Resisting Temptations: How Food-Related Control Abilities can be Strengthened through Implementation

IntentionsChristine Stich1, Philip J. Johnson2 and Bärbel Knäuper2

1Population Health, Prevention and Screening Unit, Cancer Care Ontario, Toronto, Canada2Department of Psychology, McGill University, Montreal, Canada

C H A P T E R

27

27.1 Introduction 343

27.2 The Motivational nature of Food 34427.2.1 The Rewarding Effects of Food 34427.2.2 The Rewarding Effects of Food

and Attention 34527.2.3 The Rewarding Effects of Food

and Eating Habits 346

27.3 Food-related Control Abilities 34627.3.1 Attention and Inhibitory

Behavioral Control 34627.3.2 Implementation Intentions 34727.3.3 Implementation Intentions

and Eating Behavior 34827.3.4 Replacing Unhealthy Habits

Through Implementation Intentions 349

o u T l I n E

27.1 InTrODUCTIOn

The past decade has witnessed a rise in the investigation of self-regulation, in particular in regard to the study of the processes underly-ing self-regulation failure and success in eat-ing and weight control. Successful behavioral

34Obesity Prevention: The Role of Brain and Society on Individual Behavior

control of eating involves the inhibition of the impulse to eat, particularly if it conflicts with long-term goals, such as eating more healthily or losing weight (Baumeister et al., 2007). If an individual lacks the inhibitory control necessary to resist temptation, he or she will succumb to it (Westling et al., 2006). Lapses in self-regulation

3 © 2010, Elsevier Inc.2010

27. ImPRovIng Food-RElATEd ConTRol AbIlITIES344

are thus an indication of a breakdown in inhibi-tory control. Some researchers suggest that, in the domain of eating behavior, being overweight and obese are linked to a lack of inhibitory con-trol, and, moreover, this lack might have crucial consequences for the development, maintenance and treatment of obesity in children and adults (see, for example, nederkoorn et al., 2006a, 2006b, 2007). For example, using a stop-signal task to assess inhibitory control in children, nederkoorn and colleagues (2006a) found that obese children undergoing a weight-loss treatment showed less inhibitory control than normal-weight children. They also demonstrated that less successful children in response inhibition lost less weight in the program (nederkoorn et al., 2006a). The researchers also compared obese women with normal-weight women and found that the for-mer were less likely to demonstrate inhibitory control (nederkoorn et al., 2006b).

Like inhibition control, attention control pro-cesses are necessary for successful self-regulation (mischel et al., 1989; mischel and ayduk, 2004; rueda et al., 2005). For example, in their classic work on delayed gratification in children, mischel and colleagues (mischel and ebbesen, 1970) showed that when 4-year-olds were provided with rewarding stimuli (cookies), attention paid to the rewards substantially decreased their ability to delay gratification – to wait for the reward. If not exposed to rewards, children waited on average over 11 minutes; however, if exposed to rewards, they waited less than 6 minutes. The ability to delay gratification has important implications, not only for successful self-regulation with food, but also in other domains, such as cognitive, academic, and social competences. mischel’s delay of grati-fication paradigm in children has been shown to be predictive of various indices of self-regulation later in life. For instance, 4-year-old children will-ing to wait longer before receiving their reward were over 10 years later described by their parents as adolescents who were more academically and socially competent than their peers, more able to tolerate frustration and cope maturely with stress,

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and better able to resist temptation. moreover, the time that 4-year-old children were willing to wait before receiving the reward was shown to be sig-nificantly related to their verbal and quantitative scores on the Scholastic aptitude Test (mischel et al., 1989).

It should be noted that, depending on the rewarding effects of stimuli (such as cookies in mischel’s paradigm), some stimuli are more attractive than others, thus producing an atten-tional bias (Waters et al., 2003). Consequently, when addressing people’s attention and inhibi-tory control abilities, it is also important to take into account the rewarding effects of the stimuli, as these will determine the degree to which such stimuli tax individuals’ attention and inhibitory control abilities.

We first review the motivational nature of food, and in particular high-fat/high-sugar food, and its consequences for attention to food and the devel-opment of (maladaptive) eating habits. We then discuss how certain self-control strategies might help people control their food intake. We focus here particularly on implementation intentions, and speculate how better planning with imple-mentation intentions could help people replace unhealthy eating habits with healthier ones.

27.2 THe MOTIvATIOnAl nATUre OF FOOD

27.2.1 The rewarding effects of food

In a relatively new theoretical approach to understanding food intake, Berridge (1996) sug-gests that “wanting” food and “liking” food are possibly two separate components affect-ing food intake, as they have distinct underly-ing brain substrates. In other words, although liking food is usually associated with wanting food, the two concepts can also be separated (Berridge, 1996; Berridge and robinson, 2003). For example, the sight of a cake in a bakery can draw in an individual, causing an intense desire

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34527.2 THE moTIvATIonAl nATuRE oF Food

(“want”) for the cake, even if that individual does not necessarily expect to “like” the cake very much (Winkielman and Berridge, 2003). according to Berridge (1996), “liking” refers to the hedonic preference for food, to its perceived pleasantness or palatability, and thus represents an affective component of food. In contrast, “wanting” food refers to the incentive or reward associated with food, and corresponds more closely to appetite or craving. as such, wanting represents a motivational component of eating (Berridge, 1996).

at the same time, even though food intake is influenced by both liking and wanting, sen-sory information such as the appearance, smell and taste of food is transformed into attrac-tive and desired incentives that motivate food intake through the attribution of rewarding effects, which are guided by associative learn-ing (Berridge and robinson, 2003). hence, once a specific food item is associated with reward-ing effects, the mere perception of its attributes, such as appearance or smell, can motivate eat-ing (e.g., Weingarten and elston, 1990; Fedoroff et al., 2003; Tiggemann and Kemps, 2005).

27.2.2 The rewarding effects of food and attention

as noted earlier, research has shown that stim-uli with rewarding effects can seize an individu-al’s attention (mischel and ayduk, 2004), and therefore people may develop an attentional bias or hyper-vigilance toward such stimuli (Waters et al., 2003). It has been found for a wide range of stimuli, such as smoke-related stimuli in smokers (e.g., Sharma et al., 2001; Waters et al., 2003), alco-hol stimuli in alcoholics (e.g., Sharma et al., 2001; noël et al., 2007) and mood-congruent stimuli in manic and depressed individuals (murphy et al., 1999). With respect to clinical populations, attentional bias for food stimuli has been found in both individuals with anorexia and those with bulimia nervosa (for review, see Faunce, 2002).

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Such a bias has also been demonstrated in individuals without an eating pathology. For instance, using a cued-target, covert attention paradigm, Leland and Pineda (2006; Study 1) found an attentional bias for food-related words in non-clinical normal-weight participants. In this study, participants were presented with food-related and neutral cue words. By appear-ing in the same or opposite hemifield, these cues served as either valid (75 percent) or invalid (25 percent) predictors of target (rectangles) location. Supporting the hypothesis that visual selective attention is biased by food-related stimuli, results showed that the effect of valid cues was larger for trials in which food words were cues than for trials in which neutral words were cues.

Looking further to the motivational salience of food stimuli, we recently found an attentional bias for visual food stimuli. Using a version of a go/no-go task to investigate inhibitory con-trol for food stimuli, we found that participants paid more attention to and showed a higher decision bias for food rather than for control stimuli. Specifically, participants responded faster to food pictures than to control pictures (landscapes), and tended to respond more to food than control pictures (Stich et al., 2008).

The question then arises as to whether spe-cific types of food possess particular reward-ing effects. as mentioned earlier, the rewarding effects of food (i.e., wanting) have been shown to have different underlying brain substrates than its palatability (i.e., liking). The two processes, however, are most likely interrelated when it comes to food intake (Berridge, 1996). hence, individuals want to eat food they find palat-able (e.g., epstein et al., 2003). moreover, foods that taste good (i.e., are more palatable) are often those high in fat and/or sugar. In contrast, foods that are low in fat and/or sugar are often perceived as unpalatable (Drewnowski, 1998). research has confirmed that, when given the choice between energy-dense snack foods and fruits and vegetables, most individuals choose

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snack foods (e.g., Goldfield and epstein, 2002). Such findings suggest that people have a pref-erence for palatable, energy-dense foods, and therefore they might show a higher attentional bias toward energy-dense foods. however, to our knowledge, research has yet to explore the relationship between types of food in terms of their palatability and energy density, and atten-tional bias.

27.2.3 The rewarding effects of food and eating habits

The aforementioned findings of attentional bias to food stimuli are especially important, as food stimuli can serve as cues to activate well-practiced routines or habits (e.g., Sayette, 1999; verplanken and Wood, 2006). In general, people acquire habits slowly, based on the co-variation between features of contextual cues and responses that they repeatedly experience (Wood and neal, 2007). habits are mediated by memory representations of the cue–response link, which operate automatically (Tiffany, 1990), without intention, effort or conscious awareness (Shiffrin and Schneider, 1977). This way, once a habit is formed, the behavioral response is merely triggered by the perception of the cues.

Because responses to contextual cues can occur intentionally or unintentionally, habits can be formed without being mediated by goals (Wood and neal, 2007). one way in which hab-its can be formed is in contexts in which people repeatedly experience rewards for a specific response (e.g., neal et al., 2006; Wood and neal, 2007). For example, when regularly eating chips in front of the Tv, this behavior can develop into a habit because eating in itself is rewarding. over time and with sufficient repetition, a per-son will automatically associate Tv-watching with eating chips, even if these are not avail-able. Illustrating the automaticity associated

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with habits, laboratory research and real-world studies have repeatedly demonstrated the facili-tating effect of contextual cues on speed and ac-curacy of responses (for an overview, see Wood and neal, 2007).

The self-regulatory process of permanently over-riding or inhibiting habitual and automatic rewarding responses requires conscious effort (Baumeister et al., 1994). Thus, when a goal (e.g., losing weight) conflicts with a habitual response (e.g., eating chips in front of the Tv), a per-son’s self-regulatory capacities will determine whether the goal or the habitual response will prevail. The undesirable habit will be inhibited only if sufficient self-regulatory capacities are available (Wood and neal, 2007).

overall, research suggests that if foods associ-ated with high rewarding effects are readily avail-able, they will seize individuals’ attention. Food can activate eating habits via its appearance, smell and taste, as well as through the context in which its consumption frequently occurs. The rewarding effects of food in combination with eating habits might lead to pre-potent approach tendencies that make inhibitory control chal-lenging. exerting control to inhibit attention and habitual eating responses depends on the avail-ability of self-regulatory capacities. Uninhibited, and in combination with a sedentary lifestyle, such pre-potent approach tendencies may con-tribute to the overconsumption of foods and, ultimately, to overweight and obesity, especially when the food consumed is energy dense.

27.3 FOOD-relATeD COnTrOl AbIlITIeS

27.3.1 Attention and inhibitory behavioral control

The task of controlling habitual food-related responses involves (1) attention control (mischel

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and ayduk, 2004) and (2) inhibitory control (nederkoorn et al., 2006a). attention control refers to the ability to keep oneself from getting distracted by attention-grabbing, goal-irrelevant stimuli, and to focus cognitive resources on goal-relevant behavior (e.g., avoiding fatty foods or sweet desserts and eating vegetables instead; Gollwitzer and Sheeran, 2006). as illustrated by ample research findings, failing to control attention, and therefore to inhibit the distraction through tempting stimuli, can greatly under-mine goal pursuit (e.g., Kuhl, 1981; Gollwitzer and Schaal, 1998; Gollwitzer and Sheeran, 2006; also see mischel and ayduk, 2004).

Inhibitory control is needed to inhibit or stop the execution of behavioral responses once a pre-potent or habitual behavior is initiated (e.g., Logan et al., 1997; Gollwitzer and Sheeran, 2006). In contexts where an undesired behavior can be avoided completely, inhibitory control refers to the inhibition of behavior in response to stimuli. For example, in the context of smoking cessation, it can mean avoiding stores where cigarettes are sold, not buying a package of cigarettes when seeing it in the store, or even inhibiting the act of lighting a cigarette, in order to avoid the occur-rence of the undesired behavior (i.e., smoking).

Inhibitory control with food, however, is more challenging, because individuals need to eat on a regular basis. Thus, instead of simply avoid-ing any behavior related to the tempting stimuli, people rather need to inhibit the consumption and overconsumption of particular types of food (e.g., energy-dense foods). In sum, to suc-cessfully abstain from giving in to eating temp-tations, both attention control and inhibitory behavioral control are necessary. Particularly in a world where food stimuli with significant rewarding effects are readily available, success-ful behavioral control entails the inhibition of consumptive responses to appetitive food stim-uli (attention control), as well as the inhibition of behavioral impulses (inhibitory control) that would lead to an overconsumption of calories.

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27.3.2 Implementation intentions

as mentioned, engaging in self-regulatory control processes such as attention and inhibitory behavioral control requires a significant amount of self-regulatory effort (e.g., Baumeister et al., 1994; Wood and neal, 2007). For these control efforts to be successful over time, their activation needs to be transformed from a non-automatic, conscious and effortful process into an auto-matic response (mischel and ayduk, 2004). The conversion of effortful self-regulatory pro-cesses into automatic ones lies at the center of Gollwitzer’s research on implementation inten-tions (Gollwitzer, 1993, 1996, 1999).

research has shown that by forming imple-mentation intentions, people can avoid giving in to temptations elicited by food. Implementation intentions are volitional strategies that can be used to translate behavioral intentions into actual behavior. While behavioral intentions (e.g., “I intend to eat a low-fat diet”) express people’s motivation to engage in a certain behavior, implementation intentions specify the steps to be followed in order to translate inten-tions into behavior. They do this by specifying the conditions, such as the critical environment or context, under which a target behavior will be performed. Implementation intentions are concrete if the plan of action specifies when, where and how one will perform a behavior in order to achieve a specific goal: “If situa-tion Y arises, then I will perform goal-directed response Z!” (Gollwitzer, 1993, 1999; for review, see Gollwitzer and Sheeran, 2006).

Forming implementation intentions is effec-tive because it is a conscious commitment to perform a goal-directed behavior (ignore) when encountering certain critical cues (dessert; Gollwitzer, 1999). This commitment creates a strong mental link between the critical situation/cue and one’s intended behavior. Thus, instead of relying solely on motivation and willpower, implementation intentions allow individuals to

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partly delegate control of their behavior to the situation and, as a result, the intended behavior is carried out quasi-automatically (Gollwitzer, 1999; Gollwitzer and Sheeran, 2006).

research has shown that specifically forming “if–then” links helps to partly delegate control of behavior to critical cues in the situation, thereby making action initiation immediate, efficient, and absent of conscious intent (e.g., Gollwitzer and Brandstätter, 1997; aarts and Dijksterhuis, 2000; Brandstätter et al., 2001; Webb and Sheeran, 2004). Successfully establishing this “if–then” plan assists in activating effective self-regulatory behav-ior, even under stressful or cognitively demand-ing situations (Gollwitzer, 1999; Gollwitzer and Sheeran, 2006).

The formation of implementation intentions has been shown to be impressively effective. In a recent meta-analysis of effects of implementa-tion intentions, Gollwitzer and Sheeran (2006) performed 94 independent tests, and found that implementation intentions had a positive effect of medium-to-large magnitude (d 0.65) on goal attainment. For health-related behaviors, a medium effect size was found. Particularly in the area of eating behaviors, research has shown that implementation intentions are effective in increasing the consumption of fruits and vege-tables (Kellar and abraham, 2005; armitage, 2007), reducing fat intake (armitage, 2004; Luszczynska et al., 2007a) and increasing healthy eating (verplanken and Faes, 1999).

more recently, implementation intentions have been found to enhance weight reduction among overweight and obese people (Luszczynska et al., 2007b). Gollwitzer and Sheeran (2006) observed implementation intentions to be effec-tive in every step of goal pursuit. namely, they are effective in promoting the initiation of goal-striving, shielding ongoing goal pursuits from unwanted influences, disengaging from failing courses of action, and, finally, conserving capa-bility for future goal-striving. Such effective-ness is even more remarkable considering the sheer simplicity of the implementation intention

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instructions employed in these studies, and that they are usually administered just once in stand-ard implementation intention experiments.

Finally, the effects of implementation inten-tions have been shown to be relatively endur-ing. For instance, they were still present after 48 hours between implementation intention forma-tion and cue encounter (see Gollwitzer, 1999). In intervention studies, they have been found to be effective in promoting health behavior over a period of up to 6 months (Luszczynska, 2006). Furthermore, Sheeran and orbell (1999) sug-gested that once the behavior initiated through implementation intentions has been performed regularly over a longer period of time (e.g., 3 weeks), it becomes habitual in nature. Thus, the effects of implementation intentions should not diminish greatly over longer periods of time. This, however, is an empirical question, and further studies are needed to test the long-term effects of implementation intentions on the main-tenance of health behaviors (Luszczynska, 2006).

27.3.3 Implementation intentions and eating behavior

With respect to eating behavior, while many people initiate dieting behaviors, the majority of diets are brief and unsuccessful (Stotland et al., 1991; Jeffery et al., 2000). The cardinal problem in this area is not goal initiation, but goal comple-tion. as noted previously, people are derailed, in part, because of lack of attention and/or inhibi-tory behavioral control in the face of incentive food or food cues. Thus, to attain weight loss or healthy eating goals, people’s self-regulatory task is to shield their goal-striving from unwanted influences. research by Gollwitzer and col-leagues suggests that implementation intentions can prevent “derailment” and thus protect goal-striving from unwanted influences by suppress-ing (1) unwanted attention responses (e.g., “If I see something delicious, but unhealthy on the menu, then I will ignore it”) and (2) unwanted

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behavioral responses (e.g., “If I am tempted to eat a delicious, but energy-dense dessert, I will not eat it”; Gollwitzer and Sheeran, 2006). In Gollwitzer and Sheeran’s (2006) meta-analy-sis, all studies on the inhibition of unwanted attention responses and unwanted behavioral responses showed strong beneficial effects of implementation intentions.

Forming implementation intentions to sup-press unwanted attention toward food should prevent the individual from paying attention (the original behavioral response) to appetitive but unhealthy stimuli (i.e., the cue; Gollwitzer and Sheeran, 2006), and thus should increase attention control. more precisely, depending on the situation and on the individual’s personal eating goals, suppressing unwanted attention by forming implementation intentions should allow the individual to (1) ignore (new behav-ioral response) food (cue) or, when eating is appropriate, to (2) focus on healthy food alter-natives or limit portion sizes (new behavio-ral responses). Looking at the effectiveness of implementation intentions in shielding goal-striving from distraction in eating behavior, achtziger and colleagues (2008) posited that implementation intentions help people ignore thoughts about high-fat snacks that they are craving, resulting in better diet adherence.

as illustrated earlier, it may not always be sufficient to inhibit unwanted attention responses to food in order to avoid eating, or eating too much. It is often also necessary to inhibit unwanted behavioral responses (see also Gollwitzer and Sheeran, 2006). Forming implementation intentions to inhibit unwanted behavioral responses should increase inhibi-tory behavioral control, and should also prevent unhealthy eating behaviors. again, depending on the individual’s personal goals, it should allow that individual to avoid certain food or to eat less in general. hence, implementation inten-tions could be used to replace the original behav-ioral responses to specific food cues (e.g., eating) with new, healthy and intended responses (e.g.,

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eating fruits instead of high-caloric snacks). Thus, the same attention-grabbing food cues that, in the absence of implementation inten-tions, would lead to self-regulatory failure could also be used as critical cues when form-ing implementation intentions. Future research needs to investigate in which format implemen-tation intention-based interventions aimed at inhibiting unwanted attention and behavioral responses to food should be administered in the general population, in order to effectively pro-mote healthy eating and weight loss, and to pre-vent obesity.

27.3.4 replacing unhealthy habits through implementation intentions

The automatic activation of habitual respon-ses is key to habit persistence. after all, behavior modification approaches have long recognized that habits initiated by cues can be used for intervention. These approaches change un-desired behavior, such as addictions, by altering the very contexts in which such maladaptive behaviors occur. Furthermore, people are typi-cally encouraged to limit their exposure to criti-cal cues with the potential to activate undesired habits.

however, such attempts to avoid critical-cue exposure might require a significant amount of self-regulatory effort (Wood and neal, 2007). Implementation intentions could be used to replace habitual behavioral responses to spe-cific cues (e.g., eating chips when watching Tv) with new, healthy and intended responses (e.g., ignoring the chips, eating healthy snacks instead) (cf. verplanken, 2005). While the cues remain the same, when paired with an appro-priate goal-directed response they serve to activate effective self-regulatory behavior. Like habits, implementation intentions allow indi-viduals to partly delegate control over their behavior to the situation. no conscious effort is needed, and the behavior is carried out

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quasi-automatically when the relevant cue is encountered (Gollwitzer, 1999).

Implementation intentions and habits bear important similarities (Sheeran et al., 2005). For instance, in both situations the cue is linked to the activation of behavior; once the cue is encountered, the behavior is activated without conscious effort (verplanken and Faes, 1999). however, unlike habits, which are acquired slowly through repeated covariation of cue and response, implementation intentions are formed consciously and instantaneously (Gollwitzer, 1999; Sheeran et al., 2005; verplanken and Wood, 2006). Because implementation inten-tions are associated with the automatic initia-tion of action, they can create what Gollwitzer (1999) calls “instant habits”, which can result in habitual behavior over time (Gollwitzer and Schaal, 1998).

Future research needs to show whether, simi-lar to habit formation, the rehearsal of imple-mentation intentions increases the strength of cue–response link – whether they can slowly be turned into habits. If so, rehearsing implementa-tion intentions would enhance their impact on behavioral responses (Sheeran et al., 2005). Since implementation intentions and habits share similar features, it seems plausible that, with suf-ficient repetition, the cue–response association formed initially through implementation inten-tions could help people form new, healthier hab-its (verplanken, 2005; verplanken and Wood, 2006). In sum, forming implementation intentions to inhibit unwanted attention and behavioral responses to food cues could be an important step in changing people’s unhealthy eating habits.

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