Nutrition labels influence value computation of food products in the ventromedial prefrontal cortex

Neural correlates of willingness to pay for items: A meta-analysis of functional magnetic resonance imaging studies

Willingness to pay (WTP) pervades every marketplace transaction, therefore, understanding how the brain makes bidding decisions is essential in consumer neuroscience. Although some neuroimaging studies have investigated the neural networks of WTP, systematic understanding remains limited. This study identified reliable neural networks activated by the WTP across different reward types and assessed common and distinct neural networks for different reward types (food and other) bids. We conducted an activation likelihood estimation (ALE) meta-analysis on WTP across different reward types (25 studies; 254 foci; 705 participants), and to compared neural representations of WTP for food reward (22 studies; 232 foci; 628 participants) and other rewards (7 studies, 61 foci; 177 participants). The ALE results revealed that the brain centers of WTP for different rewards mainly consist of the bilateral inferior frontal gyrus (IFG), bilateral insula, bilateral anterior cingulate cortex (ACC), along with the left caudate. This suggests that neural networks encoding WTP for different rewards consist of brain regions associated with reward processing, cost-benefit calculations, and goal-directed action activities. In addition, consistent activation of the bilateral IFG and bilateral insula for food but no other rewards bids suggest their involvement in the neural network of appetite. WTP for food and other rewards commonly activated ACC, suggesting a common region encoding bids for different rewards. Our findings provide novel insights into neural networks associated with WTP for food and other rewards bids and the mechanisms underlying WTP across different reward types.

The neural model of front-of-package label processing

Front-of-package (FOP) labels have been adopted in many countries to battle the obesity pandemic and its serious health consequences by providing clearer and easier-to-understand nutrition and health information. The effectiveness of FOP labels has been generally confirmed, with some contextual and individual factors modifying their effectiveness. Existing theories (eg, the dual-process theory) and shifting priorities for self-control, provide some explanations for the FOP label effect. However, the cognitive and neural mechanisms underlying the processing of FOP labels remain unknown. Here, a new model, namely, the neural model of FOP label processing, has been proposed to fill this gap by providing an integrated account of FOP label processing while simultaneously considering multiple important situational and individual factors in the same framework. This neural model is built on the core eating network (ie, the ventral reward pathway and the dorsal control pathway) for food cue processing and actual food consumption. The new model explains how FOP labels may facilitate attention, influence the core eating network, and thus alter food choices. It also demonstrates how motivation may modify FOP label processing in 2 ways: affecting attention (the indirect way) and changing the process of evaluating the food (the direct way). It further explains how some contextual and individual factors (eg, ego depletion, time pressure, and health knowledge) influence the process. Thus, the neural model integrates evidence from behavioral, eye-tracking, and neuroimaging studies into a single, integrated account, deepening understanding of the cognitive and neural mechanisms of FOP label processing. This model might facilitate consensus on the most successful FOP label. Moreover, it could provide insights for consumers, food industries, and policy makers and encourage healthy eating behaviors.

Economic value in the Brain: A meta-analysis of willingness-to-pay using the Becker-DeGroot-Marschak auction

Forming and comparing subjective values (SVs) of choice options is a critical stage of decision-making. Previous studies have highlighted a complex network of brain regions involved in this process by utilising a diverse range of tasks and stimuli, varying in economic, hedonic and sensory qualities. However, the heterogeneity of tasks and sensory modalities may systematically confound the set of regions mediating the SVs of goods. To identify and delineate the core brain valuation system involved in processing SV, we utilised the Becker-DeGroot-Marschak (BDM) auction, an incentivised demand-revealing mechanism which quantifies SV through the economic metric of willingness-to-pay (WTP). A coordinate-based activation likelihood estimation meta-analysis analysed twenty-four fMRI studies employing a BDM task (731 participants; 190 foci). Using an additional contrast analysis, we also investigated whether this encoding of SV would be invariant to the concurrency of auction task and fMRI recordings. A fail-safe number analysis was conducted to explore potential publication bias. WTP positively correlated with fMRI-BOLD activations in the left ventromedial prefrontal cortex with a sub-cluster extending into anterior cingulate cortex, bilateral ventral striatum, right dorsolateral prefrontal cortex, right inferior frontal gyrus, and right anterior insula. Contrast analysis identified preferential engagement of the mentalizing-related structures in response to concurrent scanning. Together, our findings offer succinct empirical support for the core structures participating in the formation of SV, separate from the hedonic aspects of reward and evaluated in terms of WTP using BDM, and show the selective involvement of inhibition-related brain structures during active valuation.

Nutrition claims influence expectations about food attributes, attenuate activity in reward-associated brain regions during tasting, but do not impact pleasantness

INTRODUCTION

Nutrition claims are one of the most common tools used to improve food decisions. Previous research has shown that nutrition claims impact expectations; however, their effects on perceived pleasantness, valuation, and their neural correlates are not well understood. These claims may have both intended and unintended effects on food perception and valuation, which may compromise their effect on food decisions.

METHODS

We investigated the effects of nutrition claims on expectations, perceptions, and valuation of milk-mix drinks in a behavioral (n = 110) and an fMRI (n = 39) study. In the behavioral study, we assessed the effects of a "fat-reduced" and a "protein-rich" nutrition claim on expected and perceived food attributes of otherwise equal food products. In the fMRI study, we investigated the effect of a "protein-rich" claim on taste pleasantness perception and valuation, and on their neural correlates during tasting and swallowing.

RESULTS

We found that both nutrition claims increased expected and perceived healthiness and decreased expected but not perceived taste pleasantness. The "protein-rich" claim increased expected but not perceived satiating quality ratings, while the "fat-reduced" claim decreased both expected and perceived satiating quality ratings. In the absence vs. presence of the "protein-rich" claim, we observed an increased activity in a cluster extending to the left nucleus accumbens during tasting and an increased functional connectivity between this cluster and a cluster in right middle frontal gyrus during swallowing.

CONCLUSION

Altogether, we found that nutrition claims impacted expectations and attenuated reward-related responses during tasting but did not negatively affect perceived pleasantness. Our findings support highlighting the presence of nutrients with positive associations and exposure to foods with nutrition claims to increase their acceptance. Our study offers insights that may be valuable in designing and optimizing the use of nutrition claims.

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.

Neural correlates of food labels on brand, nature, and nutrition: An fMRI meta-analysis

Eating is an essential act of our everyday life, and it involves complicated cognitive appraisal and gustatory evaluation. This study meta-analyzed the functional magnetic resonance imaging (fMRI) studies about food labels on brand, nature and nutrition. Web of Science Core Collection (WoS), Scopus, and PubMed were queried to identify human fMRI studies written in English and published in peer-reviewed journals and used taste or food related labels. Studies were excluded if they reported no results from taste/food related stimuli versus control, no task-based fMRI results, or no results from whole-brain analysis. Nineteen studies entered the analysis. Results for the meta-analysis on food nutrition revealed that the precuneus on the right hemisphere was significantly activated, a brain region related to internal mentation of self-consciousness and nutritional evaluation. Results for the overall analysis on all 19 studies, the analysis on food brand, and the analysis on food nature revealed no significant brain regions. Food nutrition labels were generally processed by brain regions related to internal mentation of self-consciousness and nutritional evaluation. However, the neural correlates of labels of food brand and food nature were inconsistent across studies. More future studies are needed to better understand the cognitive processing of different kinds of food labels in our brain.

Subgroup Analysis of a Randomized Trial of the Effects of Positive Messaging on Patient-Reported Outcomes with Asthma - Effect of Obesity

Objective

Asthma in obese patients represents a specific phenotype that is associated with increased symptoms, more frequent and severe exacerbations, reduced responsiveness to treatment, and decreased quality of life. Marketing and placebos have been shown to alter subjective responses to interventions in both asthma and obesity. We evaluated obesity as a potential treatment effect modifier of the effects enhanced drug messaging or placebos on subjective asthma outcomes.

Methods

We conducted a secondary analysis of a multicenter, randomized clinical trial that studied the effect of messaging and placebos on asthma outcomes. A total of 601 participants were randomized (1:1:1:1:1) to one of 5 groups: enhanced messaging with montelukast or placebo, neutral messaging with montelukast or placebo, or usual care and followed for 4 weeks after randomization. We compared baseline characteristics by obesity status for 600 participants with data on body weight. Obesity was evaluated as an effect modifier for enhanced messaging (versus neutral messaging) and on placebo effects (versus usual care) in 362 participants assigned to a placebo group or usual care for three asthma questionnaires: Asthma Control Questionnaire, Asthma Quality of Life Questionnaire and Asthma Symptoms Utility Index.

Results

Overall, 227 (37%) of participants were obese. Obese participants were older (mean age 41 vs 34), more likely female (82% vs 67%) and self-identified as Black (44% vs 25%) than non-obese participants. As previously published, enhanced messaging was associated with improvements in patient-reported asthma scores, but there was no evidence for a placebo effect. Obesity status did not influence the message effects nor did it modify responses to placebo.

Conclusion

Obesity has been shown to be an important factor associated with asthma outcomes and an effect modifier of drug treatment effects. We conducted a post hoc, subgroup analysis of data from a multicenter randomized trial of enhanced messaging and placebo associated with drug treatment on asthma outcomes. Our findings suggest that observed differences in treatment effects between obese and non-obese patients sometimes seen in trials of asthma treatments are unlikely to be due to different "placebo" effects of treatment and may reflect differential physiologic effects of active agents.

Can we have a second helping? A preregistered direct replication study on the neurobiological mechanisms underlying self-control

Self‐control is of vital importance for human wellbeing. Hare et al. (2009) were among the first to provide empirical evidence on the neural correlates of self‐control. This seminal study profoundly impacted theory and empirical work across multiple fields. To solidify the empirical evidence supporting self‐control theory, we conducted a preregistered replication of this work. Further, we tested the robustness of the findings across analytic strategies. Participants underwent functional magnetic resonance imaging while rating 50 food items on healthiness and tastiness and making choices about food consumption. We closely replicated the original analysis pipeline and supplemented it with additional exploratory analyses to follow‐up on unexpected findings and to test the sensitivity of results to key analytical choices. Our replication data provide support for the notion that decisions are associated with a value signal in ventromedial prefrontal cortex (vmPFC), which integrates relevant choice attributes to inform a final decision. We found that vmPFC activity was correlated with goal values regardless of the amount of self‐control and it correlated with both taste and health in self‐controllers but only taste in non‐self‐controllers. We did not find strong support for the hypothesized role of left dorsolateral prefrontal cortex (dlPFC) in self‐control. The absence of statistically significant group differences in dlPFC activity during successful self‐control in our sample contrasts with the notion that dlPFC involvement is required in order to effectively integrate longer‐term goals into subjective value judgments. Exploratory analyses highlight the sensitivity of results (in terms of effect size) to the analytical strategy, for instance, concerning the approach to region‐of‐interest analysis.

Dietary Restraint Related to Body Weight Maintenance and Neural Processing in Value-Coding Areas in Adolescents

BACKGROUND

There is an alarming increase in the obesity prevalence among children in an environment of increasing availability of preprocessed high-calorie foods. However, some people maintain a healthy weight even in such obesogenic environments. This difference in body weight management could be attributed to individual differences in dietary restraint; however, its underlying neurocognitive mechanisms in adolescents remain unclear.

OBJECTIVES

This study aimed to elucidate these neurocognitive mechanisms in adolescents by examining the relationships between dietary restraint and the food-related value-coding region located in the ventromedial prefrontal cortex (vmPFC).

METHODS

The association between dietary restraint and BMI was tested using a multilinear regression analysis in a large early adolescent cohort (n = 2554; age, 12.2 ± 0.3 years; BMI, 17.9 ± 2.5 kg/m2; 1354 boys). Further, an fMRI experiment was designed to assess the association between the vmPFC response to food images and dietary restraint in 30 adolescents (age, 17.6 ± 1.9 years; BMI, 20.7 ± 2.2 kg/m2; 13 boys). Additionally, using 54 individuals from the cohort (age, 14.5 ± 0.6 years; BMI, 18.8 ± 2.6 kg/m2; 31 boys), we assessed the association between dietary restraint and intrinsic vmPFC-related functional connectivity.

RESULTS

In the cohort, adolescents with increased dietary restraint showed a lower BMI (β = -0.38; P < 0.001; B = -0.06; SE = 0.003). The fMRI results showed a decreased vmPFC response to high-calorie food were correlated with greater dietary restraint. Moreover, there was an association of attenuated intrinsic vmPFC-related functional connectivity in the superior and middle frontal gyrus and the middle temporal gyrus with greater dietary restraint.

CONCLUSIONS

Our findings suggest that dietary restraint in adolescents could be a preventive factor for weight gain; its effect involves modulating the vmPFC, which is associated with food value coding.

Signs of Warning: Do Health Warning Messages on Sweets Affect the Neural Prefrontal Cortex Activity?

In the global attempt to combat rising obesity rates, the introduction of health warning messages on food products is discussed as one possible approach. However, the perception of graphical health warning messages in the food context and the possible impact that they may have, in particular at the neuronal level, have hardly been studied. Therefore, the aim of this explorative study was to examine consumers’ reactions (measured as neuronal activity and subjective reporting) of two different types of graphical health warning messages on sweets compared to sweets without warning messages. One type used the red road traffic stop sign as graphical information (“Stop”), while the other one used shocking pictures (“Shock”), an approach similar to the images on cigarette packages. The neural response of 78 participants was examined with the neuroimaging technique functional near-infrared spectroscopy (fNIRS). Different hemodynamic responses in the orbitofrontal cortex (OFC), the frontopolar cortex (FOC), and the dorsolateral prefrontal cortex (dlPFC) were observed, regions which are associated with reward evaluation, social behavior consequences, and self-control. Further, the health warning messages were actively and emotionally remembered by the participants. These findings point to an interesting health information strategy, which should be explored and discussed further.

Effect of an Educational Intervention on Therapeutic Inertia in Neurologists With Expertise in Multiple Sclerosis: A Randomized Clinical Trial

IMPORTANCE

Therapeutic inertia (TI) is the failure to escalate therapy when treatment goals are unmet and is associated with low tolerance to uncertainty and aversion to ambiguity in physician decision-making. Limited information is available on how physicians handle therapeutic decision-making in the context of uncertainty.

OBJECTIVE

To evaluate whether an educational intervention decreases TI by reducing autonomic arousal response (pupil dilation), a proxy measure of how physicians respond to uncertainty during treatment decisions.

DESIGN, SETTING, AND PARTICIPANTS

In this randomized clinical trial, 34 neurologists with expertise in multiple sclerosis (MS) practicing at 15 outpatient MS clinics in academic and community institutions from across Canada were enrolled. Participants were randomly assigned to receive an educational intervention that facilitates treatment decisions (active group) or to receive no exposure to the intervention (usual care [control group]) from December 2017 to March 2018. Participants listened to 20 audio-recorded simulated case scenarios as pupil responses were assessed by eye trackers. Autonomic arousal was assessed as pupil dilation in periods in which critical information was provided (first period [T1]: clinical data, second period [T2]: neurologic status, and third period [T3]: magnetic resonance imaging data). Data were analyzed from September 2018 to March 2020.

INTERVENTIONS

The traffic light system (TLS)-based educational intervention vs usual care (unexposed). The TLS (use of established associations between traffic light colors and actions to stop or proceed) assists participants in identifying factors associated with worse prognosis in MS care, thereby facilitating the treatment decision-making process by use of established associations between red, green, and yellow colors and risk levels, and actions (treatment decisions).

MAIN OUTCOMES AND MEASURES

Pupil assessment was the primary autonomic outcome. To test the treatment effect of the educational intervention (TLS), difference-in-differences models (also called untreated control group design with pretest and posttest) were used.

RESULTS

Of 38 eligible participants, 34 (89.4%) neurologists completed the study. The mean (SD) age was 44.6 (11.6) years; 38.3% were female and 20 (58.8%) were MS specialists. Therapeutic inertia was present in 50.0% (17 of 34) of all participants and was associated with greater pupil dilation. For every additional SD of pupil dilation, the odds of TI increased by 51% for T1 (odds ratio, 1.51; 95% CI, 1.12-2.03), by 31% for T2 (odds ratio, 1.31; 95% CI, 1.08-1.59), and by 49% for T3 (odds ratio, 1.49; 95% CI, 1.13-1.97). The intervention significantly reduced TI (risk reduction, 31.5%; 95% CI, 16.1%-47.0%). Autonomic arousal responses mediated 29.0% of the effect of the educational intervention on TI.

CONCLUSIONS AND RELEVANCE

In this randomized clinical trial, the TLS intervention decreased TI as measured by pupil dilation, which suggests that individual autonomic arousal is an indicator of how physicians handle uncertainty when making live therapeutic decisions. Pupil response, a biomarker of TI, may eventually be useful in medical education.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03134794.

Extrinsic Factors Underlying Food Valuation in the Human Brain

Subjective values for food rewards guide our dietary choices. There is growing evidence that value signals are constructed in the brain by integrating multiple types of information about flavor, taste, and nutritional attributes of the foods. However, much less is known about the influence of food-extrinsic factors such as labels, brands, prices, and packaging designs. In this mini-review article, we outline recent findings in decision neuroscience, consumer psychology, and food science about the effect of extrinsic factors on food value computations in the human brain. To date, studies have demonstrated that, while the integrated value signal is encoded in the ventromedial prefrontal cortex, information on the extrinsic factors of the food is encoded in diverse brain regions previously implicated in a wide range of functions: cognitive control, memory, emotion and reward processing. We suggest that a comprehensive understanding of food valuation requires elucidation of the mechanisms behind integrating extrinsic factors in the brain to compute an overall subjective value signal.

BOLD activity during emotion reappraisal positively correlates with dietary self-control success

We combined established emotion regulation and dietary choice tasks with fMRI to investigate behavioral and neural associations in self-regulation across the two domains in human participants. We found that increased BOLD activity during the successful reappraisal of positive and negative emotional stimuli was associated with dietary self-control success. This cross-task correlation was present in medial and lateral prefrontal cortex as well as the striatum. In contrast, BOLD activity during the food choice task was not associated with self-reported emotion regulation efficacy. These results suggest that neural processes utilized during the reappraisal of emotional stimuli may also facilitate dietary choices that override palatability in favor of healthfulness. In summary, our findings indicate that the neural systems supporting emotion reappraisal can generalize to other behavioral contexts that require reevaluation of rewarding stimuli and outcomes to promote choices that conform with the current goal.

Salient nutrition labels shift peoples' attention to healthy foods and exert more influence on their choices

Nutrition labels are the most commonly used tools to promote healthy choices. Research has shown that color-coded traffic light (TL) labels are more effective than purely numerical Guideline Daily Amount (GDA) labels at promoting healthy eating. While these effects of TL labels on food choice are hypothesized to rely on attention, how this occurs remains unknown. Based on previous eye-tracking research we hypothesized that TL labels compared to GDA labels will attract more attention, will induce shifts in attention allocation to healthy food items, and will increase the influence of attention to the labels on food choice. To test our hypotheses, we conducted an eye-tracking experiment where participants chose between healthy and unhealthy food items accompanied either by TL or GDA labels. We found that TL labels biased choices towards healthier items because their presence caused participants to allocate more attention to healthy items and less to unhealthy items. Moreover, our data indicated that TL labels were more likely to be looked at, and had a larger effect on choice, despite attracting less dwell time. These results reveal that TL labels increase healthy food choice, relative to GDA labels, by shifting attention and the effects of attention on choice.

Dissociable mechanisms govern when and how strongly reward attributes affect decisions

Theories and computational models of decision-making usually focus on how strongly different attributes are weighted in choice, for example, as a function of their importance or salience to the decision-maker. However, when different attributes affect the decision process is a question that has received far less attention. Here, we investigated whether the timing of attribute consideration has a unique influence on decision-making by using a time-varying drift diffusion model and data from four separate experiments. Experimental manipulations of attention and neural activity demonstrated that we can dissociate the processes that determine the relative weighting strength and timing of attribute consideration. Thus, the processes determining either the weighting strengths or the timing of attributes in decision-making can independently adapt to changes in the environment or goals. Quantifying these separate influences of timing and weighting on choice improves our understanding and predictions of individual differences in decision behaviour.

Neural-based valuation of functional foods among lean and obese individuals

Functional foods may contribute to establish healthy eating habits and reduce obesity and related comorbidities. Differences in the brain mechanisms underpinning the valuation of functional foods in individuals with excess weight may inform the development of attractive functional foods. We aimed to compare brain function during the Willingness to Pay task for functional vs standard foods between individuals with healthy weight (HW), overweight (OW), and obesity (OB). We hypothesized that, in participants with OB, willingness to pay for functional foods would evoke greater activation/connectivity in brain regions previously associated with subjective value. Thirty-six HW, 19 OW, and 20 OB adults performed a functional magnetic resonance imaging-Willingness to Pay task that requires them to decide how much they would pay for presented standard and functional food images tasted in a previous buffet. Whole-brain analyses compared task-related activation and connectivity between participants with OB, OW, and HW. Individuals with OB, relative to HW, showed more similar willingness to pay for functional and standard food. At the brain level, they also showed hyperactivation in the ventral posterior cingulate cortex and the right angular gyrus, as well as an increased functional connectivity between the ventral posterior cingulate cortex and the intraparietal cortices to the valuation of the functional vs the standard foods. Increased willingness to pay for functional foods in people with excessive weight may be driven by recruitment of brain regions that direct attention to internal goals.

Red for "Stop": "Traffic-Light" Nutrition Labels Decrease Unhealthy Food Choices by Increasing Activity and Connectivity in the Frontal Lobe

Food labels comprise a national health-intervention policy that informs consumers of food-product nutritional value. Previous evidence has indicated that, compared to a purely numeric guideline-daily-amount label, a traffic-light-inspired, color-coded label more effectively conveys the nutritional level and increases the selection of healthier products. Therefore, we used functional magnetic resonance imaging to assess the mechanism whereby traffic-light and guideline-daily-amount labels influence food-related decision-making. Forty-four female dieters (age, mean = 20.0, standard deviation = 1.45 years) were recruited to participate in a food-choice task; healthy or unhealthy food options were presented with color-coded traffic-light or purely numeric guideline-daily-amount labels, and the participants were asked to state their preference. We found that, compared with the guideline-daily-amount label, a salient, red traffic-light label potentially reduced unhealthy food-related decision-making and activated the superior medial frontal gyrus and the supplementary motor area, which are implicated in the execution of responses and motor inhibition. For the same stimulus contrast, we also found increased activation in the anterior cingulate cortex, which is associated with salient information monitoring. Finally, we found stronger functional connectivity between the anterior cingulate cortex and inhibitory regions (inferior and middle frontal gyri) under red-traffic-light than under guideline-daily-amount label conditions. These results suggest that traffic-light-inspired labels may be a more effective means of public-policy intervention than are numeric labels conveying guideline daily amounts.

Neuroeconomics, health psychology, and the interdisciplinary study of preventative health behavior

The goal of this article is to introduce readers to theories, tools, and evidence from the field of neuroeconomics and to describe how health psychology and neuroeconomics can be mutually informative in the study of preventative health behaviors. Preventative health behavior here refers to both individual actions that impact one's health (e.g., exercise) and broader behavioral patterns, such as those captured in personality constructs. Although neuroeconomic researchers have begun to incorporate health-relevant behaviors into their studies, the full potential of this research to inform preventative health models is as yet unrealized. What is needed to "translate up" is the unification of rich theoretical content from health psychology with investigations by neuroeconomic researchers of the decision-making process during health-relevant choices. We identify choice as a central, shared feature across models of preventative health behavior that can serve as an inroad for neuroeconomics to contribute to existing models and highlight commonalities that might not otherwise be apparent. A central premise of our argument is that, because health decisions are nearly always multiply determined, a more precise and mechanistic understanding of how choices are made is an important but understudied topic in health psychology. A partnership between health psychologists and neuroeconomic researchers can yield valuable insights into how preventative health choice is made and to identify targets and methods for intervention.

Assessment of an e-training tool for college students to improve accuracy and reduce effort associated with reading nutrition labels

Objective: Nutrition labels are often underutilized due to the time and effort required to read them. We investigated the impact of label-reading training on effort, as well as accuracy and motivation. Participants: Eighty college students (21 men and 59 women). Methods: The training consisted of a background tutorial on nutrition followed by three blocks of practice reading labels to decide which of two foods was the relatively better choice. Label-reading effort was assessed using an eye tracker and motivation was assessed using a 6-item scale of healthy food-choice empowerment. Results: Students showed increases in label-reading accuracy, decreases in label-reading effort, and increases in empowerment. Conclusions: The nutrition label e-training tool presented here, whether used alone or as part of other wellness and health programs, may be an effective way to boost students' label-reading skills and healthy food choices, before they settle into grocery shopping habits.

Environmental-friendly Eco-labeling Matters: Evidences From an ERPs Study

Nowadays, the international community is becoming increasingly concerned about the sustainable utilization of natural resources. In order to protect the environment and reward sustainable practices, eco-labeling that signifies the environmental friendliness of the labeled food is already widely promoted in many regions around the world. Thus, it is of great importance for researchers to study consumers’ attitudes toward eco-labeled food as food is supposed to satisfy consumers’ needs. This study employed the event-related potentials (ERPs) approach to investigate consumers’ attitudes toward eco-labeled food by comparing their neural processing of visual stimuli depicting eco-labeled and non-labeled food. Our results showed that behaviorally, participants preferred to buy eco-labeled food rather than non-labeled one. At the neural level, we observed markedly smaller P2 and N2 amplitudes when pictures of eco-labeled food were presented. Furthermore, we also found that amplitudes of P2 were negatively correlated with participants’ purchase intention. Therefore, our current findings suggest that, while the environmental-friendly eco-labeling was not to one’s own interests, it might still be evocative, which induce consumers’ positive emotion, bring less cognitive conflict to the purchase decision-making and then result in a greater purchasing intention. This effect might be the result of the delivered value of social desirability.

Transcranial direct current stimulation of the medial prefrontal cortex modulates the propensity to help in costly helping behavior

Social decision-making engages traditional decision-making processes (e.g. valuation), as well as social cognition processes (e.g. inferring the affective and mental states of another person). Neuroimaging and neuro-stimulation studies have suggested the involvement of the medial prefrontal cortex (mPFC) in a variety of social decision-making tasks. Yet no study has investigated the effect of the cortical excitability of mPFC in the decision-making of costly helping behavior. Here, we used tDCS to demonstrate the causal relationship between the cortical excitability of mPFC and costly helping decision-making. Subjects assigned to the anodal, cathodal and sham groups were required to decide whether they would like to cost their own money to relieve another subject (a confederate actually) from painful electrical shocks with a certain probability of success. Results showed that the subjects receiving anodal stimulation acted more prosaically than the subjects receiving cathodal stimulation. And this effect was only significant when the probability of success was high. We proposed that tDCS induced modulation of the cortical excitability, targeting the mPFC, can affect the prosocial propensity in costly helping behavior, and the possible underlying mechanisms were discussed.

Brain Activation in Response to Personalized Behavioral and Physiological Feedback From Self-Monitoring Technology: Pilot Study

Background

The recent surge in commercially available wearable technology has allowed real-time self-monitoring of behavior (eg, physical activity) and physiology (eg, glucose levels). However, there is limited neuroimaging work (ie, functional magnetic resonance imaging [fMRI]) to identify how people’s brains respond to receiving this personalized health feedback and how this impacts subsequent behavior.

Objective

Identify regions of the brain activated and examine associations between activation and behavior.

Methods

This was a pilot study to assess physical activity, sedentary time, and glucose levels over 14 days in 33 adults (aged 30 to 60 years). Extracted accelerometry, inclinometry, and interstitial glucose data informed the construction of personalized feedback messages (eg, average number of steps per day). These messages were subsequently presented visually to participants during fMRI. Participant physical activity levels and sedentary time were assessed again for 8 days following exposure to this personalized feedback.

Results

Independent tests identified significant activations within the prefrontal cortex in response to glucose feedback compared with behavioral feedback (P<.001). Reductions in mean sedentary time (589.0 vs 560.0 minutes per day, P=.014) were observed. Activation in the subgyral area had a moderate correlation with minutes of moderate-to-vigorous physical activity (r=0.392, P=.043).

Conclusion

Presenting personalized glucose feedback resulted in significantly more brain activation when compared with behavior. Participants reduced time spent sedentary at follow-up. Research on deploying behavioral and physiological feedback warrants further investigation.

Nutrition labeling reduces valuations of food through multiple health and taste channels

One popularized technique to promote healthy dietary choice involves posting calorie or other nutritional information at the time individuals make a consumption decision. While the evidence on the effectiveness of such interventions is mixed, relatively little work has focused on the underlying mechanisms of how such labels alter behavior. In the research reported here, we asked 87 hungry laboratory subjects to make bids over foods with or without nutrition labels present. We found that the presence of a nutrition label reduced bids by an average of 25 cents. Furthermore, we found this reduction was driven by differences in perceptions and the importance individuals placed on health features of the foods, but also by differences in the importance individuals placed on more visceral taste features. These results help explain the various methods in which nutritional information postings or other policy tools can nudge individuals to consume healthier options.

Overcoming Therapeutic Inertia in Multiple Sclerosis Care: A Pilot Randomized Trial Applying the Traffic Light System in Medical Education

Background

Physicians often do not initiate or intensify treatments when clearly warranted, a phenomenon known as therapeutic inertia (TI). Limited information is available on educational interventions to ameliorate knowledge-to-action gaps in TI.

Objectives

To evaluate the feasibility and efficacy of an educational intervention compared to usual care among practicing neurologists caring for patients with multiple sclerosis (MS).

Methods

We conducted a pilot double-blind, parallel-group, randomized clinical trial. Inclusion criteria included neurologists who are actively involved in managing MS patients. Participants were exposed to 20 simulated case-scenarios (10 cases at baseline, and 10 cases post-randomization to usual care vs. educational intervention) of relapsing–remitting MS with moderate or high risk of disease progression. The educational intervention employed a traffic light system (TLS) to facilitate decisions, allowing participants to easily recognize high-risk scenarios requiring treatment escalation. We also measured differences between blocks to invoke decision fatigue. The control group responded as they would do in their usual clinical practice not exposed to the educational intervention. The primary feasibility outcome was the proportion of participants who completed the study and the proportion of participants who correctly identified a high-risk case-scenario with the “red traffic light.” Secondary outcomes included decision fatigue (defined as an increment of TI in the second block of case-scenarios compared to the first block) and the efficacy of the educational intervention measured as a reduction in TI for MS treatment.

Results

Of 30 neurologists invited to be part of the study, the participation rate was 83.3% (n = 25). Of the 25 participants, 14 were randomly assigned to the control group and 11 to the intervention group. TI was present in 72.0% of participants in at least one case scenario. For the primary feasibility outcome, the completion rate of the study was 100% (25/25 participants). Overall, 77.4% of participants correctly identified the “red traffic light” for clinical-scenarios with high risk of disease progression. Similarly, 86.4% of participants correctly identified the “yellow traffic light” for cases that would require a reassessment within 6–12 months. For the secondary fatigue outcome, within-group analysis showed a significant increased prevalence of TI in the second block of case-scenarios (decision fatigue) among participants randomized to the control group (TI pre-intervention 57.1% vs. TI post-intervention 71.4%; p = 0.015), but not in the active group (TI pre-intervention 54.6% vs. TI post-intervention 63.6%; p = 0.14). For the efficacy outcome, we found a non-significant reduction in TI for the targeted intervention compared to controls (22.6 vs. 33.9% post-intervention; OR 0.57; 95% CI 0.26–1.22).

Conclusion

An educational intervention applying the TLS is feasible and shows some promising results in the identification of high-risk scenarios to reduce decision fatigue and TI. Larger studies are needed to determine the efficacy of the proposed educational intervention.

Clinical Trial Registration

www.ClinicalTrials.gov, identifier NCT03134794.

Identifying the mechanisms through which behavioral weight-loss treatment improves food decision-making in obesity

OBJECTIVES

Behavioral weight loss (BWL) programs are the recommended treatment for obesity, yet it is unknown whether these programs change one's ability to use self-control in food choices and what specific mechanisms support such change. Using experimental economics methods, we investigated whether changes in dietary behavior in individuals with obesity following BWL are driven by one or more of the following potential mechanisms: changes in the perception of the 1) health or 2) taste of food items, and/or 3) shifting decision weights for health versus taste attributes. Therefore, we compared these mechanisms between obese participants and lifetime normal weight controls (NW) both before and after BWL.

METHODS

Females with obesity (N = 37, mean BMI = 33.2) completed a food choice task involving health ratings, taste ratings, and decision-making pre- and post-standard BWL intervention. NW controls (N = 30, BMI = 22.4) completed the same task.

RESULTS

Individuals with obesity exhibited increased self-control (selecting healthier, less tasty food choices) post-treatment. However, their rates of self-control remained significantly lower than NW. We found no differences in initial health perceptions across groups, and no changes with treatment. In contrast, taste ratings and the relative value of taste versus health decreased following treatment. Although, post-treatment participants continued to perceive unhealthy foods as tastier and used less self-control than NW controls, they showed significant improvements in these domains following a BWL intervention.

CONCLUSIONS

To help individuals improve dietary decisions, additional research is needed to determine how to make greater changes in taste preferences and/or the assignment of value to taste versus health attributes in food choices.

Can functional magnetic resonance imaging studies help with the optimization of health messaging for lifestyle behavior change? A systematic review

Unhealthy behaviors, including smoking, poor nutrition, excessive alcohol consumption, physical inactivity and sedentary lifestyles, are global risk factors for non-communicable diseases and premature death. Functional magnetic resonance imaging (fMRI) offers a unique approach to optimize health messages by examining how the brain responds to information relating to health. Our aim was to systematically review fMRI studies that have investigated variations in brain activation in response to health messages relating to (i) smoking; (ii) alcohol consumption; (iii) physical activity; (iv) diet; and (v) sedentary behavior. The electronic databases used were Medline/PubMed, Web of Science (Core Collection), PsychINFO, SPORTDiscuss, Cochrane Library and Open Grey. Studies were included if they investigated subjects aged ≥10years and were published before January 2017. Of the 13,836 studies identified in the database search, 18 studies (smoking k=15; diet k=2; physical activity/sedentary behavior k=1) were included in the review. The prefrontal cortex was activated in seven (47%) of the smoking-related studies and the physical activity study. Results suggest that activation of the ventromedial, dorsolateral and medial prefrontal cortex regions were predictive of subsequent behavior change following exposure to aversive anti-smoking stimuli. Studies investigating the neurological responses to anti-smoking material were most abundant. Of note, the prefrontal cortex and amygdala were most commonly activated in response to health messages across lifestyle behaviors. The review highlights an important disparity between research focusing on different lifestyle behaviors. Insights from smoking literature suggest fMRI may help to optimize health messaging in relation to other lifestyle behaviors.

Food Decision-Making: Effects of Weight Status and Age

Food decisions determine energy intake. Since overconsumption is the main driver of obesity, the effects of weight status on food decision-making are of increasing interest. An additional factor of interest is age, given the rise in childhood obesity, weight gain with aging, and the increased chance of type 2 diabetes in the elderly. The effects of weight status and age on food preference, food cue sensitivity, and self-control are discussed, as these are important components of food decision-making. Furthermore, the neural correlates of food anticipation and choice and how these are affected by weight status and age are discussed. Behavioral studies show that in particular, poor self-control may have an adverse effect on food choice in children and adults with overweight and obesity. Neuroimaging studies show that overweight and obese individuals have altered neural responses to food in brain areas related to reward, self-control, and interoception. Longitudinal studies across the lifespan will be invaluable to unravel the causal factors driving (changes in) food choice, overconsumption, and weight gain.

Salient nutrition labels increase the integration of health attributes in food decision-making

Every day, people struggle to make healthy eating decisions. Nutrition labels have been used to help people properly balance the tradeoff between healthiness and taste, but research suggests that these labels vary in their effectiveness. Here, we investigated the cognitive mechanism underlying value-based decisions with nutrition labels as modulators of value.

More specifically, we used a binary decision task between products along with two different nutrition labels to examine how salient, color-coded labels, compared to purely information-based labels, alter the choice process. Using drift-diffusion modeling, we investigated whether color-coded labels alter the valuation process, or whether they induce a simple stimulus-response association consistent with the traffic-light colors irrespective of the features of the item, which would manifest in a starting point bias in the model. We show that color-coded labels significantly increased healthy choices by increasing the rate of preference formation (drift rate) towards healthier options without altering the starting point. Salient labels increased the sensitivity to health and decreased the weight on taste, indicating that the integration of health and taste attributes during the choice process is sensitive to how information is displayed. Salient labels proved to be more effective in altering the valuation process towards healthier, goal-directed decisions.

Crowdsourcing for self-monitoring: Using the Traffic Light Diet and crowdsourcing to provide dietary feedback

Background

Smartphone photography and crowdsourcing feedback could reduce participant burden for dietary self-monitoring.

Objectives

To assess if untrained individuals can accurately crowdsource diet quality ratings of food photos using the Traffic Light Diet (TLD) approach.

Methods

Participants were recruited via Amazon Mechanical Turk and read a one-page description on the TLD. The study examined the participant accuracy score (total number of correctly categorized foods as red, yellow, or green per person), the food accuracy score (accuracy by which each food was categorized), and if the accuracy of ratings increased when more users were included in the crowdsourcing. For each of a range of possible crowd sizes (n = 15, n = 30, etc.), 10,000 bootstrap samples were drawn and a 95% confidence interval (CI) for accuracy constructed using the 2.5th and 97.5th percentiles.

Results

Participants (n = 75; body mass index 28.0 ± 7.5; age 36 ± 11; 59% attempting weight loss) rated 10 foods as red, yellow, or green. Raters demonstrated high red/yellow/green accuracy (>75%) examining all foods. Mean accuracy score per participant was 77.6 ± 14.0%. Individual photos were rated accurately the majority of the time (range = 50%–100%). There was little variation in the 95% CI for each of the five different crowd sizes, indicating that large numbers of individuals may not be needed to accurately crowdsource foods.

Conclusions

Nutrition-novice users can be trained easily to rate foods using the TLD. Since feedback from crowdsourcing relies on the agreement of the majority, this method holds promise as a low-burden approach to providing diet-quality feedback.

Cognitive processing of food rewards

Cues associated with tasty foods, such as their smell or taste, are strong motivators of eating, but the power of food cues on behaviour varies from moment to moment and from person to person. Variation in the rewarding value of a food with metabolic state explains why food cues are more attractive when hungry. However, cognitive processes are also important determinants of our responses to food cues. An urge to consume a tempting food may be resisted if, for example, a person has a longer term goal of weight loss. There is also evidence that responses to food cues can be facilitated or inhibited by memory processes. The aim of this review is to add to the literature on cognitive control of eating by reviewing recent evidence on the influence of working memory and episodic memory processes on responses to food cues. It is argued that processing of food information in working memory affects how much attention is paid to food cues in the environment and promotes the motivation to seek out food in the absence of direct contact with food cues. It is further argued that memories of specific recent eating episodes play an important role in directing food choices and influencing when and how much we eat. However, these memory processes are prone to disruption. When this happens, eating behaviour may become more cue-driven and less flexible. In the modern food environment, disruption of cognitive processing of food reward cues may lead to overconsumption and obesity.

Effects of social sustainability signaling on neural valuation signals and taste-experience of food products

Value-based decision making occurs when individuals choose between different alternatives and place a value on each alternative and its attributes. Marketing actions frequently manipulate product attributes, by adding, e.g., health claims on the packaging. A previous imaging study found that an emblem for organic products increased willingness to pay (WTP) and activity in the ventral striatum (VS). The current study investigated neural and behavioral processes underlying the influence of Fair Trade (FT) labeling on food valuation and choice. Sustainability is an important product attribute for many consumers, with FT signals being one way to highlight ethically sustainable production. Forty participants valuated products in combination with an FT emblem or no emblem and stated their WTP in a bidding task while in an MRI scanner. After that, participants tasted-objectively identical-chocolates, presented either as "FT" or as "conventionally produced". In the fMRI task, WTP was significantly higher for FT products. FT labeling increased activity in regions important for reward-processing and salience, that is, in the VS, anterior and posterior cingulate, as well as superior frontal gyrus. Subjective value, that is, WTP was correlated with activity in the ventromedial prefrontal cortex (vmPFC). We find that the anterior cingulate, VS and superior frontal gyrus exhibit task-related increases in functional connectivity to the vmPFC when an FT product was evaluated. Effective connectivity analyses revealed a highly probable directed modulation of the vmPFC by those three regions, suggesting a network which alters valuation processes. We also found a significant taste-placebo effect, with higher experienced taste pleasantness and intensity for FT labeled chocolates. Our results reveal a possible neural mechanism underlying valuation processes of certified food products. The results are important in light of understanding current marketing trends as well as designing future interventions that aim at positively influencing food choice.

A Statistical Analysis of a Traffic-Light Food Rating System to Promote Healthy Nutrition and Body Weight

BACKGROUND

Restaurant eating while optimizing nutrition and maintaining a healthy weight is challenging. Even when nutritional information is available, consumers often consider only calories. A quick and easy method to rate both caloric density and nutrition is an unmet need. A food rating system created to address that need is assessed in this study.

METHODS

The food rating system categorizes food items into 3 color-coded categories: most healthy (green), medium healthy (yellow), or least healthy (red) based on calorie density and general nutritional quality from national guidelines. Nutritional information was downloaded from 20 popular fast-food chains. Nutritional assessments and the 3 color coded categories were compared using the Wilcoxon and Median tests to demonstrate the significance of nutrition differences.

RESULTS

Green foods were significantly lower than yellow foods, which in turn were significantly lower than red foods, for calories and calories from fat, in addition to content of total fat, saturated fat and carbohydrates per 100 g serving weight (all P < .02). The green foods had significantly lower cholesterol than the yellow (P = .0006) and red (P < .0001) foods. Yellow foods had less sugar than red foods (P < .0001). Yellow foods were significantly higher in dietary fiber than red foods (P = .001).

CONCLUSION

The food rating color-coded system identifies food items with superior nutrition, and lower caloric density. The smartphone app, incorporating the system, has the potential to improve nutrition; reduce the risk of developing diabetes, hypertension, heart disease, and stroke; and improve public health.