Obesity is a widespread problem that starts from an early age. Previous studies suggest that obese youngsters have an attentional bias and an automatic approach tendency towards high-calorie food and display difficulties inhibiting impulses, which may result in a higher intake of (high-calorie) food. An interesting idea for improvement of the current obesity treatment is adding a program that enables to train their difficulties. Subjects were 36 youngsters aged 9-15 years old from an inpatient treatment program for obesity, randomized over a training group and an active control group. The training consisted of six training sessions with cognitive tasks aimed at enhancing inhibition towards unhealthy food items (with a go/no-go task), as well as decreasing a food approach bias (using an approach/avoidance task) and a food attentional bias (using a dot-probe task). The current study evaluated the feasibility, acceptability and initial effectiveness of the training and explores if these characteristics helps obese youngsters to maintain weight-loss once they return home at the end of their inpatient treatment program. Results on the cognitive performances were investigated during two measurement sessions, spread over 5 weeks while weight evolution was followed over 13 weeks. Results showed that the training program was feasible and acceptable to the majority of participants and clinicians. Furthermore, the preliminary findings suggest that the training tasks used were ineffective in this group of obese children. Lessons learned and suggestions for future research are discussed.

BackgroundObesity is a widespread problem that not only leads to medical and psychological diseases in adults, but also in children and adolescents at an early stage in life. Because of its global burden on both the individual and society, it is necessary to develop effective evidence-based treatments. Current “Multidisciplinary Obesity Treatments” (MOT) already provide significant weight loss, but still leave room for more long-lasting improvements. In this protocol paper, we outline the research goals of the WELCOME trial, based on a substantial proof of concept.MethodsIn this Randomized Controlled Trial (RCT) – conducted in both an inpatient and two outpatient treatment settings – existing MOT will be supplemented with an Executive Function (EF) training and compare effects on various parameters in an experimental versus an active control group of obese youngsters (8–18 years old). WELCOME aims to (a) train youngsters’ executive functions to facilitate effects on weight loss, psychological and medical comorbidities, (b) to enhance the long-term effects by continuing the training in the daily home context with booster sessions, and (c) to investigate its effects until a 6-month follow-up. In comparison to the active control group, better progress is expected in the experimental group on following variables: weight, psychological comorbidities (unhealthy eating behavior, internalizing symptoms, impaired self-esteem) and medical comorbidities (metabolic syndromes, endothelia dysfunction, tonsillar hypertrophy and sleep obstruction).DiscussionIt is stated that this EF-training for enhancing self-control abilities is necessary for a long-lasting effect of childhood obesity treatment interventions.Trial registrationThe Study Procotol was registered on 10/05/2017 (n° ISRCTN14722584).

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Several versions of the dot probe detection task are frequently used to assess maladaptive attentional processes associated with a broad range of psychopathology and health behavior, including eating behavior and weight. However, there are serious concerns about the reliability of the indices derived from the paradigm as measurement of attentional bias toward or away from salient stimuli. The present paper gives an overview of different attentional bias indices used in psychopathology research and scrutinizes three types of indices (the traditional attentional bias score, the dynamic trial-level base scores, and the probability index) calculated from a pictorial version of the dot probe task to assess food-related attentional biases in children and youngsters with and without obesity. Correlational analyses reveal that dynamic scores (but not the traditional and probability indices) are dependent on general response speed. Reliability estimates are low for the traditional and probability indices. The higher reliability for the dynamic indices is at least partially explained by general response speed. No significant group differences between youth with and without obesity are found, and correlations with weight are also non-significant. Taken together, results cast doubt on the applicability of this specific task for both experimental and individual differences research on food-related attentional biases in youth. However, researchers are encouraged to make and test adaptations to the procedure or computational algorithm in an effort to increase psychometric quality of the task and to report psychometric characteristics of their version of the task for their specific sample.