I change my mind to get better: Process tracing-based microanalysis of food choice processes reveals differences between anorexia nervosa and bulimia nervosa during inpatient treatment.

Food choice and its underlying processes is understudied in bulimia nervosa (BN) and anorexia nervosa (AN). Thus, we examined cognitive processes during food choice through mouse tracing in AN (n = 36) and BN (n = 27) undergoing inpatient treatment. Both patient groups and matched healthy controls (HC, n = 59) made 153 binary food choices before rating all foods on their liking and calorie density. Choice outcomes and corresponding mouse movements were modelled as a function of inpatient treatment stage in our analyses. Compared to patients with BN and HC, those with AN showed a clear calorie avoidance on most trials. Yet, mouse paths in AN patients early in treatment, revealed a late direction reversal ('change of mind', CoM) on high-calorie choices. AN patients later in treatment, by contrast, showed fewer CoM alongside more choices for - and liking of - high-calorie foods. Patients with BN showed more CoM trials during low-calorie choices and low-calorie choices were more frequent in patients later in treatment. Thus, relative to patients early in treatment, patients who are later in treatment show less of the overall group pattern of consistently choosing low-calorie food (AN) or high-calorie food (BN). Less cognitive regulation (fewer CoM trials) went along with higher liking for high-calorie foods in AN. These cross-sectional differences between AN early and late in treatment might reflect the formation of healthier habits. In addition, clear patient group differences suggest more specific treatment strategies.

Bad mood food? Increased versus decreased food cue reactivity in anorexia nervosa and bulimia nervosa during negative emotions.

OBJECTIVE: Emotion regulation difficulties in anorexia nervosa (AN) and bulimia nervosa (BN) might underlie bingeing and purging in BN, extreme fasting in AN, or combinations of these symptoms in binge-purge type AN. In this study, we tested for decreased food cue reactivity in response to negative emotions in AN, and the opposite pattern for BN. Furthermore, we explored subgroup differences (restrictive vs. binge-purging AN; history of AN in BN). METHOD: Patients with AN (n = 41), BN (n = 39), and matched controls (n = 70) completed an emotional eating questionnaire. In a laboratory experiment, we induced negative emotions and measured food cue reactivity (pleasantness, desire to eat (DTE), and corrugator muscle activity). RESULTS: AN reported emotional undereating, while BN reported emotional overeating. In the laboratory task, BN showed increased DTE and an appetitive corrugator response during negative emotions, selectively towards high-calorie foods. AN showed generalized reduced cue reactivity to high-calorie food regardless of emotional state. This pattern appears to be characteristic of restrictive AN, while cue reactivity of both BN subgroups pointed towards emotional overeating. CONCLUSIONS: The emotional over- versus undereating framework might help to explain bingeing and restricting along the anorectic-bulimic disorder spectrum, which calls for novel transdiagnostic theories and subgroup-specific treatments.

Emotional eating across different eating disorders and the role of body mass, restriction, and binge eating.

OBJECTIVE: Different subtypes of eating disorders (ED) show dysfunctional eating behaviors such as overeating and/or restriction in response to emotions. Yet, systematic comparisons of all major EDs on emotional eating patterns are lacking. Furthermore, emotional eating correlates with body mass index (BMI), which also differs between EDs and thus confounds this comparison. METHOD: Interview-diagnosed female ED patients (n = 204) with restrictive (AN-R) or binge-purge anorexia nervosa (AN-BP), bulimia nervosa (BN), or binge-eating disorder (BED) completed a questionnaire assessing "negative emotional eating" (sadness, anger, anxiety) and "happiness eating." ED groups were compared to BMI-matched healthy controls (HCs; n = 172 ranging from underweight to obesity) to exclude BMI as a confound. RESULTS: Within HCs, higher BMI was associated with higher negative emotional eating and lower happiness eating. AN-R reported the lowest degree of negative emotional eating relative to other EDs and BMI-matched HCs, and the highest degree of happiness eating relative to other EDs. The BN and BED groups showed higher negative emotional eating compared to BMI-matched HCs. Patients with AN-BP occupied an intermediate position between AN-R and BN/BED and reported less happiness eating compared to BMI-matched HCs. DISCUSSION: Negative emotional and happiness eating patterns differ across EDs. BMI-independent emotional eating patterns distinguish ED subgroups and might be related to the occurrence of binge eating versus restriction. Hence, different types of emotional eating can represent fruitful targets for tailored psychotherapeutic interventions. While BN and BED might be treated with similar approaches, AN-BP and AN-R would need specific treatment modules.

Measuring approach-avoidance tendencies towards food with touchscreen-based arm movements.

Most tasks for measuring automatic approach-avoidance tendencies do not resemble naturalistic approach-avoidance behaviors. Therefore, we developed a paradigm for the assessment of approach-avoidance tendencies towards palatable food, which is based on arm and hand movements on a touchscreen, thereby mimicking real-life grasping or warding movements. In Study 1 (n = 85), an approach bias towards chocolate-containing foods was found when participants reached towards the stimuli, but not when these stimuli had to be moved on the touchscreen. This approach bias towards food observed in grab movements was replicated in Study 2 (n = 60) and Study 3 (n = 94). Adding task features to disambiguate distance change through either corresponding image zooming (Study 2) or emphasized self-reference (Study 3) did not moderate this effect. Associations between approach bias scores and trait and state chocolate craving were inconsistent across studies. Future studies need to examine whether touchscreen-based approach-avoidance tasks reveal biases towards other stimuli in the appetitive or aversive valence domain and relate to relevant interindividual difference variables.

The dynamics of self-control: within-participant modeling of binary food choices and underlying decision processes as a function of restrained eating.

Successful self-control during food choice might require inhibition of impulses to avoid indulging in tempting but calorie-dense foods, and this might particularly apply to individuals restraining their food intake. Adopting a novel within-participant modeling approach, we tested 62 females during a mouse-tracking based binary food choice task. Subsequent ratings of foods on palatability, healthiness, and calorie density were modeled as predictors for both decision outcome (choice) and decision process (measures of self-control conflict) while considering the moderating role of restrained eating. Results revealed that individuals higher on restrained eating were less likely to choose more high-calorie foods and showed less self-control conflict when choosing healthier foods. The latter finding is in contrast with the common assumption of self-control as requiring effortful and conscious inhibition of temptation impulses. Interestingly, restrained eaters rated healthy and low-calorie foods as more palatable than individuals with lower restrained eating scores, both in the main experiment and an independent replication study, hinting at an automatic and rather effortless mechanism of self-control (palatability shift) that obviates effortful inhibition of temptation impulses.

Effects of a Smartphone-Based Approach-Avoidance Intervention on Chocolate Craving and Consumption: Randomized Controlled Trial.

BACKGROUND: Repeatedly pushing high-calorie food stimuli away based on joystick movements has been found to reduce approach biases toward these stimuli. Some studies also found that such avoidance training reduced consumption of high-calorie foods. OBJECTIVE: This study aimed to test effects of a smartphone-based approach-avoidance intervention on chocolate craving and consumption, to make such interventions suitable for daily use. METHODS: Within a 10-day period, regular chocolate eaters (n=105, 86% female) performed five sessions during which they continuously avoided (ie, swiped upward) chocolate stimuli (experimental group, n=35), performed five sessions during which they approached and avoided chocolate stimuli equally often (placebo control group, n=35), or did not perform any training sessions (inactive control group, n=35). Training effects were measured during laboratory sessions before and after the intervention period and further continuously through daily ecological momentary assessment. RESULTS: Self-reported chocolate craving and consumption as well as body fat mass significantly decreased from pre- to postmeasurement across all groups. Ecological momentary assessment reports evidenced no differences in chocolate craving and consumption between intervention days and rest days as a function of the group. CONCLUSIONS: A smartphone-based approach-avoidance training did not affect eating-related and anthropometric measures over and above measurement-based changes in this study. Future controlled studies need to examine whether other techniques of modifying food approach tendencies show an add-on benefit over conventional, monitoring-based intervention effects. TRIAL REGISTRATION: AsPredicted 8203; https://aspredicted.org/pt9df.pdf.

Emotion regulation and emotional eating in anorexia nervosa and bulimia nervosa.

Individuals with anorexia nervosa (AN) and bulimia nervosa (BN) show emotion regulation deficits. While individuals with BN use binge eating to regulate negative affect, individuals with restricting-type AN may use self-starvation for this purpose. The current study examined the emotion regulatory function of over- and undereating in response to different emotional states in women with restrictive AN (n = 54), BN (n = 47), and women without eating disorders (n = 68). Participants completed self-report measures assessing the use of emotion regulation strategies and emotional eating. Both patient groups reported using more dysfunctional and less functional emotion regulation strategies than controls. The BN group reported eating more than usual in response to negative emotions but less than usual in response to positive emotions. In contrast, the AN group reported eating more than usual in response to positive emotions and less than usual in response to negative emotions. More dysfunctional emotion regulation related to eating less in response to negative emotions in the AN group. Less functional emotion regulation related to eating less when being happy in the BN group. The current study highlights the need to differentiate between different eating outcomes and different emotional states when examining emotion effects on food intake.

Improving Techniques to Study Equine Cervical Mucociliary Clearance.

Postbreeding bacterial uterine infections inflict major losses on the equine industry. Microcurrents propelled by ciliated cells between the folds of the uterus and cervix have been proposed as a means by which contaminants are expelled. Previous data have shown possible ciliary microcurrents propelling carbon particles, occasionally rotating, through cervical folds. However, adherence to the epithelium may have interfered with movement of carbon in these studies. Therefore, we tested potentially nonadherent substances to reveal ciliary microcurrents on the equine cervix under high magnification videoendoscopy. We hypothesized that polyethylene green microspheres 1-5 and 70 µm in diameter, would be superior to carbon in revealing microcurrents on the cervical epithelium and that 50 µm hemispherically coated bichromal microspheres would display rotation. A suspension containing these microspheres and carbon was deposited onto the cervix of five estrous mares, and movement of each type of particle was recorded under high-magnification videoendoscopy for 10-20 minutes. Particles were subjectively assessed for movement between folds, past stationary points, in opposing directions and at different speeds. Visibility, aggregation, motion, and rotation were scored numerically and analyzed by the Kruskal-Wallis test. Backward rotation of bichromal spheres was interpreted as evidence of ciliary activity. Overall, carbon scored equal to or higher than the microspheres, leading to rejection of the hypothesis. Subjective assessment concluded that cervical movement was closely related to respiratory movements of the mare, and that the constantly moving cervical folds helped clear the deposited particles.

Associations between interoceptive sensitivity, intuitive eating, and body mass index in patients with anorexia nervosa and normal-weight controls.

Reduced perception of bodily signals and low levels of intuitive eating have been reported in patients with anorexia nervosa (AN) compared with normal-weight individuals. However, findings have been inconsistent and treatment progress might account for some of these inconsistencies. Thirty-seven inpatients with AN and 39 normal-weight controls completed a heartbeat perception task and the Intuitive Eating Scale-2. Patients with AN reported lower intuitive eating than controls, whereas interoceptive sensitivity did not differ between groups. Higher interoceptive sensitivity was related to higher intuitive eating across both groups. In patients with AN, both higher interoceptive sensitivity and intuitive eating correlated with the number of days in the hospital and with higher body mass index (BMI), when controlling for BMI at admission. These relationships suggest that interoceptive sensitivity and intuitive eating improve during treatment. Future research should determine whether these improvements promote weight gain or follow it.

Approach-avoidance tendencies towards food: Measurement on a touchscreen and the role of attention and food craving.

Automatic approach tendencies are often assessed with joystick-based approach-avoidance tasks (AATs). In line with similar studies, we have previously shown that individuals show an approach bias towards palatable food only when picture valence (i.e., the content of the picture) is relevant for task performance. In the current study, we adapted this joystick-based AAT for implementation on a touchscreen, which required participants to perform more naturalistic approach-avoidance movements. One-hundred and seven participants (73% female) were instructed to pull or push pictures of chocolate-containing food and non-edible objects either based on picture content (content group, n = 36), frame color (frame group, n = 35), or a symbol superimposed in the center of each picture (symbol group, n = 36). No approach bias towards food was detected in either group. However, trait chocolate craving and a general preference for chocolate related to higher approach bias scores only in the content group, but not in the frame or symbol group. In addition, only participants in the content group reported increases of current chocolate craving throughout the task. While this touchscreen-based AAT did not replicate results from its joystick-based equivalent, results are in line with suggestions that explicit task instructions may be preferred over implicit task instructions (i.e., when participants have to respond to valence-irrelevant features). Future studies may examine if and how touchscreen-based AATs can be implemented for modifying approach tendencies towards unhealthy food and, ultimately, reducing consumption of these foods.

Implicit evaluation of chocolate and motivational need states interact in predicting chocolate intake in everyday life.

Snack food consumption has a high relevance for health and is partially controlled by implicit, motivational processes that make self-control difficult at certain times. Specifically, research suggests that individuals with a more positive implicit food evaluation consume more snack foods in the laboratory under conditions of high motivational needs (e.g., hunger and food craving). Yet, no study investigated if and under which circumstances implicit evaluation of food predicts snack food intake in real life. In the present study, 60 female undergraduate students (mean age: 22.3 ±â€¯2.34 years) at the University of Salzburg, Austria, completed a chocolate-related Single Category Implicit Association Test in the laboratory and then reported snack food intake during seven days of signal-contingent Ecological Momentary Assessment. Results showed that a more positive implicit evaluation of chocolate was associated with a higher likelihood of consuming chocolate in states of high hunger and high momentary chocolate craving, whereas no such modulatory pattern was found in states of low hunger or low chocolate craving. Therefore, interventions targeting daily chocolate craving and consumption may be particularly beneficial in specific situations (i.e., in states of high hunger and craving) and also in vulnerable populations (e.g., those with a more positive implicit food evaluation).

Recover your smile: Effects of a beauty care intervention on depressive symptoms, quality of life, and self-esteem in patients with early breast cancer.

OBJECTIVE: Medical cancer treatment is often accompanied by appearance-related side effects such as hair loss, skin irritation, and paleness, which can subsequently lead to psychosocial distress. Initial evidence suggests that beauty care interventions may reduce distress and improve quality of life (QoL), body image, and self-esteem immediately. METHODS: We investigated the effects of a brief beauty care intervention on self-reported symptoms of depression, quality of life, body image, and self-esteem in 39 female primary breast cancer patients with appearance-related treatment side effects. Patients were randomly assigned either to an immediate intervention group (IG) or to a wait-list control (WL). The intervention consisted of a single-session group makeup workshop, a photo shooting, and of receiving professionally edited portrait and upper-body photos. RESULTS: While groups did not differ regarding any measure at the pretreatment baseline assessment, IG patients reported less symptoms of depression, higher QoL, and higher self-esteem compared with baseline and compared with WL. Follow-up at 8 weeks indicated moderate stability of these improvements. CONCLUSIONS: In contrast to previous research, results indicate beneficial short-term and midterm effects of beauty care on psychological outcomes in patients with early breast cancer. These results emphasize the utility of this type of brief, low-cost intervention in women undergoing medical cancer treatment in order to improve their well-being.

A combined mindfulness-prolonged chewing intervention reduces body weight, food craving, and emotional eating.

OBJECTIVE: Conventional weight-loss programs that induce a calorie deficit mostly fail in long-term weight reduction and disadvantageous eating styles often remain unchanged. Mindfulness interventions therefore redirect the focus away from the weight-loss goal and toward the process of eating itself. By eating more mindfully, at a slower pace, and with an enhanced focus on bodily sensations, participants might not only indirectly reduce their daily calorie intake but also eat less craving and stress driven. METHOD: This study randomized participants to either intervention (n = 23) or waitlist group (n = 23) to investigate the effectiveness of a 4-session mindfulness and prolonged chewing intervention. Dependent variables were body mass index and food craving as well as emotional, external, and intuitive eating. RESULTS: Across the 8 weeks of intervention, significant Group × Measurement time interactions pointed to decreases in body mass index and disadvantageous eating styles (food cravings, emotional and external eating) and an increase in intuitive eating in the intervention group. Weight loss in the intervention group was maintained after a 4-week follow up. CONCLUSION: A combination of mindfulness and a specific chewing training that increases awareness of satiety strongly impacted energy intake and related eating styles. Such interventions obviate loss-oriented calorie reduction and foster enjoyment and focused tasting of foods. Conventional weight-loss diets might incorporate such brief interventions in more long-term dieting trials. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

It's craving time: time of day effects on momentary hunger and food craving in daily life.

OBJECTIVE: A key determinant of food intake besides hunger is food craving, which refers to an intense desire to consume a specific food. Although they commonly co-occur, they are conceptually different and their dissociation is thought to underlie unhealthy eating (e.g., eating in the absence of hunger). To date, we know almost nothing about their coherence (or dissociation) in daily life or about the role of time of day and different food types. METHODS: The present investigation assessed both hunger and food craving for several food categories in daily life using smartphone-based ecological momentary assessment. Across three independent studies (n = 50, n = 51, and n = 59), participants received five or six prompts a day and reported their momentary hunger and desire for tasty food (a subcomponent of food craving). RESULTS: Consistent across studies, hunger and desire for tasty food exhibited largely similar patterns throughout the day with two peaks (roughly corresponding to lunch and dinner). Examining more specific food categories, study 3 found that although desire for main meal-type foods had a two-peak pattern in coherence with hunger, this pattern was different for snack-type foods: Desire for fruits decreased, whereas desire for sweets and salty snacks increased throughout the day with less coherence with hunger. CONCLUSIONS: These findings suggest that dissociations between hunger and craving are found only for snack-type foods, whereas hunger and general food cravings cohere strongly. Interventions addressing snacking may take these circadian patterns of food cravings into account.

Suppressing images of desire: Neural correlates of chocolate-related thoughts in high and low trait chocolate cravers.

Chocolate is the most often craved food in Western societies and many individuals try to resist its temptation due to weight concerns. Suppressing chocolate-related thoughts might, however, lead to paradoxical enhancements of these thoughts and this effect might be more pronounced in individuals with frequent chocolate cravings. In the current study, neural and cognitive correlates of chocolate thought suppression were investigated as a function of trait chocolate craving. Specifically, 20 high and 20 low trait chocolate cravers followed suppression vs. free thinking instructions after being exposed to chocolate and neutral images. Enhanced cue reactivity was evident in high trait chocolate cravers in that they reported more chocolate-related thoughts selectively after chocolate images compared to their low trait craving counterparts. This cue reactivity was mirrored neurally by higher activation in the ventral and dorsal striatum, demonstrating enhanced reward system activity. Unexpectedly, high trait chocolate cravers successfully reduced their elevated chocolate thoughts in the suppression condition. This lends support for the use of thought suppression as a means of regulating unwanted thoughts, cravings and imagery. Whether this thought manipulation is able to curb the elevated cue reactivity and the underlying reward sensitivity in chocolate cravers in applied settings remains to be shown.

Effects of Chocolate Deprivation on Implicit and Explicit Evaluation of Chocolate in High and Low Trait Chocolate Cravers.

Diet failures are often attributed to an increase in cravings for attractive foods. However, accumulating evidence shows that food cravings actually decrease during energy-restricting weight-loss interventions. The current study aimed at elucidating possible mechanisms that may explain how and under which circumstances food cravings in- or decrease during dieting. Specifically, decreases in food cravings during weight-loss diets may be due to effects of energy restriction (homeostatic changes) and to effects of avoiding specific foods (hedonic changes). Thus, we used a selective, hedonic deprivation (i.e., restricting intake of a specific food in the absence of an energy deficit) that precludes homeostatic changes due to energy restriction. Furthermore, interindividual differences in food craving experiences might affect why some individuals are more prone to experience cravings during dieting than others. Thus, we investigated whether a selective deprivation of chocolate would in- or decrease craving and implicit preference for chocolate as a function of trait-level differences in chocolate craving. Participants with high and low trait chocolate craving (HC, LC) refrained from consuming chocolate for 2 weeks but otherwise maintained their usual food intake. Both groups underwent laboratory assessments before and after deprivation, each including explicit (i.e., state chocolate craving) and implicit measures (i.e., Single Category Implicit Association Test, SC-IAT; Affect Misattribution Procedure, AMP). Results showed that hedonic deprivation increased state chocolate craving in HCs only. HCs also showed more positive implicit attitudes toward chocolate than LCs on the SC-IAT and the AMP irrespective of deprivation. Results help to disambiguate previous studies on the effects of dieting on food cravings. Specifically, while previous studies showed that energy-restricting diets appear to decrease food cravings, the current study showed that a selective, hedonic deprivation in the absence of an energy deficit increases food cravings. However, this effect can only be observed for individuals with high trait craving levels. Thus, if attractive foods are strictly avoided through a selective deprivation, HCs are at risk to experience craving bouts in the absence of an energy deficit. As implicit preference was unaffected by chocolate deprivation, strong implicit preference for chocolate likely characterize a stable mechanism that drives consumption in HCs.

Food craving, food choice and consumption: The role of impulsivity and sham-controlled tDCS stimulation of the right dlPFC.

BACKGROUND: Impulsivity has been found to be associated with overeating and obesity. Transcranial direct current stimulation (tDCS) may enhance inhibitory control while reducing food craving and intake. Thus, the aim of the present study was to investigate whether tDCS stimulation modifies food choice, craving and consumption as a function of trait impulsivity. METHODS: Forty-two predominantly healthy-weight women received active tDCS stimulation to the right dorsolateral prefrontal cortex and sham stimulation in a within participant design. Trait impulsivity was measured with a short form of the Barratt Impulsiveness Scale. Participants completed a computerized food-choice task, during which their mouse movements were traced. Current food craving was measured by a modified version of the Food Cravings Questionnaire-State as well as by desire to eat ratings for food pictures. Food intake was measured in a taste test. RESULTS: There were no tDCS effects on any of the dependent variables. Trait impulsivity (and non-planning impulsivity in particular) was positively associated with higher calorie intake in the taste test, irrespective of tDCS stimulation. CONCLUSION: The current findings question the efficacy of single-session tDCS stimulation of the right dLPFC to reduce food craving, high caloric food choice and calorie intake in non-selected, predominantly healthy weight women. However, they do support the idea that trait impulsivity is related to overeating and, therefore, may be a risk factor for obesity. Future research needs to specify which appetitive behaviors can be modulated by brain stimulation and which populations might profit from it the most.

Food cravings in everyday life: An EMA study on snack-related thoughts, cravings, and consumption.

Food craving refers to an intense desire to consume a specific food and is regularly experienced by the majority of individuals. Yet, there are interindividual differences in the frequency and intensity of food craving experiences, which is often referred to as trait food craving. The characteristics and consequences of trait and state food craving have mainly been investigated in questionnaire-based and laboratory studies, which may not reflect individuals' behavior in daily life. In the present study, sixty-one participants completed the Food Cravings Questionnaire-Trait-reduced (FCQ-T-r) as measure of trait food craving, followed by seven days of Ecological Momentary Assessment (EMA), during which they reported snack-related thoughts, craving intensity, and snack consumption at five times per day. Results showed that 86 percent of reported snacks were high-caloric, with chocolate-containing foods being the most often reported snacks. Individuals with high FCQ-T-r scores (high trait food cravers, HCs) thought more often about high-calorie than low-calorie snacks whereas no differences were found in individuals with low FCQ-T-r scores (low trait food cravers, LCs). Further, the relationship between craving intensity and snack-related thoughts was stronger in HCs than in LCs. Higher craving intensity was associated with more consumption of snacks and again this relationship was stronger in HCs than in LCs. Finally, more snack-related thoughts were related to more frequent consumption of snacks, independent of trait food craving. Thus, HCs are more prone to think about high-calorie snacks in their daily lives and to consume more snack foods when they experience intense cravings, which might be indicative of a heightened responding towards high-calorie foods. Thus, trait-level differences as well as snack-related thoughts should be targeted in dietary interventions.

Food cravings prospectively predict decreases in perceived self-regulatory success in dieting.

Food cravings are assumed to hamper dieting success, but most findings are based on cross-sectional studies. In the current study, female students were tested at the beginning of their first semester at university and six months later. They completed the Food Cravings Questionnaire-Trait-reduced (FCQ-T-r), the disinhibition subscale of the Eating Inventory, and the Perceived Self-Regulatory Success in Dieting Scale, and their height and weight were measured. Scores on the FCQ-T-r prospectively predicted higher disinhibition and lower perceived self-regulatory success in dieting after six months. Although FCQ-T-r scores did not predict increases in body mass index (BMI) directly, a serial mediation model revealed an indirect effect of FCQ-T-r scores at baseline on BMI after six months via increased disinhibition scores and decreased perceived self-regulatory success in dieting. To conclude, the current results provide evidence for a prospective relationship between trait food craving and decreases in dieting success. Furthermore, they suggest a possible mediator of this association (i.e., increases in disinhibited eating) as well as an indirect effect on body weight. Measurement of trait food craving may be a useful tool for predicting or monitoring treatment changes and relapse in eating- and weight disorders.