Americans are bombarded with mixed messages about weight and health, while increasing images of a foodie culture found on cooking shows, addictive social media cooking video clips, and “foodporn” images clutter our communication channels. The paradox of endless weight loss advertisements combined with a culture of gluttonous food is confusing to a population with growing health and weight related issues . Obesity can’t simply be broken down to one causal factor; it is a complex issue with sociological, biological, and psychological components. According to the Robert Wood Johnson Foundation obesity and related illness, including loss of productivity, is approximately a 200 billion dollar annual burden (The Healthcare Costs of Obesity, n.d,). The American Medical Association now considers obesity a disease (Stoner & Cornwall, 2014) and there is no pill or approved cure.
Fortunately, there is growing research using mind-body medicine solutions that are simpler and less costly than conventional medicine practices like bariatric surgery and drug development. With the growing popularity and research of mindfulness meditation as a successful weight loss tool (Katterman, Kleinman, Hood, Nackers, & Corsica, 2014), it is worth examining the efficacy and success of the lesser-known mind body medicine tool of imagery and how imagery influences obesity. Studies show that cravings are influenced by images (Kemps & Tiggemann, 2007) so its worth examining if imagery can reverse cravings and over-eating as well as manage the well known stress related factor to obesity (Kiecolg-Glaser, McGuire, Robles, & Glaser, 2002). The need for self-care tools that are non-invasive and cost effective is critical to the success of individuals suffering from obesity and weight related illness.
Research Question
To what extent can imagery tools help with obesity and weight loss ? How does imagery positively impact weight loss efforts? If stress, impaired autonomic function, loneliness and food cravings contribute to weight gain, can imagery help manage the dysfunctions that contribute to weight loss?
Methods
Articles reviewed were found using electronic searches in the CINHAL complete database, ProQuest, Science Direct, PsychInfo, and Google Scholar. Main search terms included (and not limited to): imagery, guided imagery, weight loss, obesity, and cravings. The articles span from 2006-2016 and are original peer-reviewed studies that use various applications of imagery to measure food cravings, snacking behavior, cortisol levels, and perceived imagery vividness.
Landmark Study: The Elaborated Intrusion Theory of Desire
The foundation of imagery as a potentially effective tool for promoting weight loss relies on the Elaborated Intrusion Theory of Desire in the landmark study by Kavanagh, Andrade, andd May (2004). The theory argues that vivid mental imagery contributes to the cognitive processing and drive that underlies a food craving. It also suggests that a craving will persist if there is a deficit. For example, a person who eats chocolate to improve mood or cope with negative emotion gains immediate pleasure from indulging the craving. If they do not satisfy the craving for chocolate, intrusive thoughts from the spontaneous mental imagery of the chocolate can become distressing and lower cognitive functioning (Tiffany, 1990). Elaborated Intrusion Theory predicts that if pleasure or relief is not achieved through satisfying a craving, the mental image persists and the recognition of a deficit continues to cognitively affect the individual. There is so much cognitive distress from the craving that any amount of will power or diet cannot stop the individual from the craving or target acquisition.
Kavanagh, Andrade, and May (2004) found that “desires will show similar brain activation to that seen in imagery” and “episodes of desire with more vivid sensory images will be rated as stronger in intensity” (p.462). That imagery is related to cravings and desire, gives researchers adequate reason to hypothesize that imagery can support people with reducing cravings and possibly the biomarkers (insulin and stress) that lead to overeating and obesity.
Applied Elaboration Intrusion Theory of Desire to Weight Loss
Based on the notion that the more vivid an individual’s imagery, the greater the craving, researchers examined the relationship between vividness, cravings, and BMI. This section of the paper examines literature that recognizes the interplay of vividness, weight and food cravings while later on the paper addresses the application of imagery as an intervention.
Imagery vividness and food cravings
Food cravings are common amongst almost the entire population, however it’s the constant recurring of food cravings that is maladaptive and leads to health risks and even emotional shame (Macdiarmid & Hethertington, 1995). Kemps and Tiggemann (2007) conducted a three-part study elaborating on the power of the vividness of imagery in the context of Intrusion Theory of Desire and food cravings. They hypothesized that by giving an individual visual and olfactory tasks, their cravings would reduce more than if given an auditory task.
Experiment 1 randomly assigned participants to one of three conditions, visual, auditory, or olfactory and measured their craving intensity before, during and after the imagery task. First participants were asked to imagine eating their favorite foods to induce food cravings. Following the induction participants received an imagery task either with visual, olfactory or auditory cues and rated their cravings and the vividness of their image then asked what food they craved. In the final part of the experiment, the participants engaged in one of the three imagery tasks then rated the vividness of their image and craving. As they maintained their imagery task, participants were asked to block external stimulus with either an eye mask, nose plug, or earplugs.
In a preliminary trial, Kemps and Tiggemann (2007) used food craving and vividness data to construct a food-craving index. Analyzing the interactions of each of the experimental groups with the food-craving index, the authors concluded that there was an overall decrease in cravings using visual and olfactory imagery. However, the results did not produce statistical significance that the vividness of the imagery contributed to a decrease in cravings. The fact that olfactory imagery had a statistical effect on cravings is a significant contribution to the Elaborated Intrusion Theory. In summary, the study showed that food cravings ensued after inducing imagery of their favorite foods (supporting previous findings) and that olfactory and visual imagery were superior in reducing food cravings than auditory. However, vividness of the image had an unrelated impact on the strength of the food craving.
The second experiment was similar to the first experiment but the participants were asked to specifically imagine eating chocolate. The results produced a positive and statistically significant correlation between vividness of the chocolate and the level of the chocolate craving. Again the visual and olfactory response was superior to the response elicited from the auditory task.
The third experiment was similar to the first two, however this time the researchers deprived the participants of chocolate and then exposed them to actual chocolate bars rather than having them simply imagine it. The exposure to their favorite candy bars allowed for a cross-sensory experience (touch of the bar, smell of the chocolate, sound of the wrapper, visual of the chocolate) and produced a higher craving rating. However, like the other two studies, the imagery vividness did not correlate to a reduction in cravings while olfactory and visual imagery tasks produced a greater reduction in cravings than the auditory task. Kemps and Tiggermann (2007) note, “The finding that visual and olfactory imagery reduced participants’ chocolate cravings in a way that auditory imagery did not is consistent with the proposition that is the sensory modality of the craving-related imagery, rather than that of the craving induction procedure, that is important” (p.101).
This three-part study was well conducted with a strong sample size of 90, highly replicable, and employed sound statistical methodology. However, imagery based craving produced in the laboratory do not necessarily translate into real-world situations with naturally occurring cravings. The findings are hopeful that imagery techniques taught to people with weight issues could contribute as a useful tool for decreasing persistent cravings and ultimately help with weight management.
Tools for managing food-related imagery
In another study McClelland, Kemps, and Tiggerman (2006) addressed the impact of imagery on cravings and found that vividness and craving intensity could be reduced using forehead tracking. The technology of forehead tracking requires no laboratory equipment making it an accessible and realistic solution for people experiencing unmanageable cravings. The researchers set out to measure the efficacy of various visuo-spatial tasks such as eye movement, dynamic visual noise, spatial tapping, and forehead tracking on the associated food cravings with vivid food images. The study sought to have real-world application by emulating natural cravings of the participant’s personal food cravings rather than common foods like pizza, ice cream, and chocolate that had been used in prior studies. The novel finding of the study is the suggestion that because forehead tracking was the most effective tool amongst the others examined is that, “craving-related food imagery engages visual rather than spatial processing resources” (p. 363). Additional interesting findings regarding the relationship between imagery and cravings is that the predictability of strong cravings is mediated by vividness of food images compared to other women who were exposed to the same food cues. Also to note is that the individuals with stronger food cravings tended to be good imagers in general.
Imagery vividness and BMI
Given that cravings are perpetuated by mental imagery, the next question to consider is if the strong ability to image impacts or has a relationship with BMI. Following the two studies described above, Patel, Aschenbrenner, Shamah and Small (2015) did a two-part experiment to study the correlation between imagery vividness and predictor of BMI. The study involved 25 participants who filled out The Vividness of Visual Imagery Questionnaire (VVIQ) and the Vividness of Olfactory Imagery Questionnaire (VOIQ) that assessed visual and olfactory imagery ability. They also took the Food-Craving Inventory (FCI) to measure craving levels. Results in experiment one indicated that participants with higher BMI also had great odor imagery ability. Consistent with previous studies, VVIQ and VOIQ scores did not prove a correlation with FCI scores, which prohibited the researchers from being able to draw conclusions about the relationship between BMI and cravings. In the second experiment, 57 participants were retested in the same way confirming that there is a positive relationship with BMI and perceived olfactory imagery. Additionally, the participants who scored higher in the ability to image not only had higher BMI’s but also reported stronger skills in imaging non-food specific items. These findings suggest that people struggling with obesity will be more reactive to food cues resulting in heightened cravings. It is unclear if obesity heightens imagery sensitivity or if there is a pre-disposition to imagery sensitivity that contributes to weight gain. Given that there is a relationship between obesity and spontaneous imagery, it would be valuable to understand if active imagery can help with weight management.
Guided Imagery Training and Weight Loss Intervention
The first part of this paper examined the research on how involuntary imagery impacts weight while the next part of this paper discusses the research of how active imagery can improve the habits that lead to weight loss.
Functional Imagery Training
Andrade, Khalil, Dickson, May, and Kavanagh (2016) tested a new theory based intervention called Functional Imagery Training (FIT). The premise of FIT is that “vivid, highly valued goal imagery will cope with craving imagery and key decisional moments such as when we may choose between eating some carrot sticks or a chocolate bar” (p. 257). The experiment was intended to test if FIT could impact high calorie snacking, improve motivational cognitions and influence weight change. Forty-five participants started with an imagery practice task of cutting a lemon so that they could understand how all the sense can be engaged by imagery. This was followed by imagining the positive experiences they may enjoy if they reduced snacking for a year, accompanied by prompts to enhance sensory and emotional effects of the imagery. Each participant followed this episode by ranking their image form 1 (no image) to 10 (extremely vivid). Following the imagery, participants were asked what actions they could take to reduce their snacking and raise their confidence levels to do so and then imagined another time when they were able to control snacking or used self-control. They were guided through further imagery of getting started with their goal, working through challenges, re-rating confidence and then developing a concrete plan. The final part of the FIT intervention involved identifying a routine behavior so that they could attach a daily practice of imagery involving how good it would feel to be successful in being in control of snacking behavior. The imagery was enforced with setting reminders and taking photos.
The researchers took special care to use multiple layers of imagery to enforce and reinforce the feelings and emotions of what reduced snacking would feel like and the feelings of the outcome. That craving imagery is so powerful as discovered in the studies discussed previously, the need for repetitive and consistent imagery that allows the imager to hold long-term goals in their consciousness seems imperative for success.
The results in a two week follow up in fact did show that following the FIT imagery practice, participants increased the frequency of motivational thoughts as measured by the MTF-D questionnaire, decreased snacking, and lost a moderate amount of weight. The weight loss is debatably due to the Hawthorne effect and would need to be reassessed over a longer period of time to understand if there is a true correlation.
Guided Imagery and obesity biomarkers
A pilot study with obese Latino adolescents aimed to look at the relationship imagery has on biomarkers of obesity such as insulin levels, adiposity, stress, and behaviors such as physical activity and dietary choices and compared it to a didactic lifestyle education intervention (Weigensberg et al., 2014). The imagery group participated in 12 45-minute guided imagery sessions that started with 10-15 minutes of foresight of looking at the upcoming exercise, 20 minutes of insight into the actual imagery exercise, and 10-15 minutes of debrief. The imagery included focused breath and muscle relaxation, relaxed place image, physical activity image, fullness symbol, healthy eating, image, personal meaning of healthy eating and physical activity, working with resistance to healthy eating, transforming healthy habits, and looking ahead.
The results of the study reported an increase in exercise and a decrease in sedentary behavior in the guided imagery group compared to the didactic group. There was no change in insulin resistance or adiposity in either group. However, the stress reduction imagery led to a reduction in cortisol levels comparable to other mind-body modalities. The study’s strengths are in the randomization and the experiment design to isolate imagery and it’s effects on stress and behavior change.
Guided Imagery and body scan
The studies above show cravings can be interrupted by imagery tasks. Hamilton et al. (2013) compared the mindfulness technique of body scanning with the lesser-used intervention of imagery and found the impact on craving reduction to be equal. They found, “…suppressing food related imagery during a potential craving episode is the most important factor in preventing a rise in craving intensity” (p.161).
While this study demonstrates that there is value in utilizing active imagery to manage cravings, it is unclear if the modulation is due to the function of mood and relaxation or controlling mind wandering than the actual imagery.
Conclusions
The role of imagery in both contributing and helping obesity has substantial research that helps us understand more of the complexities around cravings and weight loss strategies. Several studies have successfully shown in that in the laboratory setting exposure to tempting foods or imagery are triggers for spontaneous imagery and uninhibited thinking that perpetuate uncontrollable cravings. In real world situations such as overweight kids who see their friends eating junk food at school, or adults who self-soothe with desserts, are unconsciously developing food related imagery that leads them to indulge cravings despite weight loss efforts. The role of active imagery in treating obesity to reduce the vividness and spontaneity of images that lead to cravings has the potential to help the population. While it is always useful to have more research, there is a substantial argument to teach imagery techniques to both kids and adults.
References
Andrade, J., Khalil, M., Dickson, J., & Kavanagh, D. J. (2016). Functional imagery training to reduce snacking: Testing a novel motivational intervention based on Elaborated Intrusion theory. Appetite, 100(256-262). doi: 10.1016/j.appet.2016.02.015
Andrade, J. May, D.K. Kavanagh (2012) Sensory imagery in craving: From cognitive psychology to new treatments for addiction. Journal of Experimental Psychopathology, 3 (2012)
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