The influence of attractiveness and convenience cues on food appeal in adults with and without ADHD
Introduction
Attention-deficit/hyperactivity disorder (ADHD) is a highly prevalent neurodevelopmental condition, characterized by a persistent pattern of inattentive, and/or hyperactive-impulsive behavior, leading to functional impairment (American Psychiatric Association, 2013; Faraone et al., 2015). The disorder affects approximately 5% of children and adolescents (Polanczyk, Willcutt, Salum, Kieling, & Rohde, 2014) and 2.5% of adults (Michielsen et al., 2012) worldwide.
Decades of research have consistently reported strong links between ADHD and adverse life outcomes (Faraone et al., 2015; Thapar & Cooper, 2016) (Asherson, Buitelaar, Faraone, & Rohde, 2016). Whereas ADHD-related impairments in academic, occupational and social domains have already been well established, only in recent years attention was devoted to health impairments, as sleep difficulties, physical injuries, hypertension, and obesity (Nigg, 2013; Spencer, Faraone, Tarko, McDermott, & Biederman, 2014), as well as unhealthy eating patterns.
Studies have found that Australian adolescents with ADHD consumed foods with less nutrient density and more total fat (Howard et al., 2011); Iranian children with ADHD adhered more often to the sweet- and fast-food diet (Azadbakht & Esmaillzadeh, 2012); and Korean children with higher odds of having ADHD endorsed the traditional Western pattern (Woo, Shin, & Kim, 2014). A large-sample study revealed significant associations between ADHD and both the number of overeating episodes and unhealthy food consumption in children (Kim et al., 2014). Another research (Ríos-Hernández, Alda, Farran-Codina, Ferreira-García, & Izquierdo-Pulido, 2017) revealed that children and adolescents with ADHD demonstrated reduced intake of vegetables and fruits and increased intake of sugar, candies, soft drinks, and fast food. A more recent work (Chou et al., 2018) revealed that children with ADHD consumed a lower proportion of calcium and vitamin B-2 compared with non ADHD controls. Hershko and colleagues have recently found that university students with ADHD reported eating a similar number of calories and food servings to controls, yet the composition of these calories included more unhealthy foods for ADHD ones (Hershko, Aronis, Maeir, & Pollak, 2018). These unhealthy eating patterns have the potential to increase the risk of obesity and other related diseases, urging the development of health interventions.
People are continuously exposed to food thereby making multiple food choices on a daily basis; choices that play an essential role in the regulation of food intake and consequently in weight management (Charbonnier, van der Laan, Viergever, & Smeets, 2015). Therefore, obtaining a deeper insight into the mechanisms underlying people's food choices is imperative. It has been found that visual cues can influence food choices (Wansink, Cheney, & Chan, 2003), eliciting a wide range of responses: physiological (such as a release of insulin and changes in heart rate (Drobes et al., 2001)), emotional (as the desire to eat (Ouwehand & Papies, 2010) or pleasure (Berthoud & Morrison, 2008)), and cognitive processes (memory retrieval and hedonic evaluation (Berthoud & Morrison, 2008)). Several functional MRI studies, which examined the brain responses to visual food cues found that they are primarily guided by the visual system (Linné, Barkeling, Rössner, & Rooth, 2002). For instance, they showed that viewing pictures of high calorie foods are more rewarding than low calorie ones (Charbonnier et al., 2015).
An effective intervention for altering food choices consists in making healthy choices not only more convenient (to be seen, picked up and consumed) but also more attractive (a nicely designed packaging, a catchy brand name, or a reasonable price) (Wansink, 2015). For instance, children ate 70% more apples when they were served in slices than when they were served as a whole (Wansink, Just, Hanks, & Smith, 2013), and placing apples near the cash register increased their sales by 35% (van Kleef, Otten, & van Trijp, 2012). It has also been shown that people responded, both consciously and unconsciously, to differences in these features while making food choices (Wilson, Buckley, Buckley, & Bogomolova, 2016); putting fruit in a nice bowl enticed children to take more of it, and adding a garnish to a sandwich made people rate the sandwich as tastier even though the garnish was not consumed (Hanks, Just, Smith, & Wansink, 2012). These examples demonstrate that the levels of attractiveness and convenience of food items have a significant impact on food choices and appeal.
To our knowledge, the effect of contextual cues, such as attractiveness and convenience, have not been examined in people with ADHD; therefore, the extent to which their food choices may be affected by contextual cues is still unclear. On the one hand, individuals with ADHD may be more sensitive to reward (Luman, Tripp, & Scheres, 2010; Tripp & Wickens, 2009). The mesocortical dopamine system, which has been implicated in ADHD, plays an important role in reward-related processes, and it contains circuits that function to motivate and reinforce food seeking and eating behaviors (Ikemoto & Panksepp, 1999). It has been proposed that the mesolimbic reward system increases responsiveness to visual food cues. Individuals with ADHD are also more reluctant to engage in a mental effort (Barkley, 2003), reflecting difficulties in effort allocation (Sergeant, 2005). On the other hand, they are inattentive, so they may pay less attention to the contextual details (American Psychiatric Association, 2013; Faraone et al., 2015). Taken together, these features may make them more or less prone to attractiveness and convenience cues. Therefore, the aim of the current study was to examine the extent to which adults with ADHD are inclined to convenience and attractiveness food cues.
Section snippets
Participants and protocol
The study was approved by the institutional review board of the Hebrew University. (0410I2016). The dataset is publicly available at https://osf.io/s9wx8. All participants filled out a consent form for participating in the study before completing the questionnaires. One hundred and seventy-two university undergraduate students (83 males and 89 females) were recruited through student's social media, aged 19–40, in the Faculty of Agriculture, Food and Environment, of the Hebrew University of
Demographic and clinical characteristics of the ADHD and the control groups
The comparison between the characteristics between the ADHD and the control groups showed no differences in age, sex, family status, BMI, obesity rate, and hunger. The analysis also confirmed that the means of the ASRS and the general psychopathology (GHQ) scores were both significantly higher among people with ADHD than among controls (Table 1).
Effects of attractiveness and convenience cues on the perceived appeal of food items (hypothesis testing)
Fig. 2 shows the level of food appeal by attractiveness, convenience, and diagnostic group. Table 2 reports an ANOVA test, which revealed the following
Discussion
The current research examined whether the attractiveness and convenience of food items influenced their appeal for people with and without ADHD. The findings confirmed that attractiveness and convenience cues affect the appeal of foods. All participants (both controls and people with ADHD) rated attractive and convenient foods as more appealing than unattractive and inconvenient foods. These results are in accordance with field studies demonstrating that manipulating the attractiveness or
Declaration of competing interest
Cortese, S., Honoraria for talks on ADHD from: Association form Child and Adolescent Mental Health (CADDRA), British Association of Psychopharmacology (BAP), Canadian ADHD Alliance Resource (CADDRA), and Healthcare Convention.
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