An increasing number of children and young people are living with excess weight or obesity. The World Health Organization (WHO) reports that the proportion of 5 to 19-year-olds affected has risen from 8% to 20% since 1990. “Being overweight increases the risk of physical illness and mental disorders and has negative fallout for children's social interactions,” says Anne Schienle from the University of Graz, describing the challenges inherent in this development.
Schienle, head of the Department of Clinical Psychology, is researching a new approach for children to better regulate their appetite – by administering so-called open-label placebos. In contrast to the classic covert placebos, the open-label variant is known as not containing any active ingredient. In Schienle's studies, open-label placebos reduced appetite triggered by food stimuli from surroundings. In addition, the improved self-regulation helped the children to master certain physical exercises better.
These findings emerge from the “Obesity reduction via open-label placebos in children” project, which receives funding from the Austrian Science Fund FWF. Schienle had not only to conduct research for her studies, she also had some convincing to do, as her approach met with mixed reactions from parents.
Constantly surrounded by food stimuli
“Children have a different approach to food than adults. They often disregard whether something is healthy or unhealthy, but just go ahead and eat when they feel like it,” says Schienle. An important psychological concept is food cue reactivity, i.e. the response to the sight, smell or even just the thought of food. “We live in a world of plenty. Food stimuli that whet our appetite are omnipresent, be it on TV, when walking past a shop window or on social media,” explains Schienle. In such situations, it is particularly difficult for children to eat only as much as they really need.
In one part of the research project, Schienle investigated how children and adolescents react to pictures of food having been given an open-label placebo beforehand – blue-colored water administered as a mouth spray. The participants were shown a selection of photos, including sweets and fruit. The children and young people then rated their appetite for the food. “We found that the open-label placebo reduced food cue reactivity in the children, even though they knew it was only water,” notes Schienle. The adolescents, on the other hand, were more skeptical about the concept and failed to achieve this effect. This indicates that the effect of open placebos depends on an individual’s positive predisposition.
Effect despite a lack of active ingredient
In medical studies, classic placebos are usually used in the control group, because a new active ingredient has to prove its worth against their health-promoting effects. “In clinical practice, however, covert placebos cannot be used because they work with deception and this runs counter to the idea of informed patient consent,” says Schienle. This problem could be solved with open-label placebos, as they too do nothing other than create a placebo effect.
But why do open-label placebos work? One attempt at an explanation comes from embodiment theory, which deals with the embodiment of psychological processes. “According to this theory, therapeutic success is achieved through physical rituals that we are familiar with from healthcare, such as taking medication. This triggers unconscious mechanisms and stimulates self-healing power,” notes Schienle. She expects open placebos to be particularly beneficial in areas that have to do with self-regulation, such as eating or exercise.
Opinions differ
Although the placebo effect has a long tradition in medicine, many people still have reservations. Schienle says that this makes it difficult to translate the results of basic research into clinical practice. For instance, she had a hard time finding any volunteers at all for one of the planned studies in the research project, which was to investigate the effect over several weeks. “That was actually the first time in my research career that I was unable to carry out a longitudinal study,” Schienle regrets.
To clarify the situation, she and her team analyzed the opinions of parents in a survey. It turned out that open-label placebos polarize greatly. Around a third of the parents surveyed were strongly opposed to them and considered them unlikely to work. A further third were convinced by the idea and would be ready to try an open-label placebo on themselves or their own children. The latter was particularly true for parents who considered the placebo effect to be highly credible.
Reaching people with psychoeducation
Obesity and weight loss in children are particularly sensitive topics in many families, notes Schienle, reporting on experiences from the project. “We are currently exploring how we can use training programs and psychoeducation to work on people's negative attitudes and ask about the reasons for their skepticism.” Surveys are also useful to find out early on whether someone is receptive to open-label placebos. Schienle is convinced that this would help at least some of the children. In the long run, a real turnaround in respect of the weight issue will succeed only through many small steps.
Personal details
Anne Schienle is Head of the Department of Clinical Psychology at the University of Graz. In her research, Schienle focuses on affective neuroscience, in particular coping with revulsion and the use of placebos. The project “Obesity reduction via open-label placebos in children” receives a funding from the Austrian Science Fund FWF and is set to run until fall 2025.
Source: https://scilog.fwf.ac.at