Virtual Worlds versus Real Body: Virtual Reality Meets Eating and Weight Disorders

This Special Issue presents and discusses a collection of authoritative studies suggesting that Augmented Reality (AR) and Virtual Reality (VR) computer-generated graphic environments can extend and integrate existing treatment and assessment protocols for Eating and Weight Disorders (EWDs).

The U.S. Adult obesity rate in 2013 stood at 27.2%, as indicated by the data recently gathered by the Gallup Organization in the Gallup-Healthways Well-Being Index (GHWBI). The situation regarding obesity is even more concerning. In the United States alone, 20 million women and 10 million men experience a clinically significant eating disorder during their lifetime. The spread of eating disorders is a global issue.

The health of both healthcare systems and individuals can have significant impacts on individuals with EWDs. These disorders can lead to severe disability and premature death, either directly or indirectly, in addition to the immediate effects on individual health.

However, the treatment and prevention of anorexia still pose a challenge. Anorexia is characterized by a lower energy intake compared to energy expenditure, while obesity is characterized by energy intake exceeding energy expenditure. Both of these issues can be explained by an imbalance in energy regulation.

What are the effects of obesity?

The article published in “The Lancet” by Harrison and Fairburn underlined the fact that nothing is virtually known about the individual causal processes involved in the development and maintenance of developmental disorders. The situation for anorexia is different, as there is virtually no known etiology for this disorder. In later years, Kaye and colleagues expressed a similar view in their article published in “Nature Neuroscience Review.”

The current situation is compelling researchers in the fields of obesity and eating disorders to commence a collaborative effort. More specifically, their combined undertaking is focused on identifying risk factors that are commonly associated with these disorders: stress and unhealthy weight-management practices, such as fasting (for weight control through abstaining from eating for 24 hours), purging, or misusing laxatives, serve as shared precursors for both obesity and eating disorders.

Many studies have suggested that these technologies may have a big impact on the clinical practice, as they completely replace the real environment with a virtual one and add virtual information, which induces a high level of personal efficacy, self-reflectiveness, sense of presence, and emotional engagement. In this Special Issue, the focus will be on exploring the potential clinical efficacy of virtual reality (VR) and augmented reality (AR) technologies, as they are leading the way in improving the effectiveness of available evidence-based interventions. This quest for improvement is an open and challenging challenge.

Recent studies, summarized in the review by Wiederhold et al. (2019-23), indicate that AR and VR can be utilized to extend and integrate existing protocols for the treatment, assessment, and prevention of special issue-related problems.

The first section of the Special Issue showcases the potential of VR in supporting and improving health behavior change for treatment and prevention.

The study by Bailenson and Fox highlighted the potential of VR in modeling behavioral changes and creating ideal self-models to motivate individuals to adopt new health practices or modify existing ones. The articles confirmed that individuals who viewed avatars of weight-reduced individuals in VR were more likely to choose sugar-free drinks and eat less ice cream in a taste test, compared to those in the control group. Similar results were reported in an article by Kuo et al., Suggesting that VR video games could improve exercise efficacy and support weight loss among overweight adults. The study by Behm et al. Discussed the potential of virtual social worlds in increasing self-efficacy for nutrition and exercise, thereby improving overall health.

According to the article by Mountford et al. (40), the efficacy of avatars and virtual environments may vary in terms of their fidelity and representation. Furthermore, it is true that the use of avatars comes with its challenges, just like how roses have thorns. Additionally, a study by Ahn et al. (39) suggests that virtual pets in the form of a mid-sized dog may not only improve children’s consumption of fruits and vegetables but also have an impact on their health.

Overweight individuals who have social and emotional interactions, attitudes, and measuring methods suggest that using a virtual touch in a VR haptic environment is a promising method. The article by Tremblay et al.41 explores the use of virtual reality to physically interact with overweight individuals.

Pallavicini et al.42 conducted tests on overweight patients using cue exposure with response prevention to assess their appetite response. The study found that real stimuli were perceived to be just as appetizing as food stimuli associated with appetite response, and they also elicited a similar level of arousal. Baños et al.43 examined overweight children who engaged in enhancing attentional distraction through exercise. The article found that these children experienced bodily sensations during exercise and found enjoyment in using virtual reality (VR) as a means of promoting distraction. This helped overweight and obese children to engage in exercise more easily.

The VR module that addresses the negative experience of the body may enhance the long-term effectiveness of standard CBT, as supported by the findings. The authors utilized a specific VR re-scripting protocol, which required the subject to re-experience the same negative body-related experience (such as teasing) from two different perspectives. The first-person perspective allowed the patient to express and discuss their feelings, while not seeing their full body. On the other hand, the third-person perspective allowed the patient to see their full body as an external avatar, intervening to calm and reassure their virtual avatar and counter any negative evaluation. Manzoni et al.49 conducted a study to test the long-term effectiveness of an enhanced cognitive-behavioral therapy (CBT) for obesity, which included a specific VR module that aimed to address the experience of the body and its behavioral and emotional aspects. The results showed that participants who embodied a virtual body with a skinny belly reported a decrease in the ratio between their estimated and actual body measures for most of the body parts considered. Serino et al.45 examined whether VR body-swapping, which involves embodying a virtual body, could be an effective tool for modifying the allocentric memory of the body. Their findings revealed that food objects were collected faster than control objects, and this difference was positively correlated with both individual body mass index and diet-related attitudes. Schroeder et al.44 explored the use of a VR grasping task, involving both high-calorie food and neutral objects, for assessing eating and weight disorders (EWDs). The final section of the Special Issue provides a more detailed exploration of the clinical applications of VR in both assessment and treatment.

The final article by Gutiérrez-Maldonado et al.52 tries to outline the future of VR in the treatment and assessment of EWDs, suggesting that the use of VR as a tool for exposure cues and embodiment experiences in real time is likely to reduce food cravings and alter the experience of the body in the coming years, with the growth of two types of VR interventions.

This Special Issue provides strong preliminary evidence to justify future research and identify the most effective technological interventions for supporting health behavior change, reducing anti-fat attitudes, and promoting body image in individuals with Eating and Weight Disorders (EWDs). It constitutes a sound rationale and foundation for future research aimed at integrating and extending existing methods for treatment, assessment, and prevention of EWDs, as well as testing and developing computer-generated graphic environments for research in the design and development field.