Worry or craving? A selective review of evidence for food-related attention biases in obese individuals, eating-disorder patients, restrained eaters and healthy samples

Werthmann, Jessica; Jansen, Anita; Roefs, Anne · 2014 · OpenAlex-citations

DOI: 10.1017/s0029665114001451

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Summary

This selective review investigates whether food-related attention biases are specifically linked to obesity or if they also characterize eating disorders, restrained eating, and healthy populations. The study addresses the ambiguity surrounding the motivational nature of these biases: it is unclear whether an attentional bias toward food reflects appetitive craving (hedonic motivation) or worry about weight gain and loss of control. The authors aim to determine if biased attention is merely an epiphenomenon of these motivational states or if it causally influences subsequent eating behavior. This inquiry is motivated by the challenge of maintaining weight in an "obesogenic" environment, where individual differences in susceptibility to food cues may stem from distinct cognitive processing mechanisms. The review critically analyzes empirical studies published between 2009 and 2014, focusing on methodologies that can distinguish between temporal attention components (early involuntary vs. later voluntary processing) and the direction of attention (approach vs. avoidance). The authors excluded studies using only the food-Stroop task due to its inability to clarify these specific mechanisms. Instead, they included studies utilizing visual probe tasks, exogenous cueing paradigms, visual search tasks, and eye-tracking technology. The review covers eleven studies on obese or overweight samples, five on eating-disorder patients, nine on restrained eaters, and five experimental studies manipulating attention bias to assess causal effects on food intake. Findings regarding the relationship between obesity and attention bias are contradictory. While some studies support an addiction model—showing that obese individuals exhibit increased attentional approach to food cues, particularly when satiated—others find no significant differences compared to healthy-weight individuals. Similarly, evidence for attention biases in eating-disorder patients and restrained eaters is mixed, with some studies indicating biases driven by worry or avoidance rather than craving. However, the review identifies relatively consistent evidence from experimental studies that manipulating attention bias toward food cues causally increases subsequent food intake. This suggests that biased attention is not just a reflection of motivation but a mechanism that drives overeating. The significance of this review lies in its conclusion that the interpretation of food-related attention bias depends heavily on the underlying motivation (craving versus worry) and the specific temporal component of attention being measured. The authors argue that future research must distinguish between these factors to accurately understand how cognitive processes contribute to obesity and eating disorders. Overall, the review posits that biased attention is a key cognitive mechanism through which the food environment tempts individuals into overeating, highlighting the need for more precise methodological approaches in nutritional psychology.

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