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
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.
OBESITY
Obesity is a medical condition characterized
by overweight (BMI>30) (WHO, 2003).
Obesity is a biopsychosocial pathology,
caused by complex and dynamic system of
biological, social and psychological factors.
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)
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).
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.
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 emotionshifting strategies, together with the traditional
CBT
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
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.
METHODS
Participants
60 female in-patients (Mean age=42; SD=8,6) meeting the
WHO criteria for morbid obesity (BMI  30)
Score  1 in the Emotional Overeating Questionnaire (EOQ)
Experimental design
3 conditions:
- VR
- IMAGINATIVE
- WL
TREATMENT (IN-PATIENT PROGRAM)
• 5 weeks medically-managed residential
program consisting in a moderately lowcalorie diet, physical training, psychological
support and participation in nutritional groups
PLUS…
 1°
week: 3 non-immersive
(narrative only) + mobile sessions
VR
sessions
 2° week: 3 immersive VR sessions + mobile
sessions
 3 week: 3 immersive stressfull VR sessions +
mobile sessions
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
THE RELAXING NARRATIVES
• A combination of Progressive Muscular
Relaxation (muscolar tension) and Applied
Relaxation (coping strategies)
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
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 therapist’s
assisted sessions
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)
RESULTS (SHORT TERM)
• Pre vs post treatment (BDI)
RESULTS (SHORT TERM)
• Pre vs post treatment (WELSQ)
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)
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
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
THANK YOU FOR YOUR ATTENTION!
a.gorini@auxologico.it