Skip to main content

Battle of plates: a pilot study of an approach–avoidance training for overweight children and adolescents

  • Petra Warschburger (a1), Michaela Gmeiner (a1), Marisa Morawietz (a1) and Mike Rinck (a2)

Approach–avoidance training (AAT) is a promising approach in obesity treatment. The present study examines whether an AAT is feasible and able to influence approach tendencies in children and adolescents, comparing implicit and explicit training approaches.


Fifty-nine overweight children and adolescents (aged 8–16 years; twenty-six boys) participated in an AAT for food cues, learning to reject snack items and approach vegetable items. Reaction times in the AAT and an implicit association test (IAT) were assessed pre- and post-intervention.


A significant increase in the AAT compatibility scores with a large effect (η 2=0·18) was found. No differences between the implicit and explicit training approaches and no change in the IAT scores were observed.


Automatic tendencies in children can be trained, too. The implementation of AAT in the treatment of obesity might support the modification of an unhealthy nutrition behaviour pattern. Further data from randomized controlled clinical trials are needed.

Corresponding author
* Corresponding author: Email
Hide All
1. Brettschneider, A-K, Schaffrath Rosario, A, Kuhnert, R et al. (2015) Updated prevalence rates of overweight and obesity in 11- to 17-year-old adolescents in Germany. Results from the telephone-based KiGGS Wave 1 after correction for bias in self-reports. BMC Public Health 15, 1101.
2. von Kries, R, Beyerlein, A, Müller, MJ et al. (2012) Different age-specific incidence and remission rates in pre-school and primary school suggest need for targeted obesity prevention in childhood. Int J Obes (Lond) 36, 505510.
3. Llewellyn, A, Simmonds, M, Owen, CG et al. (2016) Childhood obesity as a predictor of morbidity in adulthood: a systematic review and meta-analysis. Obes Rev 17, 5667.
4. Park, MH, Falconer, C, Viner, RM et al. (2012) The impact of childhood obesity on morbidity and mortality in adulthood: a systematic review. Obes Rev 13, 9851000.
5. Finkelstein, EA, Graham, WCK & Malhotra, R (2014) Lifetime direct medical costs of childhood obesity. Pediatrics 133, 854862.
6. Sanders, RH, Han, A, Baker, JS et al. (2015) Childhood obesity and its physical and psychological co-morbidities: a systematic review of Australian children and adolescents. Eur J Pediatr 174, 715746.
7. Sonntag, D, Ali, S, Lehnert, T et al. (2015) Estimating the lifetime cost of childhood obesity in Germany: results of a Markov model. Pediatr Obes 10, 416422.
8. Altman, M & Wilfley, DE (2014) Evidence update on the treatment of overweight and obesity in children and adolescents. J Clin Child Adolesc Psychol 44, 521537.
9. Strack, F & Deutsch, R (2004) Reflective and impulsive determinants of social behavior. Pers Soc Psychol Rev 8, 220247.
10. Hendrikse, JJ, Cachia, RL, Kothe, EJ et al. (2015) Attentional biases for food cues in overweight and individuals with obesity: a systematic review of the literature. Obes Rev 16, 424432.
11. Werthmann, J, Jansen, A & Roefs, A (2015) Worry or craving? A selective review of evidence for food-related attention biases in obese individuals, eating-disorder patients, restrained eaters and healthy samples. Proc Nutr Soc 74, 99114.
12. Jansen, A, Houben, K & Roefs, A (2015) A cognitive profile of obesity and its translation into new interventions. Front Psychol 6, 1807.
13. Turton, R, Bruidegom, K, Cardi, V et al. (2016) Novel methods to help develop healthier eating habits for eating and weight disorders: a systematic review and meta-analysis. Neurosci Biobehav Rev 61, 132155.
14. Kakoschke, N, Kemps, E & Tiggemann, M (2016) Approach bias modification training and consumption: a review of the literature. Addict Behav 64, 2128.
15. Eberl, C, Wiers, RW, Pawelczack, S et al. (2013) Approach bias modification in alcohol dependence: do clinical effects replicate and for whom does it work best? Dev Cogn Neurosci 4, 3851.
16. Wiers, RW, Eberl, C, Rinck, M et al. (2011) Retraining automatic action tendencies changes alcoholic patients’ approach bias for alcohol and improves treatment outcome. Psychol Sci 22, 490497.
17. Dickson, H, Kavanagh, DJ & MacLeod, C (2016) The pulling power of chocolate: effects of approach–avoidance training on approach bias and consumption. Appetite 99, 4651.
18. Maas, J, Keijsers, GPJ, Rinck, M et al. (2015) Does a dieting goal affect automatic cognitive processes and their trainability? Cogn Ther Res 39, 378389.
19. Schumacher, SE, Kemps, E & Tiggemann, M (2016) Bias modification training can alter approach bias and chocolate consumption. Appetite 96, 219224.
20. Becker, D, Jostmann, NB, Wiers, RW et al. (2015) Approach avoidance training in the eating domain: testing the effectiveness across three single session studies. Appetite 85, 5865.
21. Brockmeyer, T, Hahn, C, Reetz, C et al. (2015) Approach bias modification in food craving – a proof-of-concept study. Eur Eat Disord Rev 23, 352360.
22. Wiers, RW, Rinck, M, Kordts, R et al. (2010) Retraining automatic action-tendencies to approach alcohol in hazardous drinkers. Addiction 105, 279287.
23. Volkow, ND, Wang, GJ, Tomasi, D et al. (2013) Obesity and addiction: neurobiological overlaps. Obes Rev 14, 218.
24. Wiers, RW, Gladwin, TE, Hofmann, W et al. (2013) Cognitive bias modification and cognitive control training in addiction and related psychopathology: mechanisms, clinical perspectives, and ways forward. Clin Psychol Sci 1, 192212.
25. Kromeyer-Hauschild, K, Wabitsch, M, Kunze, K et al. (2001) Perzentile für den Bodymass-Index für das Kindes- und Jugendalter unter Heranziehung verschiedener deutscher Stichproben. Monatsschr Kinderheilkd 149, 807818.
26. Borrmann, A & Mensink, GBM (2015) Obst- und Gemüsekonsum von Kindern und Jugendlichen in Deutschland: Ergebnisse der KiGGS-Welle 1. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 58, 10051014.
27. Baird, SO, Rinck, M, Rosenfield, D et al. (2017) Reducing approach bias to achieve smoking cessation: a pilot randomized placebo-controlled trial. Cogn Ther Res 41, 662670.
28. Karpinski, A & Steinman, RB (2006) The single category implicit association test as a measure of implicit social cognition. J Pers Soc Psychol 91, 1632.
29. Blechert, J, Meule, A, Busch, NA et al. (2014) Food-pics: an image database for experimental research on eating and appetite. Front Psychol 5, 617.
30. Cohen, J (1988) Statistical Power Analysis for the Behavioral Sciences, 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates.
31. Victor, A, Elsäßer, A, Hommel, G et al. (2014) Wie bewertet man die p-Wert-Flut? Dtsch Arztebl 107, 5056.
32. Huijding, J, Field, AP, Houwer, J de et al. (2009) A behavioral route to dysfunctional representations: the effects of training approach or avoidance tendencies towards novel animals in children. Behav Res Ther 47, 471477.
33. Kong, G, Larsen, H, Cavallo, DA et al. (2015) Re-training automatic action tendencies to approach cigarettes among adolescent smokers: a pilot study. Am J Drug Alcohol Abuse 41, 425432.
34. Mensink, GB, Kleiser, C & Richter, A (2007) Lebensmittelverzehr bei Kindern und Jugendlichen in Deutschland. Ergebnisse des Kinder- und Jugendgesundheitssurveys (KIGGS). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 50, 609623.
35. Lanfer, A, Knof, K, Barba, G et al. (2012) Taste preferences in association with dietary habits and weight status in European children: results from the IDEFICS study. Int J Obes (Lond) 36, 2734.
36. Craeynest, M, Crombez, G, Haerens, L et al. (2007) Do overweight youngsters like food more than lean peers? Assessing their implicit attitudes with a personalized Implicit association task. Food Qual Prefer 18, 10771084.
37. Roefs, A & Jansen, A (2002) Implicit and explicit attitudes toward high-fat foods in obesity. J Abnorm Psychol 111, 517521.
38. Eberl, C, Wiers, RW, Pawelczack, S et al. (2014) Implementation of approach bias retraining in alcoholism – how many sessions are needed? Alcohol Clin Exp Res 38, 587594.
39. Boendermaker, WJ, Prins, PJM & Wiers, RW (2015) Cognitive bias modification for adolescents with substance use problems – can serious games help? J Behav Ther Exp Psychiatry 49, 1320.
40. Connor Gorber, S, Tremblay, M, Moher, D et al. (2007) A comparison of direct vs. self-report measures for assessing height, weight and body mass index: a systematic review. Obes Rev 8, 307326.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Public Health Nutrition
  • ISSN: 1368-9800
  • EISSN: 1475-2727
  • URL: /core/journals/public-health-nutrition
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score