The associations between attentional bias to food cues, parent-report appetitive traits, and concurrent adiposity among adolescents

OBJECTIVE

To assess whether attentional bias to food cues and appetitive traits are independently and interactively associated with adiposity in adolescents.

METHOD

Eighty-five adolescents, 14-17-years had their attentional bias to food images measured in a sated state by computing eye tracking measures of attention (first fixation duration, cumulative fixation duration) to food and control distractor images that bordered a computer game. Parents reported adolescent appetitive traits including the food approach domains of enjoyment of food, food responsiveness, emotional overeating, and the food avoidance domains of satiety responsiveness and emotional overeating through the Children's Eating Behavior Questionnaire.

RESULTS

First fixation bias to food cues was positively associated with enjoyment of food, and negatively associated with satiety responsiveness. In a series of regression models adjusted for relevant covariates, first fixation bias to food cues (β = 0.83, p = 0.007), higher food responsiveness (β = 0.74, p < 0.001), higher emotional overeating (β = 0.51, p = 0.002), and a composite appetite score (β = 1.42, p < 0.001) were each significantly associated with greater BMI z-scores. In models assessing the interactive effects between attentional bias and appetitive traits, higher first fixation bias to food cues interacted synergistically with food responsiveness and emotional overeating in relation to BMI z-score. A synergistic interaction between first fixation bias to food cues and the composite appetite score in relation to BMI z-score was also observed.

CONCLUSION

Individuals with high attentional bias to food cues and obesogenic appetitive traits may be particularly susceptible to weight gain.

Food stimuli decrease activation in regions of the prefrontal cortex related to executive function: an fNIRS study

PURPOSE

Overweight/obese individuals show impairments in executive functions such as inhibitory control. However, the neural mechanisms underlying these disturbances-and specifically, whether or not they involve altered activation of the specific prefrontal cortex regions-are not yet fully understood.

METHODS

The motivational dimensional model of affect suggests that high approach-motivated positive affect (e.g., desire) may impair executive function. In the present study, we investigated individual differences in neural responses to videos of food stimuli, and examined brain activity during a cognitive task in an approach-motivated positive state using functional near-infrared spectroscopy (fNIRS). In Experiment 1, in 16 healthy young adults, we tested whether prefrontal cortex activation differed during a food video clip versus a neutral video clip. Then, after viewing each video clip, we tested for differences in executive function performance and prefrontal cortex activation during a Stroop task. Experiment 2 was the same, except that we compared 20 overweight/obese with 20 healthy young adults, and it incorporated only the food video clip.

RESULTS AND CONCLUSIONS

The results of both experiments indicated that food stimuli decrease activation in regions of the prefrontal cortex related to executive function. This study also suggests that overweight/obese might consciously suppress their responses to a desired stimulus, yet here it seems that effect was less pronounced than in healthy controls.

LEVEL OF EVIDENCE

Level II, Cohort Studies.

Food cue reward salience does not explain Hyperphagia in adolescents with Prader-Willi syndrome

Prader-Willi Syndrome (PWS) is characterized by hyperphagia, an extreme and persistent hunger that emerges in early childhood. We used event-related potentials (ERPs) to objectively investigate brain responses to low- and high-calorie foods, animals, and household objects in 20 satiated adolescents with PWS. Late Positive Potential (LPP) responses to food images did not differ from non-food images. Rather, we observed larger ERPs to high-calorie foods relative to animal images (p=.001) in an earlier time window. These responses correlated with greater severity of hyperphagia (p = .01). Thus, hyperphagia associated with PWS may be due to altered satiety regulation rather than increased motivational salience.

Paediatric obesity and metabolic syndrome associations with cognition and the brain in youth: Current evidence and future directions

Obesity and components of the metabolic syndrome (MetS) are associated with differences in brain structure and function and in general and food-related cognition in adults. Here, we review evidence for similar phenomena in children and adolescents, with a focus on the implications of extant research for possible underlying mechanisms and potential interventions for obesity and MetS in youth. Current evidence is limited by a relative reliance on small cross-sectional studies. However, we find that youth with obesity and MetS or MetS components show differences in brain structure, including alterations in grey matter volume and cortical thickness across brain regions subserving reward, cognitive control and other functions, as well as in white matter integrity and volume. Children with obesity and MetS components also show some evidence for hyperresponsivity of food reward regions and hyporesponsivity of cognitive control circuits during food-related tasks, altered brain responses to food tastes, and altered resting-state connectivity including between cognitive control and reward processing networks. Potential mechanisms for these findings include neuroinflammation, impaired vascular reactivity, and effects of diet and obesity on myelination and dopamine function. Future observational research using longitudinal measures, improved sampling strategies and study designs, and rigorous statistical methods, promises to further illuminate dynamic relationships and causal mechanisms. Intervention studies targeted at modifiable biological and behavioural factors associated with paediatric obesity and MetS can further inform mechanisms, as well as test whether brain and behaviour can be altered for beneficial outcomes.

A randomised controlled feasibility study of food-related computerised attention training versus mindfulness training and waiting-list control for adults with overweight or obesity: the FOCUS study

BACKGROUND

In a feasibility randomised controlled trial in people with overweight/obesity with and without binge eating disorder (BED) symptoms, we assessed eight weekly sessions of attention bias modification training (ABMT) and mindfulness training (MT) versus waiting list (WL) and explored potential mechanisms.

METHODS

45 participants were randomly allocated to one of three trial arms. Primary outcomes were recruitment, retention and treatment adherence rates. Secondary outcomes included measures of eating behaviour, mood, attention and treatment acceptability. Assessments were conducted at baseline, post-intervention (week 8), and follow-up (week 12).

RESULTS

Participant retention at follow-up was 84.5% across groups. Session completion rates in the laboratory were 87% for ABMT and 94% for MT, but home practice was much poorer for ABMT. Changes in BMI and body composition were small between groups and there was a medium size BMI reduction in the MT group at follow-up. Effect sizes of eating disorder symptom changes were not greater for either intervention group compared to WL, but favoured ABMT compared to MT. Hedonic hunger and mindful eating scores favoured MT compared to ABMT and WL. ABMT reduced attention biases towards high-calorie food cues, which correlated with lower objective binge eating days at post-intervention. No significant changes were observed in the MT, or WL conditions.

CONCLUSIONS

Both ABMT and MT have potential value as adjuncts in the treatment of obesity and BED, and a larger clinical trial appears feasible and indicated.

TRIAL REGISTRATION

ISRCTN Registry, ISRCTN15745838. Registered on 22 May 2018.

The effects of snack foods of different energy density on self-served portions and consumption in preschool children

It is recommended that preschoolers serve themselves their own food portions; however, it is unclear what factors influence the amount they select for consumption, and particularly how their selected portions are influenced by food properties such as energy density, volume, and weight. We offered preschool children snacks differing in energy density (ED) and investigated the effects on the amounts they served and then consumed. In a crossover design, 52 children aged 4-6 y (46% girls; 21% overweight) ate an afternoon snack on 2 days in their childcare classrooms. Before each snack time, children served the amount they would like to eat of 4 snacks presented in equal volumes but differing in ED (higher-ED: pretzels, cookies; lower-ED: strawberries, carrots). Across the 2 sessions, children were given their self-served amount of either pretzels (3.9 kcal/g) or strawberries (0.3 kcal/g) and intake was measured. Later, children tasted all 4 snacks and rated liking. Results showed that the portions children served themselves were influenced by their liking ratings (p = 0.0006), but after accounting for liking, the volumes they served were similar for all 4 foods (p = 0.27). At snack time, children ate a greater proportion of self-served strawberries (92 ± 4%) than pretzels (73 ± 4%; p = 0.0003), but because of the ED difference they consumed 55 ± 4 kcal more from pretzels than strawberries (p < 0.0001). The difference in snack intake by volume was not attributable to liking ratings (p = 0.87). That children served a consistent volume of similarly-liked snacks suggests that their portions were affected more by visual cues than by weight or energy content. Despite eating a greater volume of lower-ED strawberries, children consumed more energy from the higher-ED pretzels, highlighting the contribution of energy density to children's energy intake.

Dynamic attentional bias for pictorial and textual food cues in the visual search paradigm

Previous studies have found that individuals have an attentional bias for food cues, which may be related to the energy level or the type of stimulus (e.g., pictorial or textual food cues) of the food cues. However, the available evidence is inconsistent, and there is no consensus about how the type of stimulus and food energy modulate food-related attentional bias. Searching for food is one of the most important daily behaviors. In this study, a modified visual search paradigm was used to explore the attentional bias for food cues, and eye movements were recorded. Food cues consisted of both food words and food pictures with different energy levels (i.e., high- and low-calorie foods). The results showed that there was an attentional avoidance in the early stage but a later-stage attentional approach for all food cues in the pictorial condition. This was especially true for high-calorie food pictures. Participants showed a later-stage conflicting attentional bias for foods with different energy levels in the textual condition. They showed an attentional approach to high-calorie food words but an attentional avoidance of low-calorie food words. These data show that food-related attentional bias varied along with different time courses, which was also modulated by the type of stimulus and food energy. These findings regarding dynamic attentional bias could be explained using the Goal Conflict Model of eating behavior.

Attention to food cues following media multitasking is associated with cross-sectional BMI among adolescents

Purpose

To measure attention to food cues following a multitask or a sustained attention single task, and further, to examine the associations with current weight status and excess consumption.

Methods

Ninety-six 13-to 17-year-olds were fed a standardized meal and then had their attention to food cues measured following completion of a single sustained attention task, media multitask, or a passive viewing control task. Participants then completed an eating in the absence of hunger paradigm to measure their excess consumption. Adolescents completed each condition on separate visits in randomized order. Attention to food cues was measured by computing eye-tracking measures of attention, first fixation duration, and cumulative fixation duration to distractor images while participants played the video game, Tetris. Participants also had their height and weight measured.

Results

Although not statistically significant, attention to food cues was greatest following a media multitask and weakest following a task that engaged sustained attention when compared to a control. First fixation duration was positively and statistically significantly associated with BMI-Z when measured following a multitask. Cumulative fixation duration was not associated with BMI-Z. There were no associations between BMI-Z and attention to food cues after the attention or control task, nor any association between attention to food cues and eating in the absence of hunger.

Conclusion

Among adolescents, we found that current adiposity was related to attention to food cues following a multitask. Multitasking may perturb the cognitive system to increase attention to food cues.

Children's Portion Selection Is Predicted by Food Liking and Is Related to Intake in Response to Increased Portions

BACKGROUND

When children choose amounts of food to eat, it is unclear what influences the portions they select and whether their selections are related to the amounts they consume.

OBJECTIVES

Using a computer survey, we investigated the effect of food liking on portion selection in middle childhood and examined how children's selections were related to measured intake at meals in which portions of all foods were varied across 4 test days.

METHODS

Fifty-one children aged 7-10 y completed a computer survey of 20 common foods with a range of energy density. For each food, the survey presented sliding scales with 5 images varying in portion size and children indicated their liking and the amount they would eat at a specified meal or snack. On 4 test days in a randomized crossover design, children were served a meal of 6 foods from the survey with portions of 100%, 133%, 167%, or 200% of baseline amounts. Data were analyzed using random coefficients models.

RESULTS

Across the 20 foods used in the survey, portion selection ratings were predicted by food liking ratings (P < 0.0001). After accounting for liking, portion selection ratings did not vary by food energy density (P = 0.50). At the meals, intake of all 6 foods increased when larger portions were served (P = 0.002). Furthermore, the selected portion of a food on the survey was positively related both to intake of that food at the 100%-portion meal (P = 0.014) and to increased intake as larger portions were served (P < 0.0001).

CONCLUSIONS

Children aged 7-10 y were able to use a computer survey to choose food portions that predicted their measured intake in response to increased portions. The relation of liking to selection and intake indicates that to promote children's consumption of larger portions of low-energy-dense foods such as fruits and vegetables, these foods must be well liked by the children. This trial was registered at clinicaltrials.gov as NCT02759523.

Dynamic changes in the food-cue processing of obese adolescents: A controlled eye-tracking study from a dual-system perspective

Adolescent obesity is a growing global health problem. Studies have demonstrated that exposure to food cues plays a role in both the development and the persistence of obesity. Understanding how visual attention changes dynamically in response to food cues may explain how they contribute to obesity. The primary aims were to evaluate attentional bias for food cues and conduct a time-course analysis of obese adolescents' food-cue processing. We also investigated the roles of inhibition, cognitive flexibility, and eating styles in their visual attention to food stimuli. A total of 60 age- and gender-matched 12-16-year-olds (n = 30, obese group; n = 30, control group; M = 13.9 years, SD = 1.26) were included in this study's sample. The participants viewed a series of high-calorie and low-calorie food images along with nonfood images in the free exploration paradigm during eye-tracking. Time-course analysis of the proportion of fixations on images of food and high-calorie foods determined that the attentional processing of the two groups differed, especially in later stages. The obese group had higher Stroop Interference and Trail Making Test-B scores than the control group, but these executive functions' scores did not affect their proportions of fixations on food and high-calorie food images over time. Higher Perceptual Reasoning Index scores led to a decrease in the proportions of fixations on high-calorie food images over time in the obese group, and this was particularly noticeable after about 4000 ms. This study found that time-course analysis of visual attention to food cues allows us to understand how it changes dynamically over larger time intervals. Future studies should provide knowledge about maintained attention for food cues and their relationship with top-down factors in obese adolescents.

Fluctuations in attentional bias for food and the role of executive control

Research has shown repeatedly that overweight and obesity are associated with more fluctuations in attentional bias (AB), as reflected in trial-level bias scores (TL-BS). More specifically, people with a high BMI more frequently alternate their attention towards and away from food over time. The current study proposed and tested a model on the mechanism behind the positive association between variability of AB for food and BMI. It was hypothesized that poor executive control (poor response inhibition and lower sustained attention) would be related to both higher BMI and more fluctuations in AB for food and this would, at least partly, explain the significant relationship between variability of AB for food and BMI. To test our hypotheses, 99 female participants completed both an online food dot-probe task and an online stop-signal task. It was found that response inhibition was significantly related to BMI, whereas, contrary to our hypotheses, variability of AB for food was not related to BMI nor to executive control. In conclusion, this study revealed a relation between poor inhibitory control and higher BMI. However, a role of executive control in fluctuations in attention for food could not be established.

Do children with overweight respond faster to food-related words?

Overweight in childhood is a risk factor in developing obesity as an adult, thus having severe consequences on the individuals' physical health and psychological well-being. Therefore, studying the cognitive and emotional processes that sustain overweight is essential not only at a theoretical level but also to develop effective interventions. In the present experiment, we examined whether children with overweight respond faster to food-related than non-food-related words in a word recognition task: lexical decision. The participants were 24 children diagnosed with exogenous overweight and 24 children with a healthy weight. The stimulus list included positively valenced food-related words and positively valenced non-food-related words matched in a number of psycholinguistic variables-we also included negatively valenced non-food words. While children with a healthy weight showed similar response times to positively valenced food-related and non-food-related words, children with overweight showed much faster response times to food-related words than to non-food-related words. Furthermore, both children with overweight and children with a healthy weight responded faster to positive than to negative words. These findings suggest a complex interplay of cognitive and emotional factors during word processing that can be used to implement more effective treatments for childhood overweight.

Attention towards food: Conflicting mechanisms in anorexia nervosa

In Anorexia nervosa (AN) attentional biases towards, as well as away from, food cues have been found using different paradigms. In the current study, adult and adolescent AN patients and control participants performed two tasks while their eye movements were recorded. The tasks involved viewing and rating: 1. Single photographs of food items; 2. Pairs of pictures consisting of one picture of high calorie and one of low calorie food. Girls and women suffering from AN rated pictures of high calorie food as more negative than control participants. In the task showing single food pictures, reduced fixation times within Regions of Interest of low calorie food were seen in AN; during the task using picture pairs, a visual attentional bias towards low calorie and away from high calorie stimuli for AN was demonstrated. There is evidence for heightened visual attentional capture by high calorie stimuli when presented alone as well as attraction of attention by low calorie stimuli when shown next to high calorie stimuli, possibly facilitated by avoidance of the latter. Different attentional mechanisms seem to be activated when only one stimulus is shown compared to when two stimuli are competing for the viewer's attention.

Food-related attentional bias and its associations with appetitive motivation and body weight: A systematic review and meta-analysis

Theoretical models suggest that food-related visual attentional bias (AB) may be related to appetitive motivational states and individual differences in body weight; however, findings in this area are equivocal. We conducted a systematic review and series of meta-analyses to determine if there is a positive association between food-related AB and: (1.) body mass index (BMI) (number of effect sizes (k) = 110), (2.) hunger (k = 98), (3.) subjective craving for food (k = 35), and (4.) food intake (k = 44). Food-related AB was robustly associated with craving (r = 0.134 (95% CI 0.061, 0.208); p < .001), food intake (r = 0.085 (95% CI 0.038, 0.132); p < .001), and hunger (r = 0.048 (95% CI 0.016, 0.079); p = .003), but these correlations were small. Food-related AB was unrelated to BMI (r = 0.008 (95% CI -0.020, 0.035); p = .583) and this result was not moderated by type of food stimuli, method of AB assessment, or the subcomponent of AB that was examined. Furthermore, in a between-groups analysis (k = 22) which directly compared participants with overweight/obesity to healthy-weight control groups, there was no evidence for an effect of weight status on food-related AB (Hedge's g = 0.104, (95% CI -0.050, 0.258); p = .186). Taken together, these findings suggest that food-related AB is sensitive to changes in the motivational value of food, but is unrelated to individual differences in body weight. Our findings question the traditional view of AB as a trait-like index of preoccupation with food and have implications for novel theoretical perspectives on the role of food AB in appetite control and obesity.

Children's implicit food cognition: Developing a food Implicit Association Test

Assessing children's reasoning about food, including their health knowledge and their food preferences, is an important step toward understanding how health messages may influence children's food choices. However, in many studies, assessing children's reasoning relies on parent report or could be susceptible to social pressure from adults. To address these limitations, the present study describes the development of a food version of the Implicit Association Test (IAT). The IAT has been used to examine children's implicit stereotypes about social groups, yet few studies have used the IAT in other domains (such as food cognition). Four- to 12-year-olds (n = 123) completed the food IAT and an explicit card sort task, in which children assessed foods based on their perception of the food's healthfulness (healthy vs. unhealthy) and palatability (yummy vs. yucky). Surprisingly, children demonstrated positive implicit associations towards vegetables. This pattern may reflect children's health knowledge, given that the accuracy of children's healthfulness ratings in the card sort task positively predicted children's food IAT d-scores. Implications for both food cognition and the IAT are discussed.

Measuring attentional bias to food cues in young children using a visual search task: An eye-tracking study

OBJECTIVE

Attentional bias to food cues may be a risk factor for childhood obesity, yet there are few paradigms to measure such biases in young children. Therefore, the present work introduces an eye-tracking visual search task to measure attentional bias in young children.

METHODS

Fifty-one 3-6-year-olds played a game to find a target cartoon character among food (experimental condition) or toy (control condition) distractors. Children completed the experimental and toy conditions on two separate visits in randomized order. Behavioral (response latencies) and eye-tracking measures (time to first fixation, initial gaze duration duration, cumulative gaze duration ) of attention to food and toy cues were computed. Regressions were used to test for attentional bias to food versus toy cues, and whether attentional bias to food cues was related to current BMI z-score.

RESULTS

Children spent more cumulative time looking at food versus toy distractors and took longer to locate the target when searching through food versus toy distractors. The faster children fixated on their first food versus toy distractor was associated with higher BMI z-scores.

CONCLUSIONS

Using a game-based paradigm employing eye-tracking, we found a behavioral attentional bias to food vs. toy distractors in young children. Further, attentional bias to food cues was associated with current BMI z-score.

Weight Status and Attentional Biases Toward Foods: Impact of Implicit Olfactory Priming

Objective: Numerous studies highlight the involvement of cognitive factors in the development and maintenance of obesity. We aimed to measure attentional biases (AB) toward foods (i.e., the individual tendency to automatically orient one's attention toward food stimuli) in normal-weight (NW) individuals and those with overweight (OW) and obesity (OB). We evaluated whether implicit or explicit exposure to olfactory food cues could modify AB. Methods: Eighty-five participants with different weight statuses took part in this experiment. We measured AB toward food pictures with an adapted visual probe task and the variations in AB, while participants were primed with olfactory food cues (within-subject design: no odor/low-energy dense food odor/high-energy dense food odor). Odors were non-attentively perceived during session 1 (implicit condition) and attentively perceived during session 2 (explicit condition). Results: Our results highlighted AB toward food pictures, especially when foods were energy dense, regardless of weight status (p < 0.001). The olfactory priming effect was only significant in the implicit condition. Participants with obesity had a stronger AB toward foods when they were primed with a non-attentively perceived high-energy dense food odor than with a non-attentively perceived low-energy dense food odor (p = 0.02). The trend was reversed for normal-weight participants, while no significant effect was found for participants with overweight. Conclusion: Our results support the hypothesis that an obesity-specific cognitive vulnerability may influence the processing of food-related stimuli and only while food cues are non-attentively perceived. Future research should seek to understand the mechanisms of this phenomenon.

Same, same but different: Attention bias for food cues in adults and adolescents with anorexia nervosa

OBJECTIVE

Attention processing for food may be biased in people with Anorexia Nervosa (AN). However, previous studies have had inconsistent results. This is likely to be due to indirect assessment of attention, which does not inform on the underlying attention processes, and/or the heterogeneity of participants across studies, testing either adults or adolescents with AN, that is, people at very different developmental and illness stages.

METHOD

Eye-tracking was employed as a direct assessment of attention during a visual probe task with food versus non-food pictures. Attention bias for food was measured in 39 adults and 34 adolescents with AN and in 53 adults and 31 adolescents without AN.

RESULTS

All participants had a direction bias for food, specifically for high-calorie food. However, adults with AN subsequently avoided maintaining attention on food versus non-food cues, compared to adults without AN. Adolescents with or without AN demonstrated increased attention maintenance on food versus non-food cues, and, contrary to our hypothesis, did not differ in their attention bias for food cues. Accordingly, adults with AN differed significantly from adolescents with AN in attention maintenance for food cues: while adolescents with AN showed significantly increased attention maintenance on food stimuli, adults avoided maintaining attention on food cues.

DISCUSSION

Adults with AN may apply attention strategies to facilitate restrictive eating. This strategy is absent in adolescents with AN. This difference in food-related attention bias between adolescents and adults with AN suggests that attention biases develop over time as the illness progresses.

Adolescent Attentional Bias toward Real-world Flavored E-cigarette Marketing

OBJECTIVES

E-cigarettes are now the most commonly-used tobacco product among adolescents; yet, little work has examined how the appealing food and flavor cues used in their marketing might attract adolescents' attention, thereby increasing willingness to try these products. In the present study, we tested whether advertisements for fruit/sweet/savory-flavored ("flavored") e-cigarettes attracted adolescent attention in real-world scenes more than tobacco flavored ("unflavored") e-cigarettes. Additionally, we examined the relationship between adolescent attentional bias and willingness to try flavored e-cigarettes.

METHODS

Participants were 46 adolescents (age range: 16-18 years). All participants took part in an eye-tracking paradigm that examined attentional bias to flavored and unflavored e-cigarette advertisements embedded in pictures of real-world storefront scenes. Afterwards, participants' willingness to try flavored and unflavored e-cigarettes was assessed.

RESULTS

In support of our primary hypothesis, adolescents looked longer and fixated more frequently on flavored (vs unflavored) e-cigarette advertisements. Moreover, this attentional bias towards flavored e-cigarette advertisements predicted a greater willingness to try flavored vs unflavored e-cigarettes.

CONCLUSIONS

These findings suggest that flavored e-cigarette marketing attracts the attention of adolescents, in- creases their willingness to try flavored e-cigarette products, and could, therefore, put them at greater risk for tobacco initiation.

Free will in addictive behaviors: A matter of definition

Certain people are at risk for using alcohol or other drugs excessively and for developing problems with their use. Their susceptibility might arise from a variety of factors, including their genetic make-up, brain chemistry, family background, personality and other psychological variables, and environmental and sociocultural variables. Moreover, after substance use has become established, there are additional cognitive-motivational variables (e.g., substance-related attentional bias) that contribute to enacting behaviors consistent with the person's motivation to acquire and use the substance. People who are at such risk are likely to choose to use addictive substances even though doing so entails negative consequences. In the sense of complete freedom from being determined by causal factors, we believe that there is no such thing as free will, but defined as ability to make choices from among multiple options, even though the choices are ultimately governed by natural processes, addicted individuals are free to choose. Although they might appear unable to exercise this kind of free will in decisions about their substance use, addictive behaviors are ultimately always goal-directed and voluntary. Such goal pursuits manifest considerable flexibility. Even some severely addicted individuals can cease their use when the value of continuing the use abruptly declines or when the subjective cost of continuing the use is too great with respect to the incentives in other areas of their lives. Formal treatment strategies (e.g., contingency management, Systematic Motivational Counseling, cognitive training) can also be used to facilitate this reversal.

Eye Tracking as a Marker of Hyperphagia in Prader-Willi Syndrome

This study examined the feasibility of eye tracking measures as markers of hyperphagia in 42 children and adults with Prader-Willi syndrome (PWS). Gaze data collected during free visual exploration of complex displays revealed that food images may not have an overall superior salience in PWS. However, increased attention to food in the context of other high-interest items was associated with higher scores on caregiver reports of hyperphagia. The study also provided preliminary evidence of test-retest reliability of eye tracking measures, suggesting that gaze characteristics may be a promising objective marker of food-related interests in PWS.

Developmental differences in the brain response to unhealthy food cues: an fMRI study of children and adults

BACKGROUND

Food cues are omnipresent and may trigger overconsumption. In the past 2 decades, the prevalence of childhood obesity has increased dramatically. Because children's brains are still developing, especially in areas important for inhibition, children may be more susceptible than adults to tempting food cues.

OBJECTIVE

We examined potential developmental differences in children's and adults' responses to food cues to determine how these responses relate to weight status.

DESIGN

We included 27 children aged 10-12 y and 32 adults aged 32-52 y. Functional magnetic resonance imaging data were acquired during a food-viewing task in which unhealthy and healthy food pictures were presented.

RESULTS

Children had a stronger activation in the left precentral gyrus than did adults in response to unhealthy compared with healthy foods. In children, unhealthy foods elicited stronger activation in the right inferior temporal and middle occipital gyri, left precentral gyrus, bilateral opercular part of the inferior frontal gyrus, left hippocampus, and left middle frontal gyrus. Adults had stronger activation in the bilateral middle occipital gyrus and the right calcarine sulcus for unhealthy compared with healthy foods. Children with a higher body mass index (BMI) had lower activation in the bilateral dorsolateral prefrontal cortex while viewing unhealthy compared with healthy foods. In adults there was no correlation between BMI and neural response to unhealthy compared with healthy foods.

CONCLUSIONS

Unhealthy foods might elicit more attention both in children and in adults. Children had stronger activation while viewing unhealthy compared with healthy foods in areas involved in reward, motivation, and memory. Furthermore, children activated a motivation and reward area located in the motor cortex more strongly than did adults in response to unhealthy foods. Finally, children with a higher BMI had less activation in inhibitory areas in response to unhealthy foods, which may mean they are more susceptible to tempting food cues. This trial was registered at www.trialregister.nl as NTR4255.

A developmental neuroscience perspective on affect-biased attention

There is growing interest regarding the impact of affect-biased attention on psychopathology. However, most of the research to date lacks a developmental approach. In the present review, we examine the role affect-biased attention plays in shaping socioemotional trajectories within a developmental neuroscience framework. We propose that affect-biased attention, particularly if stable and entrenched, acts as a developmental tether that helps sustain early socioemotional and behavioral profiles over time, placing some individuals on maladaptive developmental trajectories. Although most of the evidence is found in the anxiety literature, we suggest that these relations may operate across multiple domains of interest, including positive affect, externalizing behaviors, drug use, and eating behaviors. We also review the general mechanisms and neural correlates of affect-biased attention, as well as the current evidence for the co-development of attention and affect. Based on the reviewed literature, we propose a model that may help us better understand the nuances of affect-biased attention across development. The model may serve as a strong foundation for ongoing attempts to identify neurocognitive mechanisms and intervene with individuals at risk. Finally, we discuss open issues for future research that may help bridge existing gaps in the literature.

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.

Visual attentional bias for food in adolescents with binge-eating disorder

Evidence suggests that adults with binge-eating disorder (BED) are prone of having their attention interfered by food cues, and that food-related attentional biases are associated with calorie intake and eating disorder psychopathology. For adolescents with BED experimental evidence on attentional processing of food cues is lacking. Using eye-tracking and a visual search task, the present study examined visual orienting and disengagement processes of food in youth with BED. Eye-movement data and reaction times were recorded in 25 adolescents (12-20 years) with BED and 25 controls (CG) individually matched for sex, age, body mass index, and socio-economic status. During a free exploration paradigm, the BED group showed a greater gaze duration bias for food images than the CG. Groups did not differ in gaze direction biases. In a visual search task, the BED group showed a greater detection bias for food targets than the CG. Group differences were more pronounced for personally attractive than unattractive food images. Regarding clinical associations, only in the BED group the gaze duration bias for food was associated with increased hunger and lower body mass index, and the detection bias for food targets was associated with greater reward sensitivity. The study provided first evidence of an attentional bias to food in adolescents with BED. However, more research is needed for further specifying disengagement and orienting processes in adolescent BED, including overt and covert attention, and their prospective associations with binge-eating behaviors and associated psychopathology.

A Cognitive Profile of Obesity and Its Translation into New Interventions

Change your lifestyle: decrease your energy intake and increase your energy expenditure, is what obesity experts tell people who need to lose weight. Though the advice might be correct, it appears to be extremely difficult to change one’s lifestyle. Unhealthy habits usually are ingrained and hard to change, especially for people with an “obese cognitive profile.” Knowledge of the cognitive mechanisms that maintain unhealthy eating habits is necessary for the development of interventions that can change behavior effectively. This paper discusses some cognitive processes that might maintain unhealthy eating habits and make healthier eating difficult, like increased food cue reactivity, weak executive skills and attention bias. An effort is also done to translate these basic scientific findings into new interventions which aim to tackle the sabotaging cognitive processes. Preliminary studies into the effectiveness of these interventions, if available, are presented.