Comparing the effects of inhibitory control training and evaluative conditioning for unhealthy food behaviours.

Cognitive Bias Modification (CBM) is hypothesised to reduce unhealthy food preference and consumption through the completion of computerised cognitive training tasks. While there is evidence to suggest that two popular CBM paradigms (Inhibitory Control Training (ICT) and Evaluative Conditioning (EC)) can have a positive influence on food-related outcomes, issues (and inconsistencies) related to task standardisation and control group design make it difficult to evaluate their standalone efficacy. In a pre-registered laboratory study using a mixed experimental design, our aim was to directly compare a single session of ICT and EC on implicit preference, explicit choice and ad-libitum food intake, while ensuring appropriate active control groups were utilised for each training type (in addition to a passive control group). The results revealed that there were no significant differences in terms of implicit preferences, ad-libitum food consumption or food choice. These results provide limited evidence to support the use of CBM as a psychological intervention for unhealthy food choice or consumption. Further work is needed to isolate mechanisms of effect for successful training and identify the most effective CBM protocols for implementation in future studies.

Are commonly used lab-based measures of food value and choice predictive of self-reported real-world snacking? An ecological momentary assessment study.

OBJECTIVES: While the assessment of actual food intake is essential in the evaluation of behaviour change interventions for weight-loss, it may not always be feasible to collect this information within traditional experimental paradigms. For this reason, measures of food preference (such as measures of food value and choice) are often used as more accessible alternatives. However, the predictive validity of these measures (in relation to subsequent food consumption) has not yet been studied. Our aim was to investigate the extent to which three commonly used measures of preference for snack foods (explicit food value, unhealthy food choice and implicit preference) predicted self-reported real-world snacking occasions. DESIGN: Ecological Momentary Assessment (EMA) design. METHOD: Over a seven-day study period, participants (N = 49) completed three daily assessments where they reported their healthy and unhealthy snack food consumption and completed the three measures of preference (explicit food value, unhealthy food choice and implicit preference). RESULTS: Our findings demonstrated some weak evidence that unhealthy Visual Analogue Scale scores predicted between-subject increases in unhealthy snacking frequency (OR = 1.018 [1.006, 1.030], p = .002). No other preference measures significantly predicted self-reported healthy or unhealthy snacking occasions (ps > .05). CONCLUSIONS: These findings raise questions in relation to the association between measures of preference and self-reported real-world snack food consumption. Future research should further evaluate the predictive and construct validity of these measures in relation to food behaviours and explore the development of alternative assessment methods within eating behaviour research.

'Don't stop believing': The role of training beliefs in cognitive bias modification paradigms.

Cognitive Bias Modification (CBM) paradigms have previously been applied to target appetite (craving, hunger) and food intake, and are hypothesised to reduce unhealthy food consumption. However, inconsistencies in relation to training outcomes raise questions regarding the efficacy of CBM as a standalone intervention. Furthermore, individual level factors (such as belief in the intervention efficacy) may influence expectations of behaviour change following training. Across two pre-registered studies, our aim was to investigate how directly manipulating beliefs in relation to training purpose and effectiveness influenced food value and choice across two popular CBM paradigms (Inhibitory Control Training (ICT: Study 1) and Evaluative Conditioning (EC: Study 2)). In online studies, participants were presented with a paragraph describing the CBM technique positively (or an unrelated control message) prior to completing either active or control CBM training. Across both studies, the results revealed that active CBM training resulted in a reduction to unhealthy food value (relative to pre-training), but only when paired with a positive manipulation message. Participants who received a control message displayed no significant changes to food value, even where active CBM training was provided. These results suggest that participant beliefs and expectancies have important consequences for CBM effectiveness. Future research should further investigate these factors within CBM contexts to identify their role within successful behaviour change interventions.

Impact of decreasing the proportion of higher energy foods and reducing portion sizes on food purchased in worksite cafeterias: A stepped-wedge randomised controlled trial.

BACKGROUND: Overconsumption of energy from food is a major contributor to the high rates of overweight and obesity in many populations. There is growing evidence that interventions that target the food environment may be effective at reducing energy intake. The current study aimed to estimate the effect of decreasing the proportion of higher energy (kcal) foods, with and without reducing portion size, on energy purchased in worksite cafeterias. METHODS AND FINDINGS: This stepped-wedge randomised controlled trial (RCT) evaluated 2 interventions: (i) availability: replacing higher energy products with lower energy products; and (ii) size: reducing the portion size of higher energy products. A total of 19 cafeterias were randomised to the order in which they introduced the 2 interventions. Availability was implemented first and maintained. Size was added to the availability intervention. Intervention categories included main meals, sides, cold drinks, snacks, and desserts. The study setting was worksite cafeterias located in distribution centres for a major United Kingdom supermarket and lasted for 25 weeks (May to November 2019). These cafeterias were used by 20,327 employees, mainly (96%) in manual occupations. The primary outcome was total energy (kcal) purchased from intervention categories per day. The secondary outcomes were energy (kcal) purchased from nonintervention categories per day, total energy purchased per day, and revenue. Regression models showed an overall reduction in energy purchased from intervention categories of -4.8% (95% CI -7.0% to -2.7%), p < 0.001 during the availability intervention period and a reduction of -11.5% (95% CI -13.7% to -9.3%), p < 0.001 during the availability plus size intervention period, relative to the baseline. There was a reduction in energy purchased of -6.6% (95% CI -7.9% to -5.4%), p < 0.001 during the availability plus size period, relative to availability alone. Study limitations include using energy purchased as the primary outcome (and not energy consumed) and the availability only of transaction-level sales data per site (and not individual-level data). CONCLUSIONS: Decreasing the proportion of higher energy foods in cafeterias reduced the energy purchased. Decreasing portion sizes reduced this further. These interventions, particularly in combination, may be effective as part of broader strategies to reduce overconsumption of energy from food in out-of-home settings. TRIAL REGISTRATION: ISRCTN registry ISRCTN87225572.

Examining cognitive bias modification interventions for reducing food value and choice: Two pre-registered, online studies.

There is considerable interest in Cognitive Bias Modification (CBM) as a potential treatment for overweight/obesity. Inhibitory Control Training (ICT: also known as motor response training) and Evaluative Conditioning (EC) are two popular paradigms which rely on associatively learned responses (unhealthy food - > inhibition, or unhealthy food- > negative stimulus, respectively) through repeated cue-response contingencies. Both ICT and EC have demonstrated some effectiveness for reducing food intake, value and/or choice, when administered in the laboratory and online. However, studies have been criticised for inconsistencies in design (e.g. use of inadequate control groups) which makes it difficult to draw robust conclusions. In two pre-registered, online studies our aim was to examine active ICT (study 1: N = 170) and EC (study 2: N = 300) in multiple groups where the cue- > response contingencies were systematically varied (100%, 75%, 50%, 25%), before examining food-cue valuations and hypothetical food choice. In both studies varying the cue- > response contingencies did not lead to significant changes in food-cue devaluation following training. ICT did not substantially influence hypothetical food choice, whereas there was weak evidence that EC reduced choice for unhealthy foods, compared to a control group with 50% cue-response contingencies. Taken together both studies provide limited evidence for online CBM as a viable psychological treatment - at least through the mechanism of food-cue devaluation or changes in healthy and unhealthy food choice. Future research is needed to investigate the factors that contribute towards successful CBM training to critically evaluate the potential for these strategies within interventions.