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

Abstract

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 metaanalyses 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 = .134 (95% CI .061, .208); p < .001), food intake (r = .085 (95% CI .038, .132); p < .001), and hunger (r = .048 (95% CI .016, .079); p = .003), but these correlations were small. Food-related AB was unrelated to BMI (r =.008 (95% CI-.020, .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 betweengroups 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 foodrelated 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.

A Pictorial Dot Probe Task to Assess Food-Related Attentional Bias in Youth With and Without Obesity: Overview of Indices and Evaluation of Their Reliability

“…Theory (Appelhans, 2009;Berridge, 2009;Appelhans et al, 2016;Tanofsky-Kraff et al, 2020) also states that foodrelated attentional biases would get stronger in individuals with increasing weight. Although there is some debate on whether this attentional bias would reflect increased approach or increased avoidance (Liu et al, 2019a,b;Hardman et al, 2021), effects are predicted to be significantly correlated with weight parameters. However, none of the indices correlated significantly with adjusted BMI.…”

“…Neurophysiological studies, using brain imaging techniques or eye tracking procedures, indeed support the prediction that individuals with overweight and obesity show stronger attentional biases toward food than individuals with healthy weight, in adults (Hendrikse et al, 2015) and youth (van Meer et al, 2016;Biehl et al, 2020) alike. Evidence stemming from behavioral paradigms, however, is equivocal and shows small to moderate effect sizes at best, especially in youth populations (van Meer et al, 2016;Brand et al, 2020;Hagan et al, 2020;Kemps et al, 2020;Hardman et al, 2021). A possible explanation for these ambiguous results precluding clear conclusions on the role of attentional processes in eating behavior and weight, relates to the considerable methodological inconsistency between studies.…”

“…Alternatively, researchers challenged the assumption of attentional bias as a stable concept underlying the traditional calculation of the ABS, and suggest that attentional bias is a dynamic process fluctuating over time, with attention being switched back and forth between relevant and neutral stimuli (Iacoviello et al, 2014;Zvielli et al, 2014Zvielli et al, , 2015Rodebaugh et al, 2016;McNally, 2019;Hardman et al, 2021). To account for this dynamic in attention, Iacoviello and colleagues proposed the attention-bias variability score (ABVS, Iacoviello et al, 2014).…”

“…The resulting ABVS is an index of stability of attention biases, with increasing ABVS thus suggesting more fluctuation in attentional biases toward and away from relevant stimuli over time. The ABVS, however, does not allow to differentiate between the approach and avoidance aspects of these dynamics, which might be of particular interest in eating behavior (Liu et al, 2019a,b;Hardman et al, 2021). Zvielli et al (2015) proposed the trial-based bias-score (TL-BS) as a way of simultaneously distinguishing direction of attention and dynamic variability over time.…”

A Dual-Pathway Perspective on Food Choices in Adolescents: The Role of Loss of Control Over Eating

“…In particular, these results seem to indicate that, in adolescents without LOC, the level of attentional bias determines the extent to which inhibitory control capacities contribute to unhealthy food choices. One possible explanation might be that adolescents with low attentional bias are less preoccupied with food in general (for example see Brignell et al, 2009;Hardman et al, 2020). When those adolescents also have good inhibitory control capacities, they are then able to go for a healthy food option.…”