Sandra Mulkens

Overweight children overeat after exposure to food cues

Overweight is becoming more common in children, but we know nearly nothing about the eating behavior of overweight children. Learning theory predicts that overeating follows from learned associations between the smell and taste of palatable food on the one hand and intake on the other hand. It was tested whether overweight children overeat after confrontation to these cues. They indeed failed to regulate food intake after both the exposure to the intense smell of tasty food (without eating it) and after eating a small preload of appetizing food, whereas normal-weight children decreased their intake after both cues. Overweight children are thus more vulnerable to triggers of overeating. Their overeating was not related to psychological factors like mood, body esteem, and a restrained eating style, but it was related to cue-elicited salivation flow. Apart from supporting the cue reactivity model of overeating, the data point to an interesting satiety phenomenon in normal eaters after prolonged and intense smelling palatable food without eating it.

Coping with food cravings. Investigating the potential of a mindfulness-based intervention☆

The present study examined whether mindfulness-based strategies can effectively reduce food cravings in an overweight and obese adult population. Individuals participating in a dietary group treatment for overweight received an additional 7-week manual based training that aimed to promote regulation of cravings by means of acceptance. The control group did not receive this additional training program. The results showed that participants in the experimental group reported significantly lower cravings for food after the intervention compared to the control group. The findings are discussed in terms of possible mechanisms like prevention of goal frustration, disengagement of obsessive thinking and reduction of automatic relations between urge and reaction.

Fear of blushing: effects of task concentration training versus exposure in vivo on fear and physiology.

Patients with fear of blushing as the predominant complaint (N = 31) were randomly assigned to (1) exposure in vivo (EXP), or (2) task concentration training (TCT), in order to test the effect of redirecting attention above exposure only. In addition, it was investigated whether treatment reduced actual blush behavior; therefore, physiological parameters of blushing were measured during two behavioral tests. Half of the patients served as waiting-list controls first. Assessments were held before and after treatment, at 6-weeks, and at 1-year follow-up. Both treatments appeared to be effective in reducing fear of blushing and realizing cognitive change. Yet, at posttest, TCT tended to produce better results with respect to fear of blushing. At 6-weeks follow-up, TCT produced significantly more cognitive change. At 1-year follow-up, patients further improved, while differential effects had disappeared. The reduction in fear of blushing was not paralleled by a reduction in actual blush behavior during the behavioral assessments. Thus, it seems that fear of blushing reflects a fearful preoccupation, irrespective of actual facial coloration.

Task concentration training and fear of blushing

Self-focused attention (SFA) is considered to be an important factor in the maintenance of social phobia. It is argued that this might be especially so in erytrophobia since physiological arousal (notably blushing) serves to focus attention inwards and heightened SFA may cause a blushing reaction. From this perspective, a treatment strategy is proposed that specifically aims at reducing SFA in erytrophobics. Two case studies are presented to illustrate the clinical use of task concentration training. Results revealed that task concentration training strongly decreased blushing propensity, fear of blushing, avoidance behaviour, and negative beliefs about the consequences of blushing

Adding cognitive therapy to dietetic treatment is associated with less relapse in obesity

OBJECTIVE The treatment of obesity is universally disappointing; although usually some weight loss is reported directly after treatment, eventual relapse to, or even above, former body weight is common. In this study it is tested whether the addition of cognitive therapy to a standard dietetic treatment for obesity might prevent relapse. It is argued that the addition of cognitive therapy might not only be effective in reducing weight and related concerns, depressed mood, and low self-esteem, but also has an enduring effect that lasts beyond the end of treatment. METHODS Non-eating-disordered overweight and obese participants in a community health center (N=204) were randomly assigned to a group dietetic treatment+cognitive therapy or a group dietetic treatment+physical exercise. RESULTS Both treatments were quite successful and led to significant decreases in BMI, specific eating psychopathology (binge eating, weight-, shape-, and eating concerns) and general psychopathology (depression, low self-esteem). In the long run, however, the cognitive dietetic treatment was significantly better than the exercise dietetic treatment; participants in the cognitive dietetic treatment maintained all their weight loss, whereas participants in the physical exercise dietetic treatment regained part (25%) of their lost weight. CONCLUSION Cognitive therapy had enduring effects that lasted beyond the end of treatment. This potential prophylactic effect of cognitive therapy is promising; it might be a new strategy to combat the global epidemic of obesity.

From the Garden of Eden to the land of plenty. Restriction of fruit and sweets intake leads to increased fruit and sweets consumption in children.

Overweight is increasing rapidly in children, compelling researchers to seek for determinants of adverse food intake. In a previous experiment it was found that manipulating the restriction of attractive snacks increased the desirability and intake of these snacks. In the present study, we tested whether this paradoxical restricting effect is also seen in relatively less attractive but healthy food, i.e. fruit. Will fruit become more desirable through restriction, and will children eat more forbidden fruit than non-forbidden fruit? Two groups of young children were forbidden to eat fruits and sweets, respectively, whereas a control group was invited to eat everything. Desire for sweets remained high in the sweets-prohibition condition, whereas it decreased in the fruit-prohibition and no-prohibition conditions. No group differences were found regarding the desire for fruit. With respect to intake, children in both the fruit- and the sweets-prohibition condition consumed more of the formerly forbidden food during a taste session as compared to the no-prohibition condition. In addition, total food intake was higher in the two prohibition conditions than in the no-prohibition condition. These data indicate that the adverse effects of restriction apply to both attractive unhealthy and relatively less attractive but healthy food.

How to promote fruit consumption in children. Visual appeal versus restriction

The prevalence of overweight is increasing dramatically in children. A protective factor against the development of overweight is a sufficient intake of fruit and vegetables. However, the consumption of fruit and vegetables in children is far from ideal these days. Therefore, it is important to examine how the intake of fruit and vegetables can be promoted. In this study, the effects of two fruit promoting techniques were evaluated in 4-7-year-old children: presenting fruit in a more visually appealing manner versus restricting the intake of fruit. Two presentations of fruit (regular and visually appealing) were offered to the participants. In a first taste session participants were either allowed to eat from both fruit presentations (no-prohibition group) or prohibited from eating one of the two presentations (regular fruit prohibited group/visually appealing fruit prohibited group). In a second taste session all participants were allowed to eat from both fruit presentations. The results indicated that visual appeal had a strong effect on consumption of the fruit. With respect to restriction, no effects were found. Parents, schools, supermarkets and food producers should take advantage of these results, and offer children fruit and vegetables that are presented in a visually appealing manner.

Disgust sensitivity and the sex difference in fears to common indigenous animals

Daveys mediational hypothesis [Davey, G. C. L. (1994). Self-reported fears to common indigenous animals in an adult UK population: the role of disgust sensitivity. British Journal of Psychology, 85, 541-554.] suggests that the sex difference in self-assessed animal fears can be accounted for by the sex difference in disgust sensitivity. An empirical test failed to support this hypothesis in a non-clinical sample (N = 214). Holding constant the influences of confounders such as age, fear of contamination, sex roles, neuroticism, psychoticism and disgust sensitivity, biological sex kept emerging as a significant predictor in relation to four types of animal fears (fear-relevant animals, dry or non-slimy invertebrates, slimy or wet looking animals and farm animals). Other things being equal, high disgust sensitivity either lost its predictive capability (in relation to dry or non-slimy invertebrates and slimy or wet looking animals) or predicted high fear of fear-relevant animals and of farm animals inequivalently across, respectively, the sexes (high in females only) and age groups (high in the old only). A multifactorial, interactionist approach should be advocated in the study of the aetiology of animal fears if progress in this area is to be achieved.

Metacognitive therapy for body dysmorphic disorder patients in Iran: Acceptability and proof of concept

The purpose of the present study was to determine the effect of metacognitive therapy (MCT) on symptoms of body dysmorphic disorder (BDD) and on symptoms of thought-fusion, by means of a wait-list controlled clinical trial. Participants were referred from dermatology and cosmetic surgery clinics in the city of Isfahan, Iran, and 20 patients were selected on the basis of DSM-IV-TR diagnostic criteria for BDD. They were randomly assigned to either the experimental or the wait-list control group. The Yale-Brown Obsessive Compulsive Scale Modified for Body Dysmorphic Disorder (BDD-YBOCS) and the Thought-Fusion Inventory (TFI) were used as the outcome measures. The experimental group received 8 weekly metacognitive intervention sessions. The control group was in the waiting-list until the end of the follow-up. Measures were taken at pre-test, post-test (after 2 months) and follow-up (after 6-months). The results of analysis of variance showed that MCT significantly reduced the symptoms of BDD and of thought-fusion, compared to the wait-list. Effects on both outcome measures were maintained at 6-months follow-up.

Tackling childhood overweight: treating parents exclusively is effective

Objective:In general, treatment of childhood obesity focuses on treating the obese children. The results of child-directed treatments are disappointing in the long run. In the current study, it is tested whether a treatment aimed solely at obese childrens parents results in positive effects on the childrens weight status. In addition, potential predictors of treatment success are identified.Methods:The parents of 98 overweight or obese children (aged 7–13 years) were randomly assigned to either the cognitive-behavioural group treatment (eight sessions) or the waiting-list control group.Results:With respect to child body mass index (BMI) percentile, the parents’ treatment was successful in reducing overweight from pretreatment to posttreatment: BMI percentile decreased significantly by 2.4% in the treatment group, whereas there was no change in the waiting-list control group. There was no significant relapse at follow-up (3 months). Child BMI percentile did not decrease in the waiting-list control group. In addition, significant main effects of time were found for both groups with respect to eating psychopathology (decrease), self-esteem (increase) and negative thoughts (decrease). Finally, parental BMI decreased significantly only in the treatment group. Four predictors were identified with respect to treatment success, namely, lower socioeconomic status, younger age of the child, higher parental attendance and lower BMI percentile of the child before treatment.Conclusions:The parents’ treatment had significant effects on child and parent BMI. Long-term endurance of these positive effects needs to be studied. Striking are the positive effects of time in the waiting-list control group for some psychological outcome measures. Obviously, waiting for treatment already affects psychological processes (but not behaviour) in the children.