Control of Eating Behavior Using a Novel Feedback System

Subjects eat food from a plate that sits on a scale connected to a computer that records the weight loss of the plate during the meal and makes up a curve ...

A Computer-Based Platform for Aiding Clinicians in Eating Disorder Analysis and Diagnosis

Eating disorders (anorexia nervosa, bulimia nervosa, binge-eating disorder, and other specified eating or feeding disorders) have a combined prevalence of ...

Karolinska Institutet

The hypothesis that eating disorders are caused by an antecedent mental disorder, presently believed to be an obsessive compulsive disorder, has been clinically implemented during many years but has not improved treatment outcome. Alternatively, eating disorders are eating disorders and the symptoms of anorexic patients and probably bulimic patients as well, are epiphenomena which emerge as a consequence of starvation. This hypothesis is supported by the observations of the effects of a 6 month long period of semi-starvation on healthy human volunteers, which demonstrated not only the emergence of psychiatric symptoms but also the reduction in eating rate which is typical of anorexia nervosa patients. On this framework training anorexic patients how to eat may be a useful intervention. We report that anorexic patients, either with a body mass index<14 or >15.5 display the same pattern of eating behavior, with a low level of intake, a slow eating rate and a high level of satiety. They also have the same, high level of psychiatric symptoms, including obsessive compulsive symptoms. Training patients to eat more food at a progressively higher rate reverses these symptoms and patients remain free of symptoms during an extended period of follow-up. It is suggested that the pattern of eating behavior mediates between the starved condition and the psychopathology of anorexia nervosa.

Cause and treatment of anorexia nervosa.

Women were divided into those eating at a decelerated or linear rate. Eating rate was then experimentally increased or decreased by asking the women to adapt their rate of eating to curves presented on a computer screen and the effect on food intake and satiety was studied. Decelerated eaters were unable to eat at an increased rate, but ate the same amount of food when eating at a decreased rate as during the control condition. Linear eaters ate more food when eating at an increased rate, but less food when eating at a decreased rate. Decelerated eaters estimated their level of satiety lower when eating at an increased rate but similar to the control condition when eating at a decreased rate. Linear eaters estimated their level of satiety similar to the control level despite eating more food at an increased rate and higher despite eating less food at a decreased rate. The cumulative satiety curve was fitted to a sigmoid curve both in decelerated and linear eater under all conditions. Linear eaters rated their desire to eat and estimated their prospective intake lower than decelerated eaters and scored higher on a scale for restrained eating. It is suggested that linear eaters have difficulty maintaining their intake when eating rate is dissociated from its baseline level and that this puts them at risk of developing disordered eating. It is also suggested that feedback on eating rate can be used as an intervention to treat eating disorders.

Decelerated and linear eaters: effect of eating rate on food intake and satiety.

It has been suggested that restrained eating is a cognitive strategy that an individual uses for control of food intake. If losing control, the restrained eater enters a state of disinhibition and is therefore thought to be at risk for developing eating disorders and obesity. Restrained eaters eat at a constant rate and can therefore also be referred to as linear eaters. Here, we have tested the hypothesis that restrained eating is a state that can be modified by teaching linear eaters to eat at a decelerated rate. Seventeen female linear eaters scored high on a scale for restrained eating. When challenged to eat at an increased rate, a test of disinhibition, the women overate by 16% on average. The women then practiced eating at a decelerated rate by use of feedback from a training curve displayed on a computer screen during the meals. The training occurred three times each week and lasted eight weeks. When re-tested in the absence of feedback, the women ate at a decelerated rate, they did not overeat in the test of disinhibition and they scored lower on the scale for restrained eating. It is suggested that restrained eating is a state that can be reduced by training.

Linear eaters turned decelerated: reduction of a risk for disordered eating?

A method for the control of eating rate gave subjects feedback from a computer screen on how much and at what rate to eat during a meal. The method also allowed us to record the development of satiety during the meal. Linear eaters--that is, women selected for eating at an approximately constant rate--underate when challenged to eat at a lower rate and overate when challenged to eat at a higher rate, thereby modeling the eating behavior of patients with anorexia nervosa and binge eating disorder, respectively. In both cases, the women's postmeal perception of satiety mimicked that of the respective patient group. The results provide support for the notion that linear eaters have the capacity to exhibit disordered eating.

A method for the control of eating rate: a potential intervention in eating disorders.

We determined whether women and men would alter their pattern of food intake after they had deprived themselves of food. We found that women consumed 12% less food after fasting and that men ate 28% more food after fasting. Serving more food on the test day did not increase food intake of women. Women, who ate at a nearly constant rate (linear eaters), consumed less food than those eating at an initially high speed which decreased over the course of the meal (decelerated eaters). Women decreased their food intake after fasting as their eating pattern became more linear. After fasting, men increased their food intake, and the rate at which they ate became more decelerated. Food intake of both women and men was normalized after fasting by providing feedback that encouraged them to eat according to the pattern they showed in the non-fasted condition. The results support the hypothesis that linear eating, and the dieting that elicits linear eating, are risk factors for the development of the abnormal linear eating pattern that characterizes patients with anorexia nervosa. The data also provide additional support for the use of behavioral feedback to normalize the pattern of eating for individuals who have difficulty maintaining their body weight.

A sex difference in the response to fasting.

While the average frequency of chewing and food intake have been reported before, a detailed description of the pattern of chewing and the cumulative intake of food over the course of a meal have not. In order to achieve this goal, video recording of the maxillary-mandibular region of women eating food from a plate was synchronized with video recording of the plate and computer recording of the weight-loss of the plate. Video recording of chewing correlated strongly with chewing identified by magnetic tracking of jaw displacement in a test with chewing gum at three different frequencies, thus ensuring the validity of video recording of chewing. Weight-loss data were corrected by convolution algorithms, validated against human correction, using sliding window filtering to correct errors with video events as reference points. By use of this method, women ate on average 264 g of food over 114 min, they took an average of 51 mouthfuls during the meal and displayed on average 794 chews with 15 chews per chewing sequence. The number of mouthfuls decreased and the duration of the pauses after each mouthful increased in the middle of the meal and these measures were then restored. The ratio between chewing sequences and subsequent pauses remained stable although the weight of each mouthful decreased by the end of the meal, a measure that is hypothesized to be reflected in a decelerated speed of eating. The method allows this hypothesis to be tested and its implication for clinical intervention to be examined.

Description of chewing and food intake over the course of a meal.

Speed of eating, an important aspect of eating behaviour, has recently been related to loss of control of food intake and obesity. Very little time is allocated for lunch at school and thus children may consume food more quickly and food intake may therefore be affected. Study 1 measured the time spent eating lunch in a large group of students eating together for school meals. Study 2 measured the speed of eating and the amount of food eaten in individual school children during normal school lunches and then examined the effect of experimentally increasing or decreasing the speed of eating on total food intake.

Children eat their school lunch too quickly: an exploratory study of the effect on food intake.

Brainstem and hypothalamic "orexigenic/anorexigenic" networks are thought to maintain body weight homeostasis in response to hormonal and metabolic feedback from peripheral sites. This approach has not been successful in managing over- and underweight patients. It is suggested that concept of homeostasis has been misinterpreted; rather than exerting control, the brain permits eating in proportion to the amount of physical activity necessary to obtain food. In support, animal experiments have shown that while a hypothalamic "orexigen" excites eating when food is abundant, it inhibits eating and stimulates foraging when food is in short supply. As the physical price of food approaches zero, eating and body weight increase without constraints. Conversely, in anorexia nervosa body weight is homeostatically regulated, the high level of physical activity in anorexia is displaced hoarding for food that keeps body weight constantly low. A treatment based on this point of view, providing patients with computerized mealtime support to re-establish normal eating behavior, has brought 75% of patients with eating disorders into remission, reduced the rate of relapse to 10%, and eliminated mortality. 

Homeostasis in anorexia nervosa.

Diet, exercise, and pharmacological interventions have limited effects in counteracting the worldwide increase in pediatric body weight. Moreover, the promise that individualized drug design will work to induce weight loss appears to be exaggerated. We suggest that the reason for this limited success is that the cause of obesity has been misunderstood. Body weight is mainly under external control; our brain permits us to eat under most circumstances, and unless the financial or physical cost of food is high, eating and body weight increase by default. When energy-rich, inexpensive foods are continually available, people need external support to maintain a healthy body weight. Weight loss can thereby be achieved by continuous feedback on how much and how fast to eat on a computer screen. 

Control of Body Weight by Eating Behavior in Children.

The study aimed to investigate symptoms of disordered eating pre- and postpartum using a standardised and widely used measure of eating disorder (ED) psychopathology. A consecutive series of women attending either prenatal (N = 426) or postnatal (N = 345) clinics in metropolitan Stockholm were assessed using the Eating Disorder Examination Questionnaire (EDE-Q). Assessments were conducted at either the first visit to prenatal clinics (10-12 weeks of pregnancy) or 6 to 8 months postpartum. An optimised shortened version of the EDE-Q was best suited for studying eating disorders pre- and postpartum. Using the optimised version of the instrument with 14 items and a cut-off score of ≥2.8, it was estimated that 5.3 % of prepartum and 12.8 % of postpartum mothers were suffering from clinical eating disorders. Seriously disordered eating behaviour during, and especially after, pregnancy may be more common than previously thought. It is imperative that health services focus increased attention on these problems by raising awareness, developing and extending specialist services, as well as through implementing educational programmes and training directed toward frontline healthcare services.

Eating disorder symptoms pre- and postpartum.

Response: Commentary: Control of Body Weight by Eating Behavior in Children.

To report the outcomes of eating disorders treatment in Sweden in 2012-2016.

Treatment outcomes for eating disorders in Sweden: data from the national quality registry.

Mental causation takes explanatory priority over evolutionary biology in most accounts of eating disorders. The evolutionary threat of starvation has produced a brain that assists us in the search for food and mental change emerges as a consequence. The major mental causation hypothesis: anxiety causes eating disorders, has been extensively tested and falsified. The subsidiary hypothesis: anxiety and eating disorders are caused by the same genotype, generates inconsistent results because the phenotypes are not traits, but vary along dimensions. Challenging the mental causation hypothesis in Feighner et al. (1972) noted that anorexic patients are physically hyperactive, hoarding for food, and they are rewarded for maintaining a low body weight. In 1996, Feighner's hypothesis was formalized, relating the patients' behavioral phenotype to the brain mechanisms of reward and attention (Bergh and Södersten, 1996), and in 2002, the hypothesis was clinically verified by training patients how to eat normally, thus improving outcomes (Bergh et al., 2002). Seventeen years later we provide evidence supporting Feighner's hypothesis by demonstrating that in 2012, 20 out of 37 patients who were referred by a psychiatrist, had a psychiatric diagnosis that differed from the diagnosis indicated by the SCID-I. Out of the 174 patients who were admitted in 2012, most through self-referral, there was significant disagreement between the outcomes of the SCID-I interview and the patient's subjective experience of a psychiatric problem in 110 of the cases. In addition, 358 anorexic patients treated to remission scored high on the Comprehensive Psychopathological Rating Scale, but an item response analysis indicated one (unknown) underlying dimension, rather than the three dimensions the scale can dissociate in patients with psychiatric disorders. These results indicate that psychiatric diagnoses, which are reliable and valid in patients with psychiatric disorders, are less well suited for patients with anorexia. The results are in accord with the hypothesis of the present Research Topic, that eating disorders are not always caused by disturbed psychological processes, and support the alternative, clinically relevant hypothesis that the behavioral phenotype of the patients should be addressed directly.

Verifying Feighner's Hypothesis; Anorexia Nervosa Is Not a Psychiatric Disorder.

Anorexia nervosa is one of the more severe eating disorders, which is characterized by reduced food intake, leading to emaciation and psychological maladjustment. Treatment outcomes are often discouraging, with most interventions displaying a recovery rate below 50%, a dropout rate from 20% to 50%, and a high risk of relapse. Patients with anorexia nervosa often display anxiety and aversive behaviors toward food. Virtual reality has been successful in treating vertigo, anxiety disorder, and posttraumatic stress syndrome, and could potentially be used as an aid in treating eating disorders.

Virtual Reality App for Treating Eating Behavior in Eating Disorders: Development and Usability Study.

[This corrects the article DOI: 10.2196/24998.].

Correction: Virtual Reality App for Treating Eating Behavior in Eating Disorders: Development and Usability Study.

Individuals with Anorexia Nervosa are often described as restless, hyperactive and having disturbed sleep. The result reproducibility and generalisability of these results are low due to the use of unreliable methods, different measurement methods and outcome measures. A reliable method to measure both physical activity and sleep is through accelerometry. The main purpose of the study was to quantify the physical activity and sleeping behaviour of anorexia nervosa patients. Another purpose was to increase result reproducibility and generalisability of the study.

Modjtaba Zandian

Mandometer Clinic,
Department of Neurobiology,
Care Sciences and Society,
Department of Neurobiology, Care Sciences and Society

Karolinska Institutet

Control of Eating Behavior Using a Novel Feedback System

A Computer-Based Platform for Aiding Clinicians in Eating Disorder Analysis and Diagnosis

Modjtaba Zandian

.css-o250i3{font-size:18px;font-family:Open Sans,sans-serif;line-height:21.6px;}Mandometer Clinic,Department of Neurobiology,Care Sciences and Society,Department of Neurobiology, Care Sciences and Society

Karolinska Institutet

Control of Eating Behavior Using a Novel Feedback System

A Computer-Based Platform for Aiding Clinicians in Eating Disorder Analysis and Diagnosis

Mandometer Clinic,
Department of Neurobiology,
Care Sciences and Society,
Department of Neurobiology, Care Sciences and Society