Cause or consequence? Investigating attention bias and self-regulation skills in children at risk for obesity

A Pilot Randomized Control Trial Testing a Smartphone-Delivered Food Attention Retraining Program in Adolescent Girls with Overweight or Obesity

BACKGROUND/OBJECTIVES

Attention bias (AB) toward food is associated with obesity, but it is unclear if programs designed to reduce AB can impact adolescents' eating behavior. We investigated whether a two-week, smartphone-delivered attention retraining (AR) program (vs a control program) altered food AB in adolescent girls with overweight.

METHODS

Participants completed three food-cue visual-probe trainings/day. The AR and control programs directed attention away from food stimuli during 100% and 50% of trainings, respectively. Before and after completion of the programs, girls completed a food-cue visual-probe task while undergoing magnetoencephalography (MEG), and then a laboratory test meal.

RESULTS

Sixty-eight adolescents were randomized; 58 completed post-program visits. There was minimal effect of condition on AB scores (β [95%CI] = -1.9 [-20.8, 16.9]; d = -0.06). There was a small effect of condition on energy intake (EMMcontrol = 1017 kcal, EMMAR = 1088 kcal, d = 0.29). Within the AR group, there was slightly blunted initial engagement in brain areas associated with reward response and subsequent increased goal-directed attention and action control.

CONCLUSIONS

We found preliminary support for efficacy of an intensive smartphone-delivered AR program to alter neural correlates of attention processing in adolescent girls with overweight or obesity. Studies with larger sample sizes are needed to elucidate if AR trainings disrupt the link between food AB and eating behavior.

Neural correlates of obesity across the lifespan

Associations between brain and obesity are bidirectional: changes in brain structure and function underpin over-eating, while chronic adiposity leads to brain atrophy. Investigating brain-obesity interactions across the lifespan can help better understand these relationships. This study explores the interaction between obesity and cortical morphometry in children, young adults, adults, and older adults. We also investigate the genetic, neurochemical, and cognitive correlates of the brain-obesity associations. Our findings reveal a pattern of lower cortical thickness in fronto-temporal brain regions associated with obesity across all age cohorts and varying age-dependent patterns in the remaining brain regions. In adults and older adults, obesity correlates with neurochemical changes and expression of inflammatory and mitochondrial genes. In children and older adults, adiposity is associated with modifications in brain regions involved in emotional and attentional processes. Thus, obesity might originate from cognitive changes during early adolescence, leading to neurodegeneration in later life through mitochondrial and inflammatory mechanisms.

Are Emotion Regulation Strategies Associated With Visual Attentional Breadth for Emotional Information in Youth?

Attentional deployment is currently considered as one of the most central mechanisms in emotion regulation (ER) as it is assumed to be a crucial first step in the selection of emotional information. According to the broaden-and-build theory, positive emotions are associated with attentional broadening and negative emotions with attentional narrowing toward emotional information. Given that ER strategies relying on attentional deployment (i.e., rumination, cognitive reappraisal and distraction) have the possibility to influence positive and negative emotions by (re)directing one's attention, there could be an association with one's attentional scope. The current study investigated the association between the general (trait) use of three specific ER strategies and visual attentional breadth for positive, negative, and neutral information in a selected sample of 56 adolescents (M = 12.54, SD = 1.72; 49% girls) at risk for developing psychopathology. First, participants self-reported on their overall use of different ER strategies. Next, the previously validated Attentional Breadth Task (ABT) was used to measure visual attention breadth toward emotional information. No evidence was found for the relationship between 2 specific ER strategies (i.e., cognitive reappraisal and rumination) and visual attentional breadth for neutral, positive and negative emotional information. Surprisingly, "distraction" was associated with visual attentional narrowing, which was unrelated to the valence of the emotion. These unexpected results indicate the multifaceted relationship between trait ER, distraction specifically, and visual attentional breadth for emotional information. Future research, especially in younger age groups, could further elaborate on this research domain.

Do Hot Executive Functions Relate to BMI and Body Composition in School Age Children?

Deficits of 'hot' executive functions (EFs) involving emotional and motivational processes are considered as a risk factor for excessive weight, but few studies have tested the relationship between hot EFs and body composition in children. The aim of the study was to assess the association of the ability to delay gratification and affective decision-making with the body mass index (BMI) and body composition in children with typical neurocognitive development. The sample consisted of 553 Polish children aged between 6-12 y. The delay of gratification task (DGT) was applied to assess the ability to delay gratification. The Hungry Donkey test (HDT) was applied to assess affective decision-making. The indicators of decision-making in the HDT were net score and learning rate. The relationships between hot EFs and BMI, fat mass index (FMI), lean body mass index (LBMI) were tested. The association of the z scores of BMI and FMI, overweight/obesity, and the ability to delay gratification was found insignificant after controlling cofounding factors. Most of the results on affective decision-making and z scores for BMI, FMI and LBMI were insignificant as well. The relationship between the ability to delay gratification, affective decision-making, and adiposity is not pronounced in typically developed children.

Is obesity related to enhanced neural reactivity to visual food cues? A review and meta-analysis

Theoretical work suggests that obesity is related to enhanced incentive salience of food cues. However, evidence from both behavioral and neuroimaging studies on the topic is mixed. In this work we review the literature on cue reactivity in obesity and perform a preregistered meta-analysis of studies investigating effects of obesity on brain responses to passive food pictures viewing. Further, we examine whether age influences brain responses to food cues in obesity. In the meta-analysis we included 13 studies of children and adults that investigated group differences (obese vs. lean) in responses to food vs. non-food pictures viewing. While we found no significant differences in the overall meta-analysis, we show that age significantly influences brain response differences to food cues in the left insula and the left fusiform gyrus. In the left insula, obese vs. lean brain differences in response to food cues decreased with age, while in the left fusiform gyrus the pattern was opposite. Our results suggest that there is little evidence for obesity-related differences in responses to food cues and that such differences might be mediated by additional factors that are often not considered.

Appetitive Pavlovian-to-Instrumental Transfer in Participants with Normal-Weight and Obesity

Altered eating behavior due to modern, food-enriched environments has a share in the recent obesity upsurge, though the exact mechanisms remain unclear. This study aims to assess whether higher weight or weight gain are related to stronger effects of external cues on motivation-driven behavior. 51 people with and without obesity completed an appetitive Pavlovian-to-Instrumental Transfer (PIT) paradigm. During training, button presses as well as presentation of fractal images resulted in three palatable and one neutral taste outcome. In the subsequent test phase, outcome-specific and general behavioral bias of the positively associated fractal images on deliberate button press were tested under extinction. While all participants showed signs of specific transfer, general transfer was not elicited. Contrary to our expectations, there was no main effect of weight group on PIT magnitude. Participants with obesity exhibited higher scores in the Three-Factor Eating Questionnaire Disinhibition scale, replicating a very robust effect from previous literature. Individual Restraint scores were able to predict body-mass index (BMI) change after a three-year period. Our data indicate that PIT is an important player in how our environment influences the initiation of food intake, but its effects alone cannot explain differences in-or future development of-individual weight.