Completed projects (since 2011)


Researchers: Lisa Schäfer (PI), MSc, Anja Hilbert, PhD


Bariatric surgery (BS) is the most effective treatment for severe obesity, usually leading to significant weight loss and improvements in patients' medical, psychosocial, and cognitive functioning. However, little is known about the effects of BS on impulsivity. Impulsivity, particularly towards food, is a potential risk factor for increased energy intake and weight regain after behavioral and surgical weight-loss treatment. To date, only two studies have longitudinally investigated impulsivity after BS so far, indicating that general impulsivity did not change after BS, whereas food-specific impulsivity significantly decreased. The interpretation of these studies is especially limited by small sample sizes, a missing control group, or lacking prospective design. For the first time, this prospective, longitudinal study aims to assess general and food-specific impulsivity in bariatric patients from pre- to one year postsurgery in comparison to a body mass index-, sex-, and age-matched control group without BS. Different aspects of impulsivity (e.g., attention bias for visual food cues, reward sensitivity, inhibition) were assessed using a variety of methods (e.g., eye-tracking, neuropsychological tasks, self-report questionnaires) and both food and non-food stimuli-related assessments. Additionally, associations between attentional processing, impulsivity, postbariatric weight loss, and general and eating disorder psychopathology were analyzed.

Funding: MD Pro 2 Program by of the IFB AdiposityDiseases, University of Leipzig

Project number: AD2-0304

Duration: 07/2018 – 06/2019


Researchers: Ricarda Schmidt (PI), PhD, Anja Hilbert, PhD


While about half of the children with an eating disorder in middle childhood met the diagnostic criteria of the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV) for anorexia nervosa or bulimia nervosa, approximately half were diagnosed with an unspecified eating disorder. With the aim of specifying and reducing this residual category of eating disorders, "avoidant/restrictive food intake disorder" (ARFID) was included in the most recent version of the DSM (DSM-5). ARFID is characterized by the persistent and clinically significant failure to meet nutritional and/or energy needs, which is not due to body image problems. The motivation for food avoidance or restriction is only partially explored so far; in particular, a lack of interest in food and eating, sensory sensitivities, food-related anxieties, or emotional problems are assumed. To date, there has been little research into diagnostic methods and prevalence rates of ARFID as well as its clinical features and presentations, especially in the context of childhood obesity. However, there is evidence that children with obesity show specific nutritional deficiencies and selective eating behaviors. The first aim of this study was therefore to comprehensively evaluate the symptomatology of restrictive eating behaviors in children with obesity. To this end, children with obesity aged between 8 and 13 years were assessed using a newly developed interview to make a diagnosis of ARFID via self-report and parental report, questionnaires on eating disorder psychopathology, and a food diary to record the actual food intake. For weight-specific analyses, ARFID was also studied in children with underweight and normal weight. The second objective was to validate the newly developed ARFID interview module, which will allow for a standardized assessment of ARFID for the first time.

Funding: PostDoc Program of the IFB AdiposityDiseases, University of Leipzig

Project number: AD2-7106

Duration: 06/2017 – 04/2020


Researchers: Anja Hilbert (PI), PhD, Claudia Hübner, PhD, Marie Blume, MSc

Cooperation partner: Phillipa Hay, MD


Individuals with obesity (i.e., an excess of body fat) show deficits in executive functioning, for example, difficulties in decision-making, planning, problem-solving, inhibition, and flexibility. Recently, these difficulties have been assumed to play an important role in weight-loss outcome in conservative and surgical obesity treatment. Despite the relevance of executive functioning in obesity, research has only begun to develop interventions to specifically improve these functions in this condition. Cognitive remediation therapy (CRT), a well-established treatment approach with a focus on neurocognitive functioning in a range of mental and physical disorders, has preliminary evidence in improving executive functions and weight loss in obesity, however, confirmatory support, especially for preparatory pre-weight loss use, is outstanding. This randomized-controlled trial aimed at determining the efficacy of CRT versus no treatment control condition in patients with obesity enrolled at the IFB Outpatient Unit before entering behavioral weight-loss treatment. It was hypothesized that individuals who received brief group-based CRT will show greater weight-loss outcome in subsequent behavioral weight-loss treatment, beyond improved executive functioning.

Funding: Federal Ministry of Education and Research

Project number: AD2-6C89

Duration: 5/2015 – 1/2019


Researchers: Anja Hilbert (PI), PhD, Marie Blume, MSc


Individuals with binge-eating disorder (BED) exhibit strong food cravings and have difficulties controlling their eating behavior, for example, cannot stop eating or prevent overeating. This behavior is similar to the craving and addictive behaviors that individuals with substance use disorder display. BED is characterized by recurrent binge eating defined as eating a large amount of food accompanied by a sense of loss of control over eating that occurs in the absence of regular inappropriate compensatory behaviors to prevent weight gain. Individuals with BED were found to show an increased impulsivity and impaired executive functioning including a diminished ability to suppress spontaneous action impulses, an increased reward sensitivity (e.g., for food), and reduced planning and problem-solving ability. Such deficits in executive functioning may impair healthy control of eating behavior and weight management. While psychological approaches have proven efficacious in the treatment of binge eating, interventions focusing on improving impulsivity and executive control are lacking. Electroencephalographic (EEG) neurofeedback is a form of biofeedback, which helps individuals learning to control their brain activity. Numerous studies on attention-deficit/hyperactivity disorder (ADHD) showed that EEG neurofeedback can significantly improve impulsivity, attention, and hyperactivity. Due to the high prevalence of BED and its psychological and physical sequelae, it is relevant to investigate new interventions, such as EEG neurofeedback as a treatment option. If EEG neurofeedback proves to be efficacious, it could be used as adjunct intervention in the treatment of BED. The research-guiding question for this study was whether EEG neurofeedback is suitable to reduce addictive-like eating behavior within a randomized-controlled trial on the feasibility, acceptance, and efficacy of EEG neurofeedback in individuals with obesity and BED.

Funding: Institute Danone Nutrition for Health e.V.

Project number: ADI-018

Duration: 3/2015 – 9/2018


Researchers: Ricarda Schmidt (PI), PhD, Claudia Hübner, PhD, Lisa Schäfer, MSc


First part of the study (EEG): Functional magnetic resonance imaging studies indicated neuronal abnormalities in children with overweight. However, it remained unclear if these abnormalities can be found in electroencephalography (EEG) as well. Therefore, this research project aimed to examine differences in resting state and food-specific brain activity measured via EEG between children with overweight and normal-weight controls. EEG frequency band analyses were conducted in order to provide information on potentially abnormal brain activity (i.e., over- and under-activation) in children with overweight. Second part of the study (EEG neurofeedback training): Second goal was the development and evaluation of EEG neurofeedback training in children with obesity or food-specific impulsivity to increase general and food-specific self-regulation. The feasibility and efficacy of a high-beta neurofeedback paradigm was tested in a pilot study. During the EEG neurofeedback training, children received a visual feedback of their brain activity while processing food stimuli. They were instructed to regulate their EEG frequency band activity into a pre-defined range. It was hypothesized that the EEG neurofeedback training will enhance children's general as well as food-specific self-regulation.

Funding: Junior Research Program of the Medical Faculty of the University of Leipzig

Project number: IFBADI-024

Duration: 1/2017 – 6/2018


Researchers: Anja Hilbert (PI), PhD, Swen Hesse (Co-PI), MD, Claudia Hübner, PhD

Cooperation partner: Denise E. Wilfley, PhD


The long-term success of behavioral weight loss (WL) treatment in adults is limited by substantial relapse. Until now, only a few weight loss maintenance (WLM) treatments for adults have been evaluated. This clinical trial investigated the feasibility of a Social Facilitation Maintenance (SFM) program for WLM that was specifically tailored to adults with obesity, who had undergone behavioral WL treatment at the Outpatient Unit of the Integrated Research and Treatment Center AdiposityDiseases. Based on the social-ecological model, the program had established cognitive-behavioral interventions on promoting a social support network to maximize long-term behavioral change on eating behavior and physical activity. In the trial, the 16-month SFM program was compared to a treatment as usual (TAU) control condition in N = 69 adults. It was hypothesized that patients receiving SFM treatment will sustain larger amounts of weight loss compared to the control group, with at least medium effect size. Feasibility was examined with a focus on recruitment process, attrition, assessment non-completion, and patients' program evaluation.

Funding: Federal Ministry of Education and Research

Project number: ADI-K7-62

Duration: 11/2013 – 4/2015


Researchers: Anja Hilbert (PI), PhD, Rebekka Kittel, PhD, Ricarda Schmidt, PhD, Anne Tetzlaff, PhD, Anne Brauhardt, PhD


Binge-eating disorder (BED) is characterized by repeated episodes of binge eating. This disorder is the most common eating disorder, occurs in both sexes, and is frequently associated with overweight and obesity. While studies have shown that BED in adults can be effectively treated by psychotherapy, evidence for adolescents is largely lacking. For adults with BED, cognitive-behavioral therapy is the standard psychological treatment. In this single-center randomized-controlled trial, the efficacy of a cognitive-behavioral treatment program tailored to adolescents with BED was evaluated. Building on evidence-based cognitive-behavioral therapy for adults with BED, the program adapted to adolescents aimed at establishing healthy eating behaviors that prevent binge-eating episodes from occurring and contribute to a stabilization of body weight. Further goals were the development of a positive body image and self-acceptance. Strategies for coping with negative emotions and problem solving in everyday life were acquired. After baseline diagnostics, 73 participants were randomized to one of two treatment conditions. Half of the participants immediately started with cognitive-behavioral therapy, the other half started therapy after a four-month waiting period. The treatment program included 20 individual sessions with the adolescent over four months. Additionally, parents were involved in the treatment via coaching. For participants of both treatment conditions, assessments were conducted at baseline (and for the delayed treatment control condition additionally two months prior to treatment and at the beginning of treatment), midtreatment, posttreatment, six-month follow-up, and 12-month follow-up. It was expected that cognitive-behavioral therapy will significantly reduce episodes of binge eating when compared to the delayed treatment control condition. It was further expected that the specific eating disorder psychopathology, general psychopathology, body weight, quality of life, and self-esteem will be significantly improved.

Funding: Federal Ministry of Education and Research

Project number: ADI-K7-16

Duration: 9/2011 – 4/2015


Cooperating Centers: Anja Hilbert (PI), PhD, Holger Till (Leipzig, Co-PI), MD, Christian Jurowich (Würzburg), MD, Beate Herbig (Hamburg), MD, Wolfgang Tigges (Hamburg), MD, Stefan Kaiser (Konstanz), MD


Bariatric surgery is the treatment of choice for morbid obesity, resulting in a long-term weight loss and an improvement of medical comorbidity after bariatric surgery. Yet, a substantial number of patients show either no or only insufficient weight loss and weight regain over time. Although no robust predictors for treatment success were identified, there is evidence that bariatric surgery influences eating behavior and psychosocial adjustment and that these factors are relevant for postoperative weight control. The present registry on the longitudinal assessment of psychosocial parameters in bariatric surgery (PRAC) included a comprehensive assessment of the psychosocial aspects of bariatric surgery in a consecutive sample of adolescent and adult patients. Eating behavior, psychopathology, quality of life, and other psychosocial variables were prospectively documented, using state-of-the-art psychometric instruments.

Funding: Federal Ministry of Education and Research

Project number: ADI-K7-25

Duration: 9/2011 – 4/2015


Researchers: Anja Hilbert (PI), PhD, Wieland Kiess (Co-PI), MD


Eating disturbances in childhood are common, but the nosology remains largely unclear. Only about half of the children from middle childhood diagnosed with an eating disorder fulfill the diagnostic criteria of the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV-TR) for anorexia nervosa (AN) or bulimia nervosa (BN), whereas the remainder is diagnosed as an eating disorder not otherwise specified. There is increasing evidence that binge-eating disorder (BED), characterized by recurrent episodes of binge eating in the absence of regular compensatory behaviors, presents in a child-specific way, which was, however, not specified in the DSM. The DSM-5 has recently included Avoidant/Restrictive Food Intake Disorder (ARFID) as a new diagnostic category to capture food restrictions resulting in a persistent failure to meet appropriate nutritional and/or energy needs. All these eating or food intake disorders have significant impact on body weight (obesity or underweight) and impairments in physical or mental health. However, the epidemiology of these childhood eating or food intake disorders, their nosology, etiology, and course need further research. This project aimed at determining the prevalence and course of childhood eating and food intake disturbances, correlates and predictors, and implications for health and well-being based on the Leipzig Center of Civilization Diseases LIFE CHILD Health and LIFE CHILD Obesity studies. This research aimed at identifying targets of early intervention or prevention, in order to reduce chronicity and psychological, social, and medical sequelae, as well as associated societal and health care costs.

Funding: European Union and European Social Fund, Leipzig Center of Civilization Diseases

Project number: LIFE-206-Function 6 EU

Duration: 1/2014 – 12/2014


Researchers: Anja Hilbert (PI), PhD, Simone Munsch (Co-PI), PhD


Recent research indicates that binge eating, referred to as loss of control (LOC) eating, is a common and psychopathologically relevant experience in childhood. LOC eating and the clinically significant binge-eating disorder (BED) are associated with increased eating disorder and general psychopathology and risk for overweight and obesity. However, it remains unclear which psychological and social factors contribute to the maintenance of LOC eating and how LOC eating relates to comorbid conditions such as attention-deficit/hyperactivity disorder (ADHD). The goal of this research project was to examine the eating behavior of children with BED in the context of psychological and familial maintaining factors, with special consideration of impulsivity, using experimental and naturalistic designs. 102 children ages 8-12 with and without BED and with ADHD were recruited from the community. A laboratory test meal study was conducted to examine psychological determinants of satiety, the reactivity and habituation to food cues, and hedonics in an eating in the absence of hunger design. The role of general compared to food-specific reward sensitivity in LOC eating was assessed in a computer task and a behavioral observation paradigm, and general and food-specific expressed emotions were examined by interview and behavioral observation. In a dyadic ecological momentary assessment study, child and parent perceptions of negative mood, events and interactions were explored as antecedents of LOC episodes in the naturalistic environment. The research project was expected to clarify the association between BED, obesity, and ADHD and to identify targets of early intervention or prevention of childhood BED that will help stabilize body weight or prevent excessive weight gain.

Funding: Swiss National Science Foundation

Project number: 100014_132045/1

Duration: 1/2011 – 12/2014


Researchers: Martina de Zwaan (PI), MD, Anja Hilbert (Co-PI), PhD

Cooperation partners: Hans-Christoph Friederich, MD, Stephan Herpertz, MD, Brunna Tuschen-Caffier, PhD, Stefan Zipfel, MD


Cognitive-behavioral therapy (CBT) represents the most well-established treatment for binge-eating disorder (BED); however, most individuals with BED do not have access to this specialist treatment. Therefore, the aim of this multicenter, randomized-controlled trial was to evaluate the efficacy of internet-based guided self-help (GSH-I) compared with traditional face-to-face CBT. A total of 178 adult outpatients with full or subsyndromal BED was included and received either 20 individual, face-to-face CBT sessions or completed 11 internet modules with weekly email contact to a study coach. It was evaluated whether GSH-I would be noninferior compard to CBT in reducing the number of days with objective binge-eating episodes after the end of treatment (after 4 months) and up to 18 months post-treatment. This trial aimed at clarifying the role of eHealth technologies with low barriers of access for delivering psychotherapy.

Funding: Federal Ministry of Education and Research

Project number: 01GV0601

Duration: 1/2010 – 12/2013