# Food and body-related attentional biases in children and adolescents with eating disorder symptoms, overweight and obesity: a systematic review

## TL;DR

This review examines how children and adolescents with eating disorders, overweight, or obesity show attentional biases to food and body cues, which may contribute to their conditions.

## Contribution

The study provides a systematic review of attentional biases in young populations with eating disorders and obesity, highlighting inconsistencies and research gaps.

## Key findings

- Evidence on food-related attentional biases in overweight and obesity is inconclusive.
- Anorexia nervosa is associated with heightened attention to low-calorie foods and body-related cues.
- Body-related attentional biases may be a relevant marker for eating disorder psychopathology.

## Abstract

Disordered eating behaviors (DEBs), including restrictive eating, binge eating and purging, are associated with mental health problems and an increased risk of eating disorders (EDs), which often occur in adolescence and can have serious health consequences. In addition, the increasing rates of overweight and obesity among children and adolescents raise concerns about their associated physical and mental health risks. Attentional biases (ABs) to food- and body-related cues have been proposed as cognitive mechanisms that contribute to the development and maintenance of EDs and are also discussed in the etiology of overweight and obesity. While theoretical models suggest that ABs may contribute to the maintenance of EDs, DEBs, and obesity, empirical evidence in young populations is still limited.

This systematic review (PROSPERO: CRD42023399292) examined literature from PsycINFO, PubMed, and Scopus on ABs to food- and body-related stimuli in children and adolescents with overweight, obesity, or ED symptoms, compared to healthy comparisons. A total of 30 peer-reviewed studies published in English since 2003 were included.

The evidence on AB for food in young people with overweight and obesity remains inconclusive, and studies provide conflicting results. Similarly, studies in adolescents with AN show heightened attention to low-calorie foods and inconsistent attentional patterns toward high-calorie foods, indicating a complex and heterogeneous picture. Evidence on AB for food in young people with BED is scarce, with one study reporting an attentional bias towards food. For LOC eating, findings were mixed and less conclusive. This suggests that body-related AB may serve as a relevant marker for the psychopathology of EDs, particularly in AN.

This review underscores the role of ABs in EDs and overweight/obesity and highlights methodological inconsistencies as well as research gaps, particularly in samples beyond AN and overweight/obesity. Future studies should therefore employ standardized methods, diverse samples, and developmental perspectives to improve understanding of AB in the etiology of these pathologies and inform targeted interventions for at-risk youth.

The online version contains supplementary material available at 10.1186/s40337-025-01459-9.

Eating disorders (EDs) and unhealthy eating behaviors can seriously affect young people’s mental and physical health. In addition, the increasing rates of overweight and obesity among adolescents raise concerns about their associated physical and mental health risks. One possible factor influencing eating behavior and body perception is attentional bias (AB) – the tendency to selectively filter certain information, such as food or body-related cues. This review systematically examines studies on AB in young people with EDs, overweight, or obesity. Findings on food-related ABs were inconsistent, with some studies showing increased attention to food in young people with obesity/overweight or EDs compared to comparison participants, while others found no clear differences or even decreased attention to food. In contrast, research on body-related ABs in anorexia nervosa (AN) was more consistent, showing a stronger focus on thin bodies and self-perceived unattractive body areas in young people with AN compared to comparison participants. These findings suggest body-related ABs may play a role in AN, yet, overall, research remains limited and inconsistent. More studies using reliable methods are needed to clarify similarities and differences in ABs across different eating behaviors and to provide a basis for improving prevention and strategies for at-risk children and adolescents.

The online version contains supplementary material available at 10.1186/s40337-025-01459-9.