Background: Patients with restrictive Anorexia Nervosa (AN-R) severely restrict their food intake, often showing significant food avoidance behavior, especially for diet-goal threatening and high-calorie foods. Still, stringent comparisons of avoidance behaviors in relation to calorie dense foods, low-calorie food and abstract (amodal) food cues are required to better understand the underlying mechanisms.
Methods: Approach-avoidance behavior was measured in individuals with AN-R (n = 21) and Healthy Controls (HC; n = 19) using a virtual reality stop-signal task. In a virtual environment, participants had to reach a digitally rendered hand toward low-calorie, high-calorie and amodal (packaged) food cues, as well as nonfood cues (shoes). If a stop-sign appeared, they had to inhibit this movement (stop-trials). They also rated how much they liked and wanted each stimulus on a visual analog scale from 0 to 100.
Results: Participants showed more approach behavior towards amodal food cues compared to high-calorie concrete food cues (t[39] = 25.38, p <.001, d = 4.01). Furthermore, patients with AN-R reported lower wanting for high-calorie foods (t[37] = 2.13, p =.040, d = 2.13) and greater wanting for nonfood cues (t[37] = -3.35, p =.002, d = 3.35). Across groups, liking was highest for high-calorie food, both packaged (t[39] = 4.03, p =.002, d = 0.40) and unpackaged (t[39] = 3.53, p =.007, d = 0.36).
Conclusions: Food presentation can influence approach behavior toward food cues. Future research is needed to determine whether the use of abstract food cues can facilitate food approach behavior in individuals with AN-R.
Keywords: Anorexia nervosa; Construal-level theory; Low-calorie food; Modality; Virtual reality.
Individuals with anorexia nervosa (AN) tend to avoid calorie-dense foods. This avoidance also extends to food images. However, we do not fully understand which features of food lead to avoidance. In this article, we examine how four different categories - high-calorie food in packaging, high-calorie food unpackaged, low-calorie food unpackaged and nonfood (shoes) - affect avoidance in patients with AN compared to healthy control participants. We found that unpackaged foods were avoided more than packaged foods, but that packaged and unpackaged high-calorie foods were equally wanted and liked by patients with AN. This could indicate that packaged foods are easier to access for individuals with AN. If so, making food more abstract may make it easier for individuals with AN to interact with it. Future studies should thus test if using more abstract food cues could help individuals with AN reduce their avoidance of food cues all together.
© 2025. The Author(s).