Food images are frequently used in both eating disorder (ED) research and clinical practice settings. While some evidence shows food images can be beneficial for ED research and therapeutic intervention, recent research suggests a new type of image stimuli may be a more effective and reliable way to detect and treat eating disorders.
Food Preoccupation and Eating Disorders
Research shows that one of the key characteristics of eating disorders (ED) is an overconcern or preoccupation with food . While this preoccupation with food often manifests itself in obvious ways (e.g., food restriction, food avoidance, binge eating, or spending large amounts of time meal planning or cooking for others), it is also evident through numerous physiological, neurological, and emotional responses.
For example, when presented to people with eating disorders, images of food have been shown to trigger significant changes in heart rate and brain activity . Other studies show that people with eating disorders focus more attention on food stimuli images than people in healthy control groups, suggesting those with eating disorders show attentional bias towards images of food because they view food as threatening .
Since food stimuli trigger such significant physiological and psychological changes in people with EDs, food images are often used in research and clinical practice to help detect ED symptomatology and treat ED behaviors. However, recent studies suggest food images may not be the most reliable way to measure emotional, neurological, and physiological responses in ED patients.
A Review of Food Images and Eating Disorders
A group of researchers recently reviewed 29 eating disorder papers with the goal of determining which type of stimuli (food images or body/weight images) triggers the greatest response in people with eating disorders . Examining people across multiple ED diagnoses (anorexia nervosa, binge-eating disorder, and bulimia nervosa), the study compared ED patients’ emotional, neural, and physiological responses to both food and body/weight stimuli.
Similar to other findings on food images and eating disorders, the researchers found that among anorexia nervosa (AN) patients, images of food produced high levels of subjectively rated anxiety and a significant negative emotional response (detected via neuroimaging). Further, people with AN showed similar emotional responses to food images as they did to negative, non-food images, suggesting food stimuli triggers a negative effect among people with AN.
However, AN participants’ physiological responses (based on heart rate, changes in the startle-blink reflex, skin conductance response, etc.) to food stimuli were not always consistent with their subjective and emotional ratings. For example, when presented with images of food, people with anorexia did not show any significant changes in the startle-blink reflex compared to people in healthy controls.
Furthermore, the startle-blink reflex remained similar among AN patients when both food stimuli and neutral (non-food) stimuli were presented. In other words, while AN patient’s self-rated food images as “highly anxiety-provoking,” their physiological responses to food images did not reflect this anxiety.
The review also uncovered inconsistencies in the emotional and physiological responses to food images among people with bulimia nervosa (BN). Interestingly, individuals with BN demonstrated significant changes in the startle-blink reflex for food images compared to healthy controls.
This means people with BN showed an aversive and negative physiological response to food images, indicating images of food provoked anxiety among those with BN. However, when asked to verbally rate and self-respond to food images, the same group rated food images as interesting and pleasant, once again demonstrating a discrepancy between the emotional and physiological responses to food stimuli among ED patients.
Body/Weight Images and Eating Disorders
Though more research is needed, the ED literature review found evidence that body/weight images may be more reliable than food images when measuring the physiological, neural, and emotional responses of ED patients . For instance, when people with BN were presented with images of their own body, they exhibited the cardiac defense response (detected by measuring heart rate patterns), indicating a negative reaction to these images. This physiological response coincided with the negative emotional ratings they gave their self-images.
Further, when a group of people with various eating disorders was shown images of a thin ideal model and their own image in the mirror, they exhibited significant, negative physiological changes (demonstrated through postural destabilization) compared to healthy controls who also viewed the same images. The ED group’s negative physiological responses to body/weight images coincided with their self-rated negative emotional responses, suggesting the reliability of using body/weight images to measure both the emotional and physiological responses of ED patients.
Though this review of ED literature demonstrates images of food often have a negative effect on people with eating disorders, it also indicates that body/weight images may be a more reliable way to measure the neural, physiological, and emotional responses of people with ED. These findings can be used to guide further research and help inform therapeutic interventions that utilize imagery such as virtual reality-based ED treatment and cognitive behavioral therapy (CBT).
 Burmester, V., Graham, E. & Nicholls, D. Physiological, emotional and neural responses to visual stimuli in eating disorders: a review. J Eat Disord 9, 23 (2021). https://doi.org/10.1186/s40337-021-00372-1
About the Author:
Sarah Musick is a freelance writer who specializes in eating disorder awareness and education. After battling with a 4-years long eating disorder, she made it her mission to help others find hope and healing in recovery.
Her work has been featured on numerous eating disorder blogs and websites. When she’s not writing, Sarah is off traveling the world with her husband.
The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.
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Published April 15, 2021, on EatingDisorderHope.com
Reviewed & Approved on April 15, 2021, by Jacquelyn Ekern MS, LPC