Distractions Such as Toe Tapping May Reduce Food Cravings

Marlene Busko

November 17, 2014

BOSTON — New behavioral techniques, including using distracting thoughts to avoid food cravings and cognitive training to address the consequences of consuming a particularly tempting food, have shown some degree of success in two small, separate studies presented recently at Obesity Week 2014.

In the first, when 55 individuals with an average body mass index (BMI) of 43.7 used four simple distraction tasks, they were less tempted by chocolate and other favorite foods. The 30-second tasks consisted of forehead tapping, ear tapping, toe tapping, and imagining a blank white wall. Notably, the last two tasks could be done discreetly.

"One of the novelties of this study is how heavy the people were — about 80 pounds overweight," Richard Weil (Mount Sinai St. Luke's Hospital, New York) told Medscape Medical News at a poster session.

The second study, reported by psychiatrist Dr Kathryn Demos (Brown University, Providence, Rhode Island) included 25 overweight and obese participants who were coached to alter their thoughts about a desirable food when shown a picture of it.

This led to differences in activity in different regions of the brain, as monitored on functional MRI scan. The findings suggest that when faced with a tempting food, being able to think about something else or to focus on the long-term negative consequences might help prevent overeating.

Commenting on both studies in an Obesity Society statement, incoming cochair of the Obesity Society Public Affairs Committee, Dr Chris Ochner (Icahn School of Medicine at Mount Sinai, New York), said: "There's a lot we can learn from studying the brain and human behavior, especially eating behavior, and we hope to see more research in this area so we can provide better treatment to people with obesity and overweight."

Distraction Tasks

Mr Weil and colleagues aimed to determine whether simple distraction tasks could reduce food cravings. They enrolled 10 men and 45 women who had an average age of 49.9 and a BMI ranging from 30.2 to 71.7.

Each participant identified four favorite foods. The foods that elicited the biggest cravings were cheese, pasta, ice cream, pizza, chocolate, bread, chicken, steak, French fries, and rice.

The researchers read a script to the participants to get them to think about how much they wanted a particular food, and the participants then rated how intensely they craved it and how vividly they pictured it, on a scale of 0 to 100.

The experiment was repeated when the participants tapped their forehead, ear, or toe or imagined a blank wall.

Forehead tapping (where participants could see their finger doing the tapping) reduced the craving by up to 10% more than the other strategies, but all of the distraction tasks diminished the intensity of craving.

"We think that what happens is they induce this craving, and it gets on their 'visuospatial sketchpad' — [the part of working memory that is related to what people see] — and then the distraction task interrupts this brain circuitry," Dr Weil said.

"We want to train [obese people] to 'take their temperature' [that is, to be aware of the intensity of their craving] and, as it starts rising, to quickly do this distraction task," he said.

Anecdotally, patients have told him that this strategy works. When people viewed a commercial about chocolate on television or were tempted by candy in their children's bag of Halloween treats, they were able to halt the craving by quickly tapping on their forehead.

Cognitive Strategies

In the second study, Dr Demos and colleagues taught 25 overweight or obese individuals four cognitive strategies, similar to techniques that have been used in smoking-cessation trials.

The strategies were: "allow," where people accept their thoughts but recognize that they do not have to act on these thoughts; "distract," where they think about something other than eating the food; "later," where they focus on the negative long-term consequences of consumption; and "now," where they picture the immediate reward of the food.

Participants had functional MRI scans of their brain as they viewed images of a tempting food and used one of the thought-control strategies. They were also asked to rate their urge to eat at that moment.

When the participants focused on the negative long-term consequences, they reported a decreased desire to eat the food and the dorsolateral prefrontal cortex lit up under functional MRI, showing that there was an increase in inhibitory control.

"We found that simply thinking in a different way affects how the brain responds to tempting food cues in individuals with obesity," Dr Demos said.

"Our results show the promising possibility that focusing on the long-term consequences of consuming unhealthy foods could help diminish cravings and, as a result, potentially enhance weight-loss efforts."

Mr Weill, Dr Demos, and Dr Ochner have reported no relevant financial relationships.

Obesity Week 2014: The American Society for Metabolic and Bariatric Surgery and the Obesity Society Joint Annual Scientific Meeting; November 4 and 6, 2014; Boston, MA. Abstracts T-2658 and T-3023-OR.


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