# Attentional bias toward food in binge eating disorder: baseline differences and the limits of attention modification training

## TL;DR

People with binge eating disorder show stronger attention to high-calorie foods, but a short training did not significantly reduce this attention or improve eating behaviors.

## Contribution

This study confirms food-related attentional bias in BED and shows that a brief attention modification training lacks lasting or specific effects.

## Key findings

- Individuals with BED showed greater attentional bias toward high-calorie foods than control groups.
- AMT and placebo training led to similar, modest improvements in attentional measures after one week.
- Changes in attentional bias were not significantly linked to reduced eating pathology.

## Abstract

Attentional processes toward high-calorie foods contribute to the maintenance of binge eating disorder (BED) and have been targeted by attentional modification trainings (AMTs). In this study, we quantified food-related attentional bias (AB) in individuals with BED versus control groups with normal-weight (NCG) and overweight (OCG), and evaluated whether AMT effects would persist after one week and generalize to novel stimuli.

We assessed eating pathology and AB in 135 participants (BED: n = 72; NCG: n = 32; OCG: n = 31). We used a dot-probe paradigm with concurrent eye-tracking and reaction-time measures. Sixty-one participants with BED were then randomized to four sessions of AMT or placebo training. All participants with BED underwent re-evaluations of AB and eating pathology one week after the final training session.

At baseline, the group with BED presented significantly greater AB toward high-calorie food cues than both the NCG and OCG did. One week post-training, no differential effects of AMT were observed: both the AMT and placebo groups showed modest, nonspecific reductions in initial fixation duration bias and reaction-time variability. Correlations between changes in AB toward food and eating pathology were small and not significant.

The presence of a food-related AB in individuals with BED was confirmed. However, AMT did not yield sustained or generalized modifications in attentional processing beyond those observed in the placebo condition. Nonspecific improvements may reflect enhanced overall attentional control or general exposure effects. Future research should isolate the active components of AMT and explore strategies to increase its ecological validity.

Trial registration: Registered in the German Clinical Trials Register (DRKS00012984) on 2017-11-30.

The online version contains supplementary material available at 10.1186/s40337-025-01450-4.

People with binge eating disorder (BED) tend to pay more attention to high-calorie foods automatically. To study this, we showed images of food and neutral items side by side while tracking eye movements and reaction times. As expected, individuals with BED looked longer at food pictures than people with normal-weight and overweight without BED did. Next, we tested whether a brief computer-based training (attentional modification training, or AMT) could sustainably reduce this food-focused attention. Sixty-one participants with BED were randomly assigned to either four real AMT sessions or sham training that did not target attention. One week later, we repeated the attention tests using new food images. Both groups showed small, similar improvements in how quickly they shifted attention away from food; no lasting or unique benefit of the AMT could be found. These minor attentional changes were not strongly linked to reductions in binge eating episodes or cravings. It appears that simple repeated exposure to food images or general practice effects, rather than the specific AMT, may explain the slight improvements. In summary, people with BED do have a stronger focus on high-calorie foods, but our short AMT did not produce lasting changes in attention or clearly improved their eating behaviors. Future research should identify which training elements truly help and how to make effects last in everyday life.

The online version contains supplementary material available at 10.1186/s40337-025-01450-4.