, and treatments used exclusively for one of these conditions may prove beneficial for the others.

Cerebral processing of food-related stimuli: effects of fasting and gender

To maintain nutritional homeostasis, external food-related stimuli have to be evaluated in relation to the internal states of hunger or satiety. To examine the neural circuitry responsible for integration of internal and external determinants of human eating behaviour, brain responses to visual and complex gustatory food-related stimuli were measured using functional magnetic resonance imaging in 18 healthy non-smokers (10 women, 8 men). Each individual was studied on two occasions, the order of which was counterbalanced; after eating as usual and after 24 h fasting. Raised plasma free fatty acids and lower insulin and leptin concentrations confirmed that participants fasted as requested. When fasted, participants reported more hunger, nervousness and worse mood and rated the visual (but not gustatory) food-related stimuli as more pleasant. The effect of fasting on hunger was stronger in women than in men. No circuitry was identified as differentially responsive in fasting compared to satiety to both visual and gustatory food-related stimuli. The left insula response to the gustatory stimuli was stronger during fasting. The inferior occipito-temporal response to visual food-related stimuli also tended to be stronger during fasting. The responses in the occipito-temporal cortex to visual and in the insula to gustatory stimuli were stronger in women than in men. There was no interaction between gender and fasting. In conclusion, food reactivity in modality-specific sensory cortical areas is modulated by internal motivational states. The stronger reactivity to external food-related stimuli in women may be explored as a marker of gender-related susceptibility to eating disorders.

The somatic marker hypothesis: A critical evaluation

The somatic marker hypothesis (SMH; [Damasio, A. R., Tranel, D., Damasio, H., 1991. Somatic markers and the guidance of behaviour: theory and preliminary testing. In Levin, H.S., Eisenberg, H.M., Benton, A.L. (Eds.), Frontal Lobe Function and Dysfunction. Oxford University Press, New York, pp. 217-229]) proposes that emotion-based biasing signals arising from the body are integrated in higher brain regions, in particular the ventromedial prefrontal cortex (VMPFC), to regulate decision-making in situations of complexity. Evidence for the SMH is largely based on performance on the Iowa Gambling Task (IGT; [Bechara, A., Tranel, D., Damasio, H., Damasio, A.R., 1996. Failure to respond autonomically to anticipated future outcomes following damage to prefrontal cortex. Cerebral Cortex 6 (2), 215-225]), linking anticipatory skin conductance responses (SCRs) to successful performance on a decision-making paradigm in healthy participants. These 'marker' signals were absent in patients with VMPFC lesions and were associated with poorer IGT performance. The current article reviews the IGT findings, arguing that their interpretation is undermined by the cognitive penetrability of the reward/punishment schedule, ambiguity surrounding interpretation of the psychophysiological data, and a shortage of causal evidence linking peripheral feedback to IGT performance. Further, there are other well-specified and parsimonious explanations that can equally well account for the IGT data. Next, lesion, neuroimaging, and psychopharmacology data evaluating the proposed neural substrate underpinning the SMH are reviewed. Finally, conceptual reservations about the novelty, parsimony and specification of the SMH are raised. It is concluded that while presenting an elegant theory of how emotion influences decision-making, the SMH requires additional empirical support to remain tenable.

Smoking status, cigarettes per day, and their relationship to overweight and obesity among former and current smokers in a national adult general population sample

BACKGROUND

Weight gain after smoking cessation is perceived to be a barrier against quitting smoking. The goal was to analyze overweight and obesity depending on smoking status and number of cigarettes per day (cpd) among former and current smokers.

METHODS

The sample included 7124 residents of Germany aged 18-79 y from a national health examination survey (participation rate: 61.4%). Body weight and height were objectively measured; smoking status and cpd were assessed by a questionnaire administered in a health examination center.

RESULTS

The number of cpd was positively related to being overweight and more so to obesity among former smoking men, but not women. The results were adjusted for age, school education, exercise and alcohol consumption. Men who formerly had smoked more than 30 cpd had an adjusted odds ratio (OR) of 5.0 for obesity compared to men who had never smoked.

CONCLUSION

With an increasing number of cpd more psychological and physiological processes of compensation of nicotine supply after smoking cessation may be expected. Male smokers should be provided with information on how to prevent weight gain after smoking cessation. To foster smoking cessation, female smokers should be informed that women who stop smoking manage to have no increase in the rates of overweight or obesity when considered at the general population level.