Hemispheric asymmetries in resting-state EEG and fMRI are related to approach and avoidance behaviour, but not to eating behaviour or BMI.

Much of our behaviour is driven by two motivational dimensions-approach and avoidance. These have been related to frontal hemispheric asymmetries in clinical and resting-state EEG studies: Approach was linked to higher activity of the left relative to the right hemisphere, while avoidance was related to the opposite pattern. Increased approach behaviour, specifically towards unhealthy foods, is also observed in obesity and has been linked to asymmetry in the framework of the right-brain hypothesis of obesity. Here, we aimed to replicate previous EEG findings of hemispheric asymmetries for self-reported approach/avoidance behaviour and to relate them to eating behaviour. Further, we assessed whether resting fMRI hemispheric asymmetries can be detected and whether they are related to approach/avoidance, eating behaviour and BMI. We analysed three samples: Sample 1 (n = 117) containing EEG and fMRI data from lean participants, and Samples 2 (n = 89) and 3 (n = 152) containing fMRI data from lean, overweight and obese participants. In Sample 1, approach behaviour in women was related to EEG, but not to fMRI hemispheric asymmetries. In Sample 2, approach/avoidance behaviours were related to fMRI hemispheric asymmetries. Finally, hemispheric asymmetries were not related to either BMI or eating behaviour in any of the samples. Our study partly replicates previous EEG findings regarding hemispheric asymmetries and indicates that this relationship could also be captured using fMRI. Our findings suggest that eating behaviour and obesity are likely to be mediated by mechanisms not directly relating to frontal asymmetries in neuronal activation quantified with EEG and fMRI.

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

Impaired self-regulation, especially in food-specific situations, has been linked to childhood obesity. These deficits may be acquired during the development of obesity rather than being a prerequisite thereof. The current study, hence, focused on an at-risk population versus controls. Normal-weight children of obese and normal-weight parents were tested regarding attentional flexibility, emotion regulation, and inhibitory control. A sample of 50 preschoolers of obese parents (n=25) or normal-weight parents (n=25) participated in this study. Through eye-tracking, attentional bias for food cues was measured during a visual probe task using food and toy images. Emotion regulation was assessed during a distress-evoking task, and inhibitory control was examined through a delay-of-gratification task. Both tasks are standardized and were conducted in non-food contexts. Results showed no significant group differences in overall attentional bias to food images over toy images. However, children of normal-weight parents showed a preference for toy images. Regarding emotion regulation, children in the risk group expressed significantly less overall emotional distress. In addition, less gaze aversion and bodily sadness could be observed in this group. No differences were found for inhibitory control. Findings suggest that general deficits in self-regulation are not yet present in normal-weight children at risk for obesity. Instead, they might develop as a by-product of unhealthy weight gain. Results indicate, however, that children of obese parents are less emotionally expressive compared with children of normal-weight parents. Furthermore, children of normal-weight parents appeared to be more interested in toy images than in food images.

A randomized-controlled trial to evaluate the app-based multimodal weight loss program zanadio for patients with obesity.

OBJECTIVE: This study aimed to evaluate the effectiveness of the app-based, multimodal weight loss program zanadio. METHODS: A randomized-controlled trial was conducted from January 2021 to March 2022. A total of 150 adults with obesity were randomized into an intervention group and used zanadio for 1 year or into a wait list control group. The primary end point, weight change, and the secondary end points, quality of life, well-being, and waist to height ratio, were assessed every 3 months for up to 1 year via telephone interviews and online questionnaires. RESULTS: After 12 months, participants of the intervention group lost, on average, -7.75% (95% CI: -9.66% to -5.84%) of their initial weight, achieving a clinically relevant and statistically stronger weight reduction than the control group (mean = 0.00% [95% CI: -1.98% to 1.99%]). All secondary end points improved significantly in the intervention group, with significantly greater improvements in well-being and waist to height ratio than in the control group. CONCLUSIONS: This study showed that adults with obesity who have used zanadio achieved a significant and clinically relevant weight loss within 12 months and improved further obesity-related health variables compared with a control group. Because of its effectiveness and flexible applicability, the app-based multimodal treatment zanadio might alleviate the present care gap for patients with obesity in Germany.

Introducing zanadio-A Digitalized, Multimodal Program to Treat Obesity.

While the prevalence of overweight and obesity has been increasing annually, the accessibility of on-site treatment programs is not rising correspondingly. Digital, evidence-based obesity treatment programs could potentially alleviate this situation. The application zanadio has been developed to enable patients with obesity (BMI 30-45 kg/m2) to participate in a digital, multimodal weight reduction program based on current treatment guidelines. This article is divided into two parts: (I) it introduces zanadio, its aims and therapeutic concept, and (II) provides a first impression and demographic data on more than 11,000 patients from across the country who have used zanadio within the last 16 months, which demonstrates the demand for a digital obesity treatment. zanadio has the potential to partially close the current gap in obesity care. Future work should focus on identifying predictors of successful weight loss to further individualize digital obesity treatment, and an important next step would be to prevent obesity, i.e., to start the treatment at lower BMI levels, and to invent digital treatment programs for children and adolescents.

Unhealthy yet Avoidable-How Cognitive Bias Modification Alters Behavioral and Brain Responses to Food Cues in Individuals with Obesity.

Obesity is associated with automatically approaching problematic stimuli, such as unhealthy food. Cognitive bias modification (CBM) could beneficially impact problematic approach behavior. However, it is unclear which mechanisms are targeted by CBM in obesity. Candidate mechanisms include: (1) altering reward value of food stimuli; and (2) strengthening inhibitory abilities. Thirty-three obese adults completed either CBM or sham training during functional magnetic resonance imaging (fMRI) scanning. CBM consisted of implicit training to approach healthy and avoid unhealthy foods. At baseline, approach tendencies towards food were present in all participants. Avoiding vs. approaching food was associated with higher activity in the right angular gyrus (rAG). CBM resulted in a diminished approach bias towards unhealthy food, decreased activation in the rAG, and increased activation in the anterior cingulate cortex. Relatedly, functional connectivity between the rAG and right superior frontal gyrus increased. Analysis of brain connectivity during rest revealed training-related connectivity changes of the inferior frontal gyrus and bilateral middle frontal gyri. Taken together, CBM strengthens avoidance tendencies when faced with unhealthy foods and alters activity in brain regions underpinning behavioral inhibition.

Retraining automatic action tendencies in obesity.

Eating behavior in obesity resembles addictive disorders in that individuals have difficulties inhibiting problematic eating behavior. They show an approach bias - a tendency to approach rather than avoid problematic stimuli. Here, we investigate the existence of such a bias towards healthy and unhealthy food in individuals with normal-weight and obesity. We further aimed to assess whether it is possible to retrain a bias, and whether training would differentially affect our two weight groups. 60 participants completed a training form of the Approach-Avoidance Task (AAT) on three consecutive days. Using a joystick, they were implicitly trained to approach healthy and to avoid unhealthy food pictures. Prior to training, individuals with obesity showed stronger approach tendencies towards food pictures than normal-weight individuals. In individuals with obesity, approach tendencies could be diminished for unhealthy food through one training session and stayed weakened for the following days. In normal-weight participants, approach tendencies towards healthy food could be enhanced over the days of training. Findings indicate that automatic approach tendencies can be changed through training, thus offering possibilities for obesity treatment. Future studies should expand on these findings, for example by including pictures of neutral objects or a no-training control condition.