Perceived weight-related stigma, loneliness, and mental wellbeing during COVID-19 in people with obesity: A cross-sectional study from ten European countries.

BACKGROUND: Increased weight-related stigma during the COVID-19 pandemic has amplified the need to minimise the impacts on mental wellbeing. We investigated the relationship between the perceived changes in the representation of obesity in the media and mental wellbeing during the pandemic in a sample of people with obesity across 10 European countries. We also investigated the potential moderating effect of loneliness. METHODS: Between September to December 2020 during the COVID-19 pandemic, participants reported data on demographics, mental wellbeing (measured by World Health Organisation Five Wellbeing Index and Patient Health Questionaire-4), loneliness (measured by De Jong Gierveld short scale), and perceived change in the representation of obesity in media (measured by a study-specific question) using the online, cross-sectional EURopean Obesity PatiEnt pANdemic Survey (EUROPEANS). Data were analysed using linear mixed-effects models, controlling for age, gender, body mass index, and shielding status, with random incept for country. RESULTS: The survey was completed by 2882 respondents. Most identified as female (56%) and reported their ethnicity as White or White-mix (92%). The total sample had a mean age of 41 years and a BMI of 35.4 kg/m2. During the peak of the pandemic, compared to pre-pandemic, perceiving more negative representation of people with obesity on social media was associated with worse psychological distress, depression, and wellbeing. Perceiving more positive representation, compared to no change in representation, of people with obesity on television was associated with greater wellbeing, yet also higher psychological distress and anxiety. Loneliness, as a moderator, explained ≤0.3% of the variance in outcomes in any of the models. CONCLUSIONS: Perceiving negative representation of obesity on social media was associated with poorer mental wellbeing outcomes during the pandemic; positive representation on television was associated with both positive and negative mental wellbeing outcomes. We encourage greater media accountability when representing people with obesity.

Sign-tracking modulates reward-related neural activation to reward cues, but not reward feedback.

Research shows cognitive and neurobiological overlap between sign-tracking [value-modulated attentional capture (VMAC) by response-irrelevant, discrete cues] and maladaptive behaviour (e.g. substance abuse). We investigated the neural correlates of sign-tracking in 20 adults using an additional singleton task (AST) and functional magnetic resonance imaging (fMRI). Participants responded to a target to win monetary reward, the amount of which was signalled by singleton type (reward cue: high value vs. low value). Singleton responses resulted in monetary deductions. Sign-tracking-greater distraction by high-value vs. low-value singletons (H > L)-was observed, with high-value singletons producing slower responses to the target than low-value singletons. Controlling for age and sex, analyses revealed no differential brain activity across H > L singletons. Including sign-tracking as a regressor of interest revealed increased activity (H > L singletons) in cortico-subcortical loops, regions associated with Pavlovian conditioning, reward processing, attention shifts and relative value coding. Further analyses investigated responses to reward feedback (H > L). Controlling for age and sex, increased activity (H > L reward feedback) was found in regions associated with reward anticipation, attentional control, success monitoring and emotion regulation. Including sign-tracking as a regressor of interest revealed increased activity in the temporal pole, a region related to value discrimination. Results suggest sign-tracking is associated with activation of the 'attention and salience network' in response to reward cues but not reward feedback, suggesting parcellation between the two at the level of the brain. Results add to the literature showing considerable overlap in neural systems implicated in reward processing, learning, habit formation, emotion regulation and substance craving.

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

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 meta-analyses 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 = 0.134 (95% CI 0.061, 0.208); p < .001), food intake (r = 0.085 (95% CI 0.038, 0.132); p < .001), and hunger (r = 0.048 (95% CI 0.016, 0.079); p = .003), but these correlations were small. Food-related AB was unrelated to BMI (r = 0.008 (95% CI -0.020, 0.035); 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 between-groups 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 food-related 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.

The effects of exposure to appetitive cues on inhibitory control: A meta-analytic investigation.

Inhibitory control refers to the ability to stop, change or delay a response, and is often used in order to protect higher order goals. Theoretical models suggest that appetitive cues such as pictures of alcoholic drinks or food evoke strong automatic appetitive responses which lead to transient impairments in inhibitory control, and that these effects of cues may be related to individual differences (e.g. in body mass index, or alcohol consumption). In order to investigate these claims we conducted a random effects meta-analysis of 66 effect sizes (35 alcohol, 31 food) from 37 articles that tested the effect of exposure to appetitive (alcohol/food) cues on indices of inhibitory control. The overall effect of cue exposure was small, but robust (SMD = -0.12 [95% CI -0.23, -0.02]; Z = 2.34, p = .02, I2 = 84%). Exposure to alcohol-related cues significantly impaired inhibitory control (SMD = -0.21 [95% CI = -0.32, -0.11]; Z = 4.17, p < .001), however exposure to food-related cues did not lead to impairments (SMD = -0.03 [95% CI = -0.21, 0.15]; Z = 0.36, p = .720). There was no evidence that drinking or weight status significantly moderated the effects of cues on inhibitory control. Similarly, cue modality (words, pictures, or smells) did not significantly moderate the effects. Trim and Fill analysis suggested bias in the literature, which when corrected, made the overall effect of cues non-significant. Overall, these findings provide some tentative support for theoretical claims that exposure to appetitive cues prompts transient impairments in inhibitory control. Further research is required to determine the clinical significance of these observations. However, care should be taken when drawing conclusions from a potentially biased evidence base.

Internal reliability of the alcohol-related visual probe task is increased by utilising personalised stimuli and eye-tracking.

BACKGROUND: In the current study, we investigated whether the internal reliability of the visual probe task measure of attentional bias for substance-related cues could be improved by incorporating eye-tracking methods and personalised stimuli. METHOD: Sixty social drinkers completed two visual probe tasks: one with a broad range of different alcohol pictures, the other containing only images of the participants' preferred drink. Attentional bias was inferred from manual reaction times to probes replacing the pictures, and from the duration of eye movement fixations towards the pictures (gaze dwell time). RESULTS: Internal reliability was highest for personalised (versus general) alcohol stimuli, and for eye-tracking (versus manual reaction time) measures of attentional bias. The internal reliability of both reaction time (α=.73) and gaze dwell time measures (α=.76) of attentional bias for personalised alcohol stimuli was acceptable. Internal reliability of indices of attentional bias for general alcohol stimuli was inferior, although better for the gaze dwell time (α=.51) compared to the reaction time measure (α=.19). Attentional bias towards personalised stimuli was larger than bias to general stimuli, but only for the reaction time measure. There were no statistically significant associations between measures of attentional bias and alcohol consumption or craving. CONCLUSIONS: Adopting personalised stimuli and eye movement monitoring significantly improves the internal reliability of the alcohol-related visual probe task.