Battle of plates: a pilot study of an approach–avoidance training for overweight children and adolescents

Warschburger, Petra; Gmeiner, Michaela Silvia; Morawietz, Marisa; Rinck, Mike

doi:10.1017/s1368980017002701

Cited by 15 publications

(9 citation statements)

References 40 publications

(83 reference statements)

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“…In the current study, although between-condition changes were not significant, analyses per condition showed that our 10 sessions of AAT resulted in a significant reduction in approach tendencies toward unhealthy and healthy food pictures. This finding is in line with previous research showing that during a six-session AAT, obese children successfully learned to reduce their automatic approach tendencies toward snack food pictures, but otherwise the study of Warschburger and colleagues (2017) showed an increase in approach tendencies toward vegetable items. Further, the current training resulted also in a significant reduction in craving but failed to reduce the attentional bias toward unhealthy food pictures.…”

Section: Discussionsupporting

confidence: 92%

Feasibility and Effectiveness of Adding an Approach Avoidance Training With Game Elements to a Residential Childhood Obesity Treatment — A Pilot Study

et al. 2018

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Childhood obesity treatment programs only result in moderate outcomes in the short term and do not reduce risk for future weight gain. Therefore, in the current study, Approach Avoidance Training (AAT) with motivational game elements will be added to an inpatient childhood obesity program with the aim of improving outcomes. Forty-one children (10–15 years) in the final months of an inpatient treatment program were randomised to either the AAT plus care-as-usual condition group or to a care-as-usual-only control group. During the 10 sessions, the children were trained to approach healthy food stimuli and to avoid unhealthy food stimuli. Treatment outcomes were child performances on tasks of AAT, implicit attitudes and attentional bias, self-report ratings on craving symptoms, and weight loss maintenance after leaving the clinic (12-week follow-up). Changes over time were not significantly different between conditions for the measures of automatic processes, craving, and weight loss maintenance. Possible accounts for the null findings, including sample size, influence of game elements, point of time in therapeutic process, limitations of the setting, and the control group are discussed. More research is needed before firm conclusions can be drawn about the clinical usefulness of CBM for weight control in childhood obesity.

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Section: Discussionsupporting

confidence: 92%

Feasibility and Effectiveness of Adding an Approach Avoidance Training With Game Elements to a Residential Childhood Obesity Treatment — A Pilot Study

et al. 2018

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“…The fact that children with overweight and obesity versus those with normal weight did not show greater approach behavior towards high-calorie foods during the AAT is contrary to expectations, but fits into the inconsistent findings of previous studies in child and adult samples (e.g., References [80,81]). Within an intervention study in 276 8–16 years old youth, baseline AAT data already indicated avoidance tendencies for snack foods in children with obesity, much like in the present study; however, there were no data of a normal-weight control group available [82]. Similarly, the only study investigating adults with obesity did not find an approach bias towards high- or low-calorie foods [81], while university students with high levels of food cravings showed greater approach behavior towards food cues than adults with low levels of food craving [83].…”

Section: Discussionsupporting

confidence: 51%

Neuropsychological and Neurophysiological Indicators of General and Food-Specific Impulsivity in Children with Overweight and Obesity: A Pilot Study

et al. 2018

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Impulsivity, particularly towards food, is a potential risk factor for increased energy intake and the development and maintenance of obesity in children. However, neuropsychological and neurophysiological indicators of general and food-specific impulsivity and their association with children’s weight status are poorly understood. This pilot study examined electroencephalography (EEG) frequency band profiles during eyes-closed and eyes-open resting state in n = 12 children with overweight or obesity versus n = 22 normal-weight controls and their link to child- and parent-reported and experimentally assessed impulsivity of children (e.g., risk-taking behavior, approach-avoidance behavior towards food). The main results indicated that children with overweight/obesity versus normal weight showed significantly increased delta and decreased alpha band activity during eyes-closed resting state. Across the total sample, EEG slow-wave band activity was particularly linked to self- and parent-reported impulsivity and greater risk-taking behavior, but not to approach behavior towards food, after controlling for children’s age and weight status. The identification of specific EEG patterns in children with excess weight may provide a new basis for developing neurophysiological diagnostic and treatment approaches for childhood obesity. Future studies with larger samples and longitudinal designs are needed to replicate the present findings and test their stability over time.

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“…With respect to the question of general trainability, our findings support data from a small pilot study (Warschburger et al, ) and suggest that AAT is also suitable for children and adolescents with obesity. In line with other studies using single sessions (Dickson et al, ; Fishbach & Shah, ; Maas et al, ; Schumacher et al, ), we observed a modification of the AAB after the last training session.…”

Section: Discussionsupporting

confidence: 86%

“…Hence, future studies should directly compare single-and multiple-session training. Multiple sessions of a highly standardized training intervention with a repetitive design might also be too boring for children (Warschburger et al, 2017). A gamification of computer-based applications for children might be more appealing (Boendermaker, Prins, & Wiers, 2015).…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of an approach–avoidance training intervention for children and adolescents with obesity: A randomized placebo‐controlled prospective trial

Warschburger

Gmeiner

Morawietz

et al. 2018

Euro Eating Disorders Rev

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This study evaluated the efficacy of approach-avoidance training as an additional treatment for children and adolescents with obesity seeking inpatient treatment. Two hundred thirty-two participants (8-16 years, 53.9% girls) were randomly assigned either to multisession approach-avoidance (IG) or to placebo training (CG). As outcomes, cognitive biases post intervention, body mass index, eating behaviour, food intake, self-regulation, and weight-related quality of life were assessed, also at 6- and 12-month follow-up. Modification of approach-avoidance bias was observed, but lacked in transfer over sessions and in generalization to attention and association bias. After 6 months, the IG reported less "problematic" food consumption, higher self-regulation, and higher quality of life; effects did not persist until the 12-month follow-up; no significant interaction effects were observed regarding weight course. Despite there was no direct effect on weight course, approach-avoidance training seems to be associated with promising effects on important pillars for weight loss. Further research concerning clinical effectiveness is warranted.

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Battle of plates: a pilot study of an approach–avoidance training for overweight children and adolescents

Abstract: Automatic tendencies in children can be trained, too. The implementation of AAT in the treatment of obesity might support the modification of an unhealthy nutrition behaviour pattern. Further data from randomized controlled clinical trials are needed.

Cited by 15 publications

References 40 publications

Feasibility and Effectiveness of Adding an Approach Avoidance Training With Game Elements to a Residential Childhood Obesity Treatment — A Pilot Study

Feasibility and Effectiveness of Adding an Approach Avoidance Training With Game Elements to a Residential Childhood Obesity Treatment — A Pilot Study

Neuropsychological and Neurophysiological Indicators of General and Food-Specific Impulsivity in Children with Overweight and Obesity: A Pilot Study

Evaluation of an approach–avoidance training intervention for children and adolescents with obesity: A randomized placebo‐controlled prospective trial

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