Technological-enhanced treatment of emotional eating in obese subjects:

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Technological-enhanced treatment of emotional
eating in obese subjects
A randomized controlled clinical trial
Alessandra Gorini Mauro Manzoni, Francesco
Pagnini, Gianluca Castelnuovo, Enrico Molinari,
Giuseppe Riva

• Applied Technology for Neuro-Psychology Lab
• Istituto Auxologico Italiano, Milan, Italy

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AIMS OF THE STUDY

• Goal of the study evaluate the IMMEDIATE and
  LONG TERM efficacy (6-month follow up) of a
  technological based clinical protocol for the
  management of emotional eating in obese subjects.
  

Clinical aim help obese subjects to cope and
manage negative emotions that usually provoke
emotional eating episodes.
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OBESITY

• Obesity is a medical condition characterized by
  overweight (BMIgt30) (WHO, 2003).
• Obesity is a biopsychosocial pathology, caused by
  complex and dynamic system of biological, social
  and psychological factors.

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EMOTIONAL EATING (1)

• Definition
• Eating an unusually amount of food in response to
  negative (or positive) emotions instead of in
  response to physiological needs
• INAPPROPRIATE COPING MECHANISM Excessive eating
  is used to reduce distress (Kaplan and Kaplan,
  1957 psychosomatic theory of obesity)

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EMOTIONAL EATING (2)

• Overweighted and obese people tend to eat more
  food in response to emotions than normal-weighted
  individuals (Ganley, 1989)
• WHY?
• Dysfunctional brain metabolism (serotonin)
• Behavioural factors association between food
  and release of anxiety (Canetti, 2002).

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EMOTIONAL EATING (3)

• Emotional eating is a dysfunctional eating
  behaviour that affects many obese people (Masheb
  and Grilo, 2005).
• It seems to be a component of binge eating and
  Binge Eating Disorder (BED)
• Even if we cannot sustain that emotional eating
  is implicated in the aetiology of obesity, we can
  say that in many cases it contributes to its
  maintenance and increase.

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A NEW TREATMENT PERSPECTIVE

• If stress and negative emotions are critical
  factors that may induce overeating, then
  psychological and behavioural interventions for
  obese patients with emotional eating should
  include stress management and emotion-shifting
  strategies, together with the traditional CBT

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HOW TO REDUCE STRESS

• Stress management can be achieved by relaxation
• BUT
• Relaxation is difficult to be achieved and
  usually takes a long time to be learned

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AIM OF THE STUDY

• Evaluate the effect of a three-week relaxation
  training protocol partially provided through a
  relaxing VR environment and supported by portable
  mp3 players on stress and negative emotions in a
  sample of obese female patients with emotional
  eating.

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METHODS

• Participants
• 60 female in-patients (Mean age42 SD8,6)
  meeting the WHO criteria for morbid obesity (BMI
  ? 30)
• Score ? 1 in the Emotional Overeating
  Questionnaire (EOQ)
• Experimental design
• 3 conditions
• - VR
• - IMAGINATIVE
• - WL

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TREATMENT (IN-PATIENT PROGRAM)

• 5 weeks medically-managed residential program
  consisting in a moderately low-calorie diet,
  physical training, psychological support and
  participation in nutritional groups
• PLUS

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• 1 week 3 non-immersive VR sessions (narrative
  only) mobile sessions
• 2 week 3 immersive VR sessions mobile
  sessions
• 3 week 3 immersive stressfull VR sessions
  mobile sessions

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THE VIRTUAL ENVIRONMENT (1)

The Green Valley (NeuroVR 1.5) was used in order
to enhance relaxation by visually presenting key
images for facilitating the process
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THE RELAXING NARRATIVES

• A combination of Progressive Muscular Relaxation
  (muscolar tension) and Applied Relaxation (coping
  strategies)

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THE VIRTUAL ENVIRONMENT (2)
A buffet in a restaurant was used in order to
expose patients to a common stressful situation
teaching them how to cope with stress
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MOBILE SESSIONS

• Subjects included in the VR and IM groups were
  given an mp3 player in order to practice, at
  least once a day, the relaxation techniques
  learned during the therapists assisted sessions

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COLLECTED VARIABLES
First session EOQ (Emotional Overeating
Questionnaire) First and last sessions WELSQ
(Weight efficacy life style questionnaire) BDI
(Beck Depression Inventory) Before and after
each treatment sessions STAI (State Anxiety
Inventory) VAS (Visual Analogue Scale) Heart
rate was also recorder (psychophisiological
assessment)
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RESULTS (SHORT TERM)

• Pre vs post treatment (BDI)

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RESULTS (SHORT TERM)

• Pre vs post treatment (WELSQ)

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RESULTS (SHORT TERM)

• Pre vs post sessions
• Significant decrease of state anxiety (STAI) and
  significant increase of relaxation (VAS-R) before
  and after each treatment session both in the VR
  and in the IM groups, while no differences were
  found between them
• Significant decreases in heart rate values both
  in the VR and IM groups after each session.
• The same results were found when patients were
  exposed to the stressful environments (last week
  of treatment)

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RESULTS (6-MONTH FOLLOW UP)

• 36 patients (12 VR, 14 IM and 10 WL)
• At follow up, VR and IM groups show a significant
  higher score on WELSQ and lower scores on BDI
  than WL

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CONCLUSIONS

• A brief relaxation training (12 sessions in 3
  weeks) based on the use of VR mp3 or mp3 alone
  increased the perceived self-efficacy for eating
  control and reduced the depression level in both
  the experimental groups
• Regarding the within sessions effects, the
  relaxation training was effective in reducing
  state anxiety and in increasing the relaxation
  level, in the two groups of patients
• Results have been mainteined at 6-month follow up

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• THANK YOU FOR YOUR ATTENTION!
• a.gorini_at_auxologico.it