Testing Augmented Reality
for Cue Exposure in Obese Patients:
An Exploratory Study
Federica Pallavicini, PhD,
Silvia Serino, PhD,
Pietro Cipresso, PhD,
Elisa Pedroli, PSYD,
Irene Alice Chicchi Giglioli, MA,
Alice Chirico, MA,
Gian Mauro Manzoni, PhD,
Gianluca Castelnuovo, PhD,
Enrico Molinari, PhD,
and Giuseppe Riva, PhD
Binge eating is one of the key behaviors in relation to the etiology and severity of obesity. Cue exposure with
response prevention consists of exposing patients to binge foods while actual eating is not allowed. Augmented
reality (AR) has the potential to change the way cue exposure is administered, but very few prior studies have
been conducted so far. Starting from these premises, this study was aimed to (a) investigate whether AR foods
elicit emotional responses comparable to those produced by the real stimuli, (b) study differences between
obese and control participants in terms of emotional responses to food, and (c) compare emotional responses to
different categories of foods. To reach these goals, we assess in 15 obese (age, 44.6 – 13 years; body mass index
[BMI], 44.2 – 8.1) and 15 control participants (age, 43.7 – 12.8 years; BMI, 21.2 – 1.4) the emotional responses
to high-calorie (savory and sweet) and low-calorie food stimuli, presented through different exposure conditions
(real, photographic, and AR). The State-Trait Anxiety Inventory was used for the assessment of state anxiety,
and it was administered at the beginning and after the exposure to foods, along with the Visual Analog Scale
(VAS) for Hunger and Happiness. To assess the perceived pleasantness, the VAS for Palatability was ad-
ministered after the exposure to food stimuli. Heart rate, skin conductance response, and facial corrugator
supercilii muscle activation were recorded. Although preliminary, the results showed that (a) AR food stimuli
were perceived to be as palatable as real stimuli, and they also triggered a similar arousal response; (b) obese
individuals showed lower happiness after the exposure to food compared to control participants, with regard to
both psychological and physiological responses; and (c) high-calorie savory (vs. low-calorie) food stimuli were
perceived by all the participants to be more palatable, and they triggered a greater arousal response.
besity is a major public health problem worldwide, and
its prevalence in the world population is dramatically
Numerous studies have pointed out that obesity
is a multifactorial disorder, including psychological factors,
such as anxiety and distress, that involve individuals in a
variety of behaviors that serve to regulate their emotions.
key behavior in relation to the etiology and severity of obesity
is binge eating (BE),
a dysfunctional behavior that can be
triggered by food craving,
which is an appetitive motiva-
tional–emotional state that triggers the search for food and
the consequent intake behaviors even in a state of satiety.
The conditioning model of BE postulates that, in addition
to internal states (e.g., psychological emotional states), ex-
posure to certain stimuli associated with BE (e.g., the pres-
ence of high-calorie meals) provokes physiological
responses and subjective craving. Cue exposure with re-
sponse prevention of binge eating (ERP-B) is a type of
treatment derived from this model, which consists of ex-
posing patients to binge-triggering foods and preventing BE
while the food is present and can be smelled.
The main objective of ERP-B is to extinguish food craving
by breaking the link between the conditioned and the un-
conditioned stimulus (for a recent review, see Ref.
the cue exposure approach has been proven to be an effective
Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy.
Psychology Research Laboratory, Ospedale San Giuseppe, Istituto Auxologico Italiano, Verbania, Italy.
Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy.
*Current afﬁliation: Faculty of Psychology, eCampus University, Novedrate, Como, Italy.
CYBERPSYCHOLOGY,BEHAVIOR, AND SOCIAL NETWORKING
Volume 19, Number 2, 2016
ª Mary Ann Liebert, Inc.
treatment of BE behaviors,
it has important constraints that
make its implementation difﬁcult, such as logistical difﬁ-
culties, the time required to carry out the treatment, and the
need for natural environments adapted to the requirements of
Among the technologies that have emerged in more
recent years, augmented reality (AR) represents an inno-
vative tool that has the potential to dramatically change the
way psychological treatments are administered,
ing cue exposure treatments.
Essentially, the concept of
AR is that synthetic objects can be added to the real world
in real time, enriching reality with helpful and relevant
Despite the opportunities that AR could offer in the ad-
ministration of cue exposure, including the prevention of BE
behavior in obesity, very few prior studies have compared
emotional reactions to AR and real stimuli. Nevertheless, a
necessary condition for the successful use of AR in cue ex-
posure is that it must elicit roughly the same emotional re-
action as a real-life stimulus. In particular, the studies
conducted so far have mainly investigated the level of
presence, deﬁned as ‘‘the feeling of being in a world that
exists outside of the self,’’
as experienced in AR sys-
tems, compared to that experienced in a real environment
and virtual reality (VR) environments.
To our knowledge, only one previous study has investigated
the differences in terms of emotional responses to stimuli
presented through AR compared to other exposure meth-
—while no study has yet compared
the responses with respect to those shown in response to real-
world stimuli. Moreover, previous studies have focused on
AR only in terms of exposure to phobic stimuli, showing the
usefulness of AR in the treatment of a speciﬁc phobia, such
as cockroach and spider phobias,
(for a recent review, see Ref.
). As yet, nothing is known
about its possible application of AR for cue exposure in the
treatment of other conditions, including obesity.
Starting from these premises, the ﬁrst goal of this study was
to investigate whether AR food stimuli elicit emotional re-
sponses comparable to those produced by real exposure
stimuli. The second aim of this study was to investigate dif-
ferences between obese and control group participants in
terms of emotional responses to food stimuli. Finally, the third
aim was to compare emotional responses to the different ca-
tegories of food stimuli adopted to extend to which the effects
of cue exposure are related to a speciﬁc category of food.
Materials and Methods
The experimental sample included 15 obese (OB) patients
(7 males and 8 females), as well as a control group (CTR) of
15 individuals (7 males and 8 females). OB patients were
recruited from the inpatient units of a public hospital in
Verbania (Italy), while CTR subjects were recruited through
local advertisements among college students and adminis-
trative and workers’ staff at the hospitals. The mean body
mass index (BMI)
was 44.2 – 8.1 in the OB group (fre-
quency of OB Class II = 33.3%; Class III = 66.7%) and
21.2 – 1.4 in the CTR group. The mean age and years of
education were 44.6 – 13 and 11 – 3.83 in the OB group and
43.7 – 12.8 and 15.7 – 2.43 in the CTR group, respectively.
To be included in the study, individuals were required to
meet the following criteria: (a) no Axis I disorders as deﬁned
in the Diagnostic and Statistical Manual of Mental Dis-
orders, Fourth Edition (DSM-IV-TR)
; (b) age between 18
and 60 years; (c) not to be presently using pharmacotherapy;
(d) no history of neurological diseases, psychosis, alcohol,
or drug dependence; (e) no migraine, headache, or vestibular
abnormalities; (f) no food allergies or intolerances; (g) not
currently dieting for weight loss or in any dietary restric-
tions; and (h) no BMI less than 18.5.
A semistructured clinical interview and the Mini Inter-
national Neuropsychiatric Interview Plus (MINI)
used to exclude the presence of any psychiatric diseases,
including actual or past eating disorders, according to the
Before participating in the study, each par-
ticipant was provided with written information about the
study and required to give written consent for inclusion in the
study. The study received ethical approval by the Ethical
Committee of the Istituto Auxologico Italiano.
The following questionnaires were administered to each
State-Trait Anxiety Inventory, Form Y-1 (STAI-
The STAI-Y1 is a validated and widely used
measure of state anxiety.
Visual Analog Scale (VAS):
The VAS is a hori-
zontal line, 100 mm in length, anchored by word de-
scriptors at each end. The participants mark on the
line the point that they feel represents their perception
of their current state. Participants’ level of hunger
was measured using Visual Analog Scale for Hunger
(VAS-H), a rating scale headed ‘‘How strong is your
hunger right now?’’ A similar scale, the Visual
Analog Scale for Happiness (VAS-HP), was also
used. All the scales were anchored by the phrases
‘‘Not at all’’ and ‘‘Extremely.’’ Moreover, since the
hedonic component of sensation (or the ‘‘pleasant-
ness’’) of food stimuli is an integral part of their
sensory proﬁle and it can inﬂuence appetite and eat-
the Visual Analog Scale for Palatability
(VAS-P) was administered.
At the beginning of the experiment and during the labo-
ratory session, skin conductance response (SCR), heart rate
(HR; in particular, NN50 values), and facial corrugator su-
percilii muscle electromyography (fEMG) were recorded to
obtain participants’ physiological responses to food stimuli.
are considered indexes of arousal
responses, fEMG is considered a good measure of negative
The physiological signals were acquired using a ProComp
Inﬁniti device from Thought Technology, including Biograph
Inﬁniti 5.0.2 software to record and export all raw signals.
Every signal was synchronously acquired at 2,048 Hz and
exported at a minimum of a 256 Hz sampling rate (every
3.9 ms). Amplitude is measured in microvolts.
108 PALLAVICINI ET AL.
Food stimuli and exposure conditions
We selected nine food items—three in each of the three
categories—based on nutritional estimates (i.e., total fat and
high-calorie savory foods (HC-SAVs) included three
salty foods (salami, potato chips, and crackers) rela-
tively high in total fat (>20 g/100 g) and saturated fat
(>6.25 g/100 g),
high-calorie sweet foods (HC-SW) consisted of three
sweets (chocolates, cookies, and mufﬁns) containing at
least moderate levels of total fats (>10 g/100 g) and
saturated fats (>5 g/100 g), and
low-calorie (LC) foods were three food stimuli (pears,
tomatoes, and carrots) containing low total fats (<4g/
100 g) and saturated fats (<1.25 g/100 g).
Food stimuli were presented in three exposure conditions
(Fig. 1): (a) real (RE), (b) photographic (PH), and (c) AR.
The order of presentation of each exposure condition (RE,
PH, and AR), as well as the order of appearance of each food
category (HC-SAV, HC-SW, and LC) within the three dif-
ferent conditions, was counterbalanced for each participant
following a previously established randomization schema.
Participants were told to freely examine the food stimuli,
without any speciﬁc request. All participants were tested not
more than 4 hours after a meal to avoid effects related to
excessive hunger or overeating.
Before the start of the experiment, participants were
administered the MINI interview. Once this ﬁrst phase was
completed, there was a 3-minute baseline during which
subjects were asked to stay completely relaxed while their
physiological parameters were recorded. Once the physi-
ological baselines were recorded, participants were also
asked to complete the STAI-Y1, the VAS-H, and the VAS-
HP. Thereafter, the experimental session started, and SCR
and fEMG were continuously recorded until the end of the
To measure the variations that occurred during the three
different exposure conditions, subjects completed the STAI-
Y1 and the VAS-H, and the VAS-HP again immediately
after each session. In addition, at the end of each exposure
condition, the VAS-P was administered. There was a pause
of 5 minutes between exposure condition sessions.
FIG. 1. Experimental exposure conditions. Food stimuli were presented in the following exposure conditions. (A) Real (RE)
food stimuli: Each participant was exposed to real food, presented on a plate on a table in front of the subject. During the
pause, all food items were covered with red plastic lids, so that the subjects could not see them. (B) Photographic (PH) food
stimuli: Subjects were asked to view food stimuli presented in picture format. Photographs were adjusted to balance the images
for contrast and luminance using Photoshop software. Particular care was taken to ensure identical lighting and arrangement of
the plate across food items and portion sizes. Images (180 · 260 mm) were printed on A4 paper (210 · 297 mm), centered
vertically. (C) Augmented reality (AR) food stimuli: In the AR condition, subjects were asked to hold a plate that was marker
based. A camera positioned on the PC recognized the marker on the plate projecting each food onto the plate. Subjects were
able to move and turn the plate to explore and observe the food. In particular, the AR setting included the following hardware
units: (a) Microsoft’s HD LifeCam camera, which offers true HD capture in 720p resolution, able to capture 30 frames per
second (Microsoft, Redmond, WA, USA); (b) the marker to decode the AR stimulus; and (c) a portable computer (Acer Aspire
Corei5, graphics processor NVIDIA GeForce GT 540M, and Bluetooth support).
AUGMENTED REALITY AND CUE EXPOSURE IN OBESE PATIENTS 109
Statistical analyses and experimental design
The analyses were performed using SPSS version 22.0
(Statistical Package for the Social Sciences for Windows,
Chicago, IL) for PC. All collected biosignals were analyzed
using MATLAB 7.0 (The Mathworks, Natick, MA) for the
signal processing and computation of psychophysiological
Independent t tests were conducted to verify the base-
line homogeneity of the sample in age. Since the sample
was characterized by statistically signiﬁcant differences at
baseline, both psychological and physiological, differences
were calculated in STAI-Y1, VAS-H, VAS-HP, NN50,
SCR, and fEMG data measured after the exposure com-
pared to the corresponding baseline (delta scores).
Next, mixed ANOVAs were conducted to test whether the
psychological and/or physiological responses changed de-
pending on the group (OB or CTR), the exposure condition (RE,
PH, or VR), or the type of food (HC-SAV, HC-SW, or LC).
One participant in the OB group was excluded from the
SCR and fEMG analyses due to problems with the recording.
Regarding analyses of NN50, eight OB patients and ﬁve
CTR participants were excluded due to problems with the
Finally, a 2 · 3 · 3(Group[OBandCTR]· Exposure
Condition [RE, PH, and AR] · Food Stimulus Category [HC-
SAV, HC-SW, and LC]) mixed ANOVA was conducted on
VAS-P scores assessed after the exposure to the food stimuli.
The level of signiﬁcance was set at a = 0.05. Post hoc tests (with
Bonferroni adjustment) were carried out to compare signiﬁcant
differences. In graphs, error bars represented standard errors.
Psychological responses to food stimuli
First, analyses of the VAS-P showed a statistically sig-
niﬁcant main effect of Exposure Condition, F(2, 56) = 5.1,
p < 0.01, g
¼ 0:154, and Food Stimulus Category, F(2, 56) =
7.5, p < 0.01, g
¼ 0:212 (Figs. 2 and 3 for detailed results).
Second, analyses of the VAS-HP revealed a statistically
signiﬁcant main effect of Group, F(1, 28) = 5.9, p < 0.05,
¼ 0:176 (Fig. 4). No other statistically signiﬁcant main
effects and/or interactions were observed.
Regarding the VAS-H and the STAI-Y1, we did not ob-
serve any statistically signiﬁcant main effects or interactions
Physiological responses to food stimuli
First, ﬁndings of the analyses of SCR showed a statisti-
cally signiﬁcant main effect of Food Stimulus Category, F(2,
54) = 3.2, p < 0.05, g
¼ 0:108. Pairwise comparisons (with
Bonferroni adjustment) were not signiﬁcant.
For SCR, we did not observe any other statistically sig-
niﬁcant main effects and/or interactions of Exposure
Condition or Group. Second, ﬁndings on NN50 showed a
statistically signiﬁcant main effect of Exposure Condition,
F(2, 30) = 3.79, p < 0.05, g
¼ 0:202. Pairwise comparisons
(with Bonferroni adjustment) indicated that RE food stimuli
were characterized by higher NN50 delta values, indicating
higher arousal responses, compared to PH food stimuli (RE:
20.6 [SD = 5.47]; PH: 5.33 [SD = 3.02]). No difference was
found between RE and AR (AR: 28 [SD = 10.1]). No other
statistically signiﬁcant main effects or interactions were
Finally, analyses of fEMG revealed a statistically sig-
niﬁcant main effect of Group, F(1, 27) = 6.7, p < 0.01,
¼ 0:199. In particular, data showed that OB patients were
characterized by signiﬁcantly higher fEMG values, indicating
higher negative emotional responses to food stimulus exposure,
compared to CTR participants (OB patients: 0.237 [SD = 0.489]
and CTR participants: -1.59 [SD = 0.987]). We did not observe
statistically signiﬁcant main effects and/or interactions of Ex-
posure Condition or Food Stimulus Category.
Regarding the ﬁrst main goal of this study (i.e., to inves-
tigate whether AR food stimuli elicit emotional responses
comparable to those produced by real exposure), analyses of
psychological responses showed that stimuli presented in AR
were perceived by individuals to be as palatable as real
foods. In fact, the results revealed a signiﬁcant difference in
the entire sample in palatability scores between the real and
photographic stimuli but not between the real and AR
FIG. 2. Mean scores at the VAS-P in the
sample by Exposure Condition. Error bars
represent standard error (SE). Pairwise
comparisons (with Bonferroni adjustment)
indicated that the RE food stimuli were
signiﬁcantly ( p < 0.05) more palatable than
the PH stimuli (VAS-P RE food stimuli:
46.7 [SD = 3.64]; VAS-P PH food stimuli:
36.7 [SD = 3.91]). No difference was found
in the food’s palatability between RE and
AR (42.7 [SD = 4.14]) or between PH and
AR. *p < 0.01.
110 PALLAVICINI ET AL.
This result appears relevant since AR stimuli must be
perceived to be as palatable as real ones to be effective in cue
exposure. Palatability (the hedonic component of sensation
or the ‘‘pleasantness’’ of food) is, in fact, an integral part of
the sensory proﬁle for a given food.
As reported in the
literature, palatable foods can stimulate appetite and eating
rate, leading to excessive food consumption.
With regard to physiological responses, analyses showed a
signiﬁcantly higher arousal response (particularly in the
NN50) after real food stimulus exposure than after exposure
to photographic stimuli; values after exposure to real and AR
foods were very similar. Such a difference was not observed
in the other physiological measure related to arousal re-
sponse (SCR) and in the hunger experienced by individuals.
However, these results may be linked to a longer response
latency of SCR compared to the HR index
and the partic-
ipants’ difﬁculty in assessing their subjective hunger, re-
spectively. Finally, analyses showed no differences in the
other emotional responses: No differences were found be-
tween the exposure conditions regarding the VAS-HP and
Taken together, these results offer preliminary evidence
that AR food stimuli were perceived to be as palatable as real
ones, and they triggered an arousal response (with regard to
NN50) similar to that shown in response to real stimuli. One
possible explanation for this result could be related to the
speciﬁc features of AR.
As stated by Botella et al.,
in particular, perceiving a
virtual object in a real environment can enhance the sense of
presence and reality judgment. In their study, she and her
colleagues used an AR system developed for cockroach
and they analyzed the emotional responses (i.e.,
subjective level of anxiety) shown by individuals in response
to AR stimuli (i.e., virtual cockroaches). The results ﬁt with
what would be expected if an in vivo exposure procedure had
The ﬁrst main ﬁnding of our study could have important
implications in relation to cue exposure for obese patients.
AR could potentially offer a more realistic and interactive
experience compared to fully immersive VR
the ecological validity of the ‘‘mixed reality’’
the direct interaction of the individuals and patients with
FIG. 3. Mean scores at the VAS-P in the
sample by Food Stimulus Category. Error
bars represent standard error (SE). Pairwise
comparisons (with Bonferroni adjustment)
indicated that HC-SAV stimuli (48.7
[SD = 4.07]) were signiﬁcantly ( p < 0.01)
more palatable than LC stimuli (32.9
[SD = 3.99]). No difference was found in
the food’s palatability between HC-SW
(44.3 [SD = 4.55]) and HC-SAV stimuli or
between HC-SW and LC food stimuli.
HC-SW, high-calorie sweet food; LC, low
calorie. *p < 0.01.
FIG. 4. Mean delta scores at the VAS-HP
in the sample by Group. Error bars represent
standard error (SE). In particular, pairwise
comparisons (with Bonferroni adjustment)
indicated that OB patients showed signiﬁ-
cantly ( p < 0.05) lower happiness delta
scores compared to CTR participants, indi-
cating more intense negative emotional re-
actions to food stimuli (OB patients: -6.84
[SD = 3.84]; CTR participants: 6.41
[SD = 3.81]). *p < 0.05. OB, obese.
AUGMENTED REALITY AND CUE EXPOSURE IN OBESE PATIENTS 111
virtual stimuli. Moreover, AR could become a part of obesity
rehabilitation programs. Such technology could make it
possible to administer cue exposure at home, enabling psy-
chologists and patients to save time and money and poten-
tially offering more engaging and interactive experiences
compared to traditional programs.
Regarding the second main aim of this study (i.e., to in-
vestigate differences between obese patients and control
group participants in terms of emotional responses to food
stimuli), we found that obese patients were characterized by
more intense negative emotional reactions to food stimuli
compared to control group participants.
Results on psychological responses showed that obese pa-
tients were characterized by lower happiness scores compared
to control group participants, regardless of the exposure con-
dition or the food stimulus category. Conversely, and in line
with what has been observed in a previous study,
group participants showed an increase in happiness after ex-
posure to food stimuli.
Analyses of the fEMG seem to conﬁrm this result, showing
stronger activations in the obese patients than in the control
group participants and indicating higher negative emotional
responses to food stimuli.
A similar result has been also
reported in a previous study, in which obese participants
showed strong negative emotional responses to foods high in
One possible explanation of this observed result could be
related to the speciﬁc sample of obese patients included in this
study: The patients were hospitalized and undergoing diets for
weight management. Therefore, certain foods may have been
perceived by the obese participants as ‘‘prohibited,’’ thus
potentially triggering inhibitory emotional strategies.
Regarding the self-reported hunger and the physiological
values related to arousal responses (SCR and NN50), we did
not ﬁnd any signiﬁcant differences after exposure to food
stimuli between obese and control group participants. One
possible explanation could be that obese participants may
have been very hungry at the sight of food, but they lied
because of social stigma, creating bias in the VAS-H col-
However, results regarding physiological arousal re-
sponses seem to disagree with this hypothesis: No differ-
ences were observed between obese and control group
participants in SCR and NN50 values. This result must be
interpreted with caution since in the literature there are still
mixed results regarding differences in terms of arousal in
response to food stimuli between obese patients and healthy
individuals. In particular, while one previous study reported
(similar to what we observed in this re-
search), another study found that obese patients were char-
acterized by higher arousal responses.
Finally, results showed that all the participants perceived
food stimuli to be more palatable and showed a greater
arousal response after exposure to high-calorie foods (par-
ticularly, the savory ones) versus low-calorie food stimuli.
Analyses of psychological responses showed that HC-SAV
stimuli were assessed as signiﬁcantly more palatable than
low-calorie stimuli. Along these lines, analyses of physio-
logical responses showed greater arousal activation in the
whole sample (particularly with regard to SCR) after expo-
sure to HC-SAVs than after exposure to low-calorie foods,
regardless of exposure conditions.
Taken together, these results seem to conﬁrm previous
studies reporting that the most palatable and arousing foods
are those that are both energy dense and high in fat content.
High-calorie foods appear to be the most effective in in-
ducing an emotional response, and thus, they seem to be the
best type of food stimuli to use in cue exposure treatments.
Although our results are interesting for their possible ap-
plications to cue exposure treatments for obesity, our study
has some limitations that could affect the generalizability of
the results or that may have inﬂuenced the ﬁndings. The main
issues are related to the small sample size and the speciﬁc
sample of obese patients included in this study (who were
hospitalized and undergoing diets).
Table 1. Mean (and Standard Deviation) of Values
for STAI, VAS-H, VAS-HP, and VAS-P of the Sample by Group
Obese group (n = 15) Control group (n = 15)
Exposure condition Real Picture Augmented reality Real Picture Augmented reality
High-calorie sweet 27.2 (6) 27.1 (6.1) 26.2 (5.9) 28.8 (9) 29.3 (9.3) 28.3 (8.6)
High-calorie salt 27.1 (5.7) 26.5 (5.7) 26.1 (6.3) 28.6 (8.6) 28.8 (9.7) 28.3 (8.6)
Low calorie 26.1 (4.1) 26.5 (6.7) 25 (9.2) 28.1 (9.3) 29.4 (12.2) 28.1 (8.8)
High-calorie sweet 24.4 (25.9) 20.20 (23.5) 20.8 (27.5) 42.1 (31.6) 36.1 (26.8) 38.6 (25.9)
High-calorie salt 22.1 (21.8) 16.1 (19.5) 21.1 (27.6) 40.8 (25.3) 41.6 (25.3) 45.4 (23.1)
Low calorie 17.4 (20.7) 15.1 (20.3) 19.4 (26.4) 37.0 (29.2) 35.8 (27.2) 40.8 (24.3)
High-calorie sweet 48.8 (36.8) 52 (35.2) 54.4 (36.6) 63.1 (21.3) 55.2 (21.5) 63.8 (16.8)
High-calorie salt 48.5 (36.7) 54 (36.7) 56 (36.7) 61.0 (19.6) 58.4 (22.7) 61.0 (17.8)
Low calorie 45 (35.3) 54 (35.2) 56.47 (37) 64.7 (21) 55.6 (25.9) 63.1 (18)
High-calorie sweet 43.8 (28) 38.2 (23.6) 41.4 (29.9) 56.5 (30.2) 37.5 (24.1) 48.4 (31.5)
High-calorie salt 47.9 (26.2) 42.5 (26.7) 49.1 (29.8) 60.9 (19.7) 42.3 (23.4) 49.7 (21.4)
Low calorie 24.9 (21) 26.6 (19.8) 26.6 (24.3) 45.8 (2.7) 32.8 (30.1) 41 (26.2)
STAI-Y1, State-Trait Anxiety Inventory, Form Y-1; VAS-H, Visual Analog Scale for Hunger; VAS-HP, Visual Analog Scale for
Happiness; VAS-P, Visual Analog Scale for Palatability.
112 PALLAVICINI ET AL.
Despite these limitations, the present study found that (a)
AR food stimuli were perceived to be as palatable as real
stimuli, and they also triggered a similar arousal response;
(b) obese individuals showed lower happiness after the ex-
posure to food compared to control participants, with regard
to both psychological and physiological responses; and (c)
high-calorie savory (vs. low-calorie) food stimuli were per-
ceived by all the participants to be more palatable, and they
triggered a greater arousal response.
Future studies are needed to investigate the differences in
emotional responses between food stimuli presented through
AR compared to other exposure conditions. In particular, the
relationship between levels of stimulus realism, interactivity,
and the intensity of emotional response should be deeply
investigated (e.g., assessing the level of presence experi-
enced by users and comparing AR food exposure with the
same stimuli presented through a VR system).
Moreover, in the future, additional studies could expand
knowledge about the emotional responses to food stimuli of
obese individuals compared to healthy individuals (e.g.,
measuring other informative physiological responses, such
as cortical and visual attention responses).
Finally, it would be interesting to replicate the assessment
of emotional responses to high-calorie versus low-calorie
foods to deﬁne a set of effective food stimuli to be adopted in
cue exposure treatments (e.g., conducting studies focused on
a larger sample size of obese individuals).
The authors wish to thank the company Regola S.r.l. of
Torino (Italy) and Fabio Ferrara.
Author Disclosure Statement
No competing ﬁnancial interests exist.
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Address correspondence to:
Dr. Federica Pallavicini
Applied Technology for Neuro-Psychology Lab
IRCCS Istituto Auxologico Italiano
Via Magnasco, 2
114 PALLAVICINI ET AL.
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