Eating in the absence of hunger and overweight in girls from 5 to 7 y of age

Eating in the Absence of Hunger and Weight Gain in Low-income Toddlers

OBJECTIVE

To identify predictors of eating in the absence of hunger (EAH) in low-income toddlers, describe affect during EAH, test EAH as a predictor of body mass index (BMI), and examine the type of food eaten as a predictor of BMI.

METHODS

EAH, indexed as kilocalories (sweet, salty, and total) of palatable foods consumed after a satiating meal, was measured (n = 209) at ages 21, 27, and 33 months. Child gender, age, race/ethnicity, and previous exposure to the foods; maternal education and depressive symptoms; and family chaos, food insecurity, and structure were obtained via questionnaire. Child and mother BMI were measured. Child affect was coded from videotape. Linear regression was used to examine predictors of EAH and the association of kilocalories consumed and affect with 33 month BMI z-score (BMIz).

RESULTS

Predictors of greater total kilocalories included the child being a boy (P < .01), being older (P < .001), and greater maternal education (P < .01). Being in the the top quartile of sweet kilocalories consumed at 27 months and showing negative affect at food removal had higher BMIz (β = 0.29 [95% confidence interval 0.10 to 0.48] and β = 0.34 [95% confidence interval, 0.12 to 0.56], respectively).There was no association of salty kilocalories consumed or positive affect with BMIz.

CONCLUSIONS

There was little evidence that maternal or family characteristics contribute to EAH. EAH for sweet food predicts higher BMIz in toddlerhood. Studies investigating the etiology of EAH and interventions to reduce EAH in early childhood are needed.

Intuitive eating is inversely associated with body weight status in the general population-based NutriNet-Santé study

OBJECTIVE

To examine the relationship between intuitive eating (IE), which includes eating in response to hunger and satiety cues rather than emotional cues and without having forbidden foods, and weight status in a large sample of adults.

METHODS

A total of 11,774 men and 40,389 women aged ≥18 years participating in the NutriNet-Santé cohort were included in this cross-sectional analysis. Self-reported weight and height were collected as well as IE levels using the validated French version of the Intuitive Eating Scale-2. The association between IE and weight status was assessed using multinomial logistic regression models.

RESULTS

A higher IE score was strongly associated with lower odds of overweight or obesity in both men and women. The strongest associations were observed in women for both overweight [quartile 4 vs. 1 of IE: odds ratio, 95% confidence interval: (0.19, 0.17-0.20)] and obesity (0.09, 0.08-0.10). Associations in men were as follows: for overweight (0.43, 0.38-0.48) and obesity (0.14, 0.11-0.18).

CONCLUSIONS

IE is inversely associated with overweight and obesity which supports its importance. Although no causality can be inferred from the reported associations, these data suggest that IE might be relevant for obesity prevention and treatment.

Eating Behaviours of Preadolescent Children over Time: Stability, Continuity and the Moderating Role of Perceived Parental Feeding Practices

The links between childhood eating behaviours and parental feeding practices are well-established in younger children, but there is a lack of research examining these variables in a preadolescent age group, particularly from the child's perspective, and longitudinally. This study firstly aimed to examine the continuity and stability of preadolescent perceptions of their parents' controlling feeding practices (pressure to eat and restriction) over a 12 month period. The second aim was to explore if perceptions of parental feeding practices moderated the relationship between preadolescents' eating behaviours longitudinally. Two hundred and twenty nine preadolescents (mean age at recruitment 8.73 years) completed questionnaires assessing their eating behaviours and their perceptions of parental feeding practices at two time points, 12 months apart (T1 and T2). Preadolescents' perceptions of their parental feeding practices remained stable. Perceptions of restriction and pressure to eat were continuous. Perceptions of parental pressure to eat and restriction significantly moderated the relationships between eating behaviours at T1 and T2. The findings from this study suggest that in a preadolescent population, perceptions of parental pressure to eat and restriction of food may exacerbate the development of problematic eating behaviours.

Latina mothers' influences on child appetite regulation

Parents influence child weight through interactions that shape the development of child eating behaviors. In this study we examined the association between maternal autonomy promoting serving practices and child appetite regulation. We predicted that maternal autonomy promoting serving practices would be positively associated with child appetite regulation. Participants were low-income Latino children-a group at high risk for the development of childhood obesity. A total of 186 low-income Latina mothers and their 4-5 year old children came to a laboratory on two separate days. On the first day, mothers and children chose foods for a meal from a buffet and were audio/videotaped so that maternal autonomy promoting serving practices could be later coded. On the second day, children completed the Eating in the Absence of Hunger (EAH) task to measure child appetite regulation. Mothers also completed the Child Eating Behavior Questionnaire (CEBQ) to measure other aspects of child appetite regulation (food responsiveness, satiety responsiveness, and emotional overeating). Maternal autonomy promotion during serving was assessed using seven separate measures of child and maternal behavior. Principal components analyses of these serving measures yielded three components: allows child choice, child serves food, and mother does not restrict. Consistent with hypotheses, maternal autonomy promoting serving practices (i.e., allows child choice and does not restrict) were negatively associated with maternal reports of child food responsiveness and emotional overeating (CEBQ). The results for the EAH task were more complex-mothers who were autonomy promoting in their serving practices had children who ate the most in the absence of hunger, but this linear effect was moderated somewhat by a quadratic effect, with moderate levels of autonomy promotion during serving associated with the greatest child EAH.

Maternal behavior as a predictor of sibling interactions during mealtimes

Children who frequently experience encouragement or pressure to eat are more likely to exhibit less favorable eating behaviors and dietary outcomes. Siblings can encourage or pressure each other to eat during mealtimes, but the role of mothers in shaping sibling mealtime interactions is not understood. The objective of this study was to examine the association between the behavior of mothers and siblings during mealtimes. The associations of maternal presence and maternal engagement with children during mealtimes with encouragements to eat delivered by the child to his/her sibling were examined. Children aged 4-8years (n=73) were videotaped while eating a routine evening meal at home with one sibling present. Encouragement to eat delivered by the index child to the sibling, maternal presence, and non-food-related and food-related maternal engagement were coded from the videotapes. Poisson regression showed that maternal presence was associated with fewer encouragements to eat from the index child to the sibling (rate ratio (RR): 0.40, 95% confidence interval (CI): 0.26, 0.62). Each type of maternal engagement was independently associated with the number of encouragements to eat from the index child to the sibling: maternal engagement that was not food-related was associated with fewer encouragements to eat (RR: 0.62, 95% CI: 0.53, 0.73), while maternal engagement that was food-related was associated with more encouragements to eat (RR: 1.49, 95% CI: 1.22, 1.81). Future studies may explore how sibling interactions may mediate links between maternal behavior during mealtimes and children's health-related outcomes.

Satiety and the Self-Regulation of Food Take in Children: a Potential Role for Gene-Environment Interplay

Child eating self-regulation refers to behaviors that enable children to start and stop eating in a manner consistent with maintaining energy balance. Perturbations in these behaviors, manifesting as poorer child eating self-regulation, are associated with higher child weight status. Initial research into child eating self-regulation focused on the role of parent feeding styles and behaviors. However, we argue that child eating self-regulation is better understood as arising from a complex interplay between the child and their feeding environment, and highlight newer research into the heritable child characteristics, such as cognitive ability, that play an important role in this dynamic. Therefore, child eating self-regulation arises from gene-environment interactions. Identifying the genes and environmental influences contributing to these will help us tailor our parental feeding advice to the unique nature of the child. In this way, we will devise more effective advice for preventing childhood obesity.

Parental control and overconsumption of snack foods in overweight and obese children

The associations between snack food consumption, parent feeding practices and general parenting in overweight in obese children are largely unknown. Therefore, we examined these relationships in 117 treatment-seeking overweight and obese children (10.40 ± 1.35 years; 53% female; 52% Caucasian; BMI-z: 2.06 ± .39). Children consumed a dinner meal, completed an Eating in the Absence of Hunger (EAH) free access paradigm (total EAH intake = EAH%-total; sweet food intake = EAH%-sweet), and completed the Child Report of Parent Behavior Inventory. Parents completed the Child Feeding Questionnaire. Child EAH%-total and EAH%-sweet were positively associated with dinner consumption (p's < .01). Girls had significantly higher EAH%-total compared to boys (p < .05). In separate models, higher EAH%-total was associated with greater use of maternal psychological control (p < .05) and EAH%-sweet was positively associated with parent monitoring (p < .05). In analyses examining factors associated with the consumption of specific foods, EAH snack food, parent restriction, pressure to eat, monitoring, and maternal psychological control were positively correlated with intake of Hershey's(®) chocolate bars (p's < .05). In summary, parental monitoring is associated with child sweet snack food intake and maternal psychological control is associated with child total snack food consumption. Future research should evaluate the complex relationship between child eating and parenting, especially with regard to subgroups of foods.

Low Childhood Socioeconomic Status Promotes Eating in the Absence of Energy Need

Life-history theory predicts that exposure to conditions typical of low socioeconomic status (SES) during childhood will calibrate development in ways that promote survival in harsh and unpredictable ecologies. Guided by this insight, the current research tested the hypothesis that low childhood SES will predict eating in the absence of energy need. Across three studies, we measured (Study 1) or manipulated (Studies 2 and 3) participants’ energy need and gave them the opportunity to eat provided snacks. Participants also reported their SES during childhood and their current SES. Results revealed that people who grew up in high-SES environments regulated their food intake on the basis of their immediate energy need; they ate more when their need was high than when their need was low. This relationship was not observed among people who grew up in low-SES environments. These individuals consumed comparably high amounts of food when their current energy need was high and when it was low. Childhood SES may have a lasting impact on food regulation.

Childhood Obesity and Delayed Gratification Behavior: A Systematic Review of Experimental Studies

OBJECTIVE

To evaluate the extent of the association between instant gratification behavior and childhood obesity.

STUDY DESIGN

PubMed, Scopus, EMBASE, EBSCOhost, and Cochrane databases were searched for the terms delayed gratification, children, and obesity. Studies were eligible if they included a sample of at least 100 children who were made to choose between an immediate reward and a larger one later, with the authors comparing the response in different populations and observing some relationship with obesity. A specifically designed data extraction form was used, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The methodologic quality of the included studies was assessed with the methodologic index for nonrandomized studies.

RESULTS

Nine articles were included after we applied the inclusion and exclusion criteria. Almost all studies conducted the test in populations of preschool children and offered food and/or nonfood rewards. The studies found a clear relationship between an inability to defer gratification and overweight and obesity. The quality assessment of the publications was ranked high in 5 studies and medium in 4.

CONCLUSIONS

Children with the inability to delay gratification are more likely to be overweight or obese. Observation of such trends is useful in its implications for reeducation programs. Although the methodologic quality of the eligible studies was acceptable, additional experimental controlled studies are required to associate these behaviors with other aspects.

Appetitive traits and food intake patterns in early life

BACKGROUND

High food responsiveness (FR) and low satiety responsiveness (SR) are 2 appetitive traits that have been associated longitudinally with risk of excessive weight gain; however, to our knowledge, no studies have examined the associations between these traits and eating patterns in daily life in young children.

OBJECTIVE

We tested the hypothesis that higher FR is independently associated with a higher meal frequency and that lower SR is associated with a larger meal size.

DESIGN

Data were from 1102 families (2203 children) from the Gemini twin birth cohort. Appetite was assessed with the use of the Child Eating Behavior Questionnaire when the children were 16 mo old (mean ± SD: 15.73 ± 1.08 mo old), and meal frequency (eating occasions per day) and meal size (kilojoules per eating occasion) were determined from 3-d diet diaries completed by parents when the children were 21 mo old (mean ± SD: 20.65 ± 1.10 mo old). Complex samples general linear models were used to explore cross-sectional associations between appetitive traits and meal variables.

RESULTS

After adjustment for the covariates gestational age, birth weight, sex, difference in age at diet-diary completion, and appetite measurement, higher FR was associated with more-frequent meals (B ± SE: 0.13 ± 0.04; P = 0.001) but not with meal size (P = 0.41), and lower SR was associated with a larger meal size (B ± SE: -47.61 ± 8.79; P < 0.001) but not with meal frequency (P = 0.15).

CONCLUSIONS

FR and SR predict different eating variables with more food-responsive children eating more frequently, whereas less-satiety-responsive children eat more food on each eating occasion. Different strategies may be required to reduce the potential effects of FR and SR on weight gain.

Parental feeding behaviour and motivations regarding pre-school age children: A thematic synthesis of qualitative studies

Poor childhood diet is a major risk factor for disease and obesity, and parents of pre-school children are in a powerful position to influence diet for life. The technique of thematic synthesis (Thomas & Harden, 2008) was used to synthesise recent qualitative research on parental feeding of pre-school age children (18 months-6 years). The aim was to inform development of nutrition advice by gaining a comprehensive picture of parental feeding behaviours and motivations. Six key parental feeding behaviours were identified: modelling, rewards, pressure and encouragement, repeated exposure, creativity, and limiting intake. Four overarching themes regarding motivations were identified: promoting good health (balance and variety, and weight control); building positive relationships (child involvement, and parental engagement and responsiveness); practicalities and constraints (time, cost, and lack of culinary skill, and pressure and flexibility); and emotional motivations (problem avoidance, and emotional investment). Practicalities and constraints, and emotional motivations impacted more significantly on low income parents. In order to be effective, nutrition advice ought to tap into parents' strong desire to build positive relationships and promote good health while remaining sensitive to the significant constraints and practicalities faced.

Feasibility and Acceptability of Adapting the Eating in the Absence of Hunger Assessment for Preschoolers in the Classroom Setting

Eating in the Absence of Hunger (EAH) represents a failure to self-regulate intake leading to overconsumption. Existing research on EAH has come from the clinical setting, limiting our understanding of this behavior. The purpose of this study was to describe the adaptation of the clinical EAH paradigm for preschoolers to the classroom setting and evaluate the feasibility and acceptability of measuring EAH in the classroom. The adapted protocol was implemented in childcare centers in Houston, Texas (N=4) and Phoenix, Arizona (N=2). The protocol was feasible, economical, and time efficient, eliminating previously identified barriers to administering the EAH assessment such as limited resources and the time constraint of delivering the assessment to participants individually. Implementation challenges included difficulty in choosing palatable test snacks that were in compliance with childcare center food regulations and the limited control over the meal that was administered prior to the assessment. The adapted protocol will allow for broader use of the EAH assessment and encourage researchers to incorporate the assessment into longitudinal studies in order to further our understanding of the causes and emergence of EAH.

Maternal intuitive eating as a moderator of the association between concern about child weight and restrictive child feeding

Mothers who are concerned about their young child's weight are more likely to use restrictive feeding, which has been associated with increased food seeking behaviors, emotional eating, and overeating in young children across multiple prospective and experimental studies. In the present study, we examined whether mothers' intuitive eating behaviors would moderate the association between their concern about their child's weight and their use of restrictive feeding. In a sample of 180 mothers of young children, two maternal intuitive eating behaviors (i.e., eating for physical reasons, trust in hunger and satiety cues) moderated this association after controlling for maternal age, body mass index, years of education, race/ethnicity, awareness of hunger and satiety cues and perceptions of child weight. More specifically, concern about child weight was unrelated to restrictive feeding for mothers with higher levels of eating for physical reasons and trust in hunger and satiety cues. However, concern about child weight was positively related to restrictive feeding among mothers with lower or average levels of eating for physical reasons and trust in hunger and satiety cues. These findings indicate that it may be important address maternal intuitive eating within interventions designed to improve self-regulated eating in children, as mothers who attend these interventions tend to be highly concerned about their child's weight and, if also low in intuitive eating, may be at risk for using restrictive feeding behaviors that interfere with children's self-regulated eating.

Sibling feeding behavior: Mothers as role models during mealtimes

Siblings may act as caregivers and role models during mealtimes, and develop caregiving skills by observing and imitating the behavior of their mothers. The objective of this study was to examine the association between maternal feeding behaviors and encouragements to eat delivered from the sibling to the index child during mealtimes. Index children aged 4-8 years (n = 69) were videotaped while eating a routine evening meal at home with one sibling present. Encouragements to eat delivered from the sibling to the index child were coded from the videotapes. Mothers completed the Child Feeding Questionnaire and the Caregiver's Feeding Styles Questionnaire. Poisson regression was used to examine the association of maternal Pressure to Eat, Restriction, Monitoring, Verbal Direction, and Coercion with number of encouragements to eat delivered from the sibling to the index child. Models were adjusted for index child's age, sex, and race/ethnicity, and maternal education. Results showed that maternal Pressure to Eat (Rate Ratio (RR): 1.39, 95% confidence interval (CI): 1.19, 1.69), Restriction (RR: 1.31, 95% CI: 1.07, 1.60), Verbal Direction (RR: 2.04, 95% CI: 1.68, 2.47), and Coercion (RR: 1.58, 95% CI: 1.29, 1.92) were each positively associated with the number of encouragements to eat delivered from the sibling to the index child. Maternal Monitoring was not associated with the number of encouragements to eat delivered from the sibling to the index child (RR: 0.92, 97% CI: 0.78, 1.09). Findings suggest that maternal behavior during mealtimes may affect the index child indirectly by shaping the behavior of siblings. Since controlling feeding behaviors have been associated with greater child obesity risk, future studies may evaluate the compounded effect of experiencing controlling feeding behaviors from both mothers and siblings.

The relationship between parent feeding styles and general parenting with loss of control eating in treatment-seeking overweight and obese children

OBJECTIVE

To examine differences in parent feeding behaviors and general parenting of overweight children with and without loss of control (LOC) eating.

METHOD

One-hundred-and-eighteen overweight and obese children (10.40 ± 1.35 years; 53% female; 52% Caucasian; BMI-z: 2.06 ± 0.39) and their parents (42.42 ± 6.20 years; 91% female; 70% Caucasian; BMI: 31.74 ± 6.96 kg/m(2) ) were seen at a baseline assessment visit for a behavioral intervention that targeted overeating. The Eating Disorder Examination, adapted for children (ChEDE) was administered to assess for LOC eating. Parents completed the Parental Feeding Styles Questionnaire (PFSQ) and the Child Feeding Questionnaire (CFQ) to assess parent feeding styles and behaviors. Children also completed a self-report measure of general parenting (Child Report of Parent Behavior Inventory, CRPBI-30).

RESULTS

Forty-three children (36.40%) reported at least one LOC eating episode in the month prior to assessment. Parents who reported greater restriction and higher levels of pressure to eat were more likely to have children that reported LOC eating (ps < 0.05). Parents who utilized more instrumental feeding and prompting/encouragement to eat techniques were less likely to have children that reported LOC eating (ps < 0.05). Child-reported parenting behaviors were unrelated to child LOC eating (ps > 0.05).

DISCUSSION

Parent feeding styles and behaviors appear to be differentially and uniquely related to LOC eating in treatment-seeking overweight and obese children. Future research is needed to determine if implementing interventions that target parent feeding behaviors may reduce LOC eating, prevent full-syndrome eating disorders, and reduce weight gain in youth.

Increased Snacking and Eating Occasions Are Associated with Higher Energy Intake among Mexican Children Aged 2-13 Years

BACKGROUND

Little is known about the dietary behaviors of Mexican children with regard to frequency, amount, and quality of foods consumed at eating occasions and their impact on total daily energy intake.

OBJECTIVES

The objectives were to 1) describe foods consumed across eating occasions and 2) examine whether the number or type of total eating occasions was associated with increased total daily energy intake and differed between 2- to 5-y-old and 6- to 13-y-old Mexican children.

METHODS

A nationally representative sample of 5031 children from the 2012 ENSANUT (Encuesta Nacional de Salud y Nutrición) was used to examine the percentage of meals and snacks consumed, mean energy intake from meals and snacks, and the top food groups contributing to meals and snacks. Multivariate linear regression was used to examine the association between meals, snacks, and total eating occasions with daily energy intake for 2- to 5-y-old and 6- to 13-y-old children.

RESULTS

Eating patterns were similar across age groups (per capita mean intake of 3 meals and 1.4-1.6 snacks/d). Each additional snack was associated with greater increases in mean daily energy for older children (+191-289 kcal/d; P < 0.01) relative to younger children (+102-130 kcal/d; P < 0.01). Likewise, each additional eating occasion was associated with greater increases in mean daily energy for older children (+323 kcal/d; P < 0.01) relative to younger children (+166-261 kcal/d; P < 0.01). In both younger and older children, snacking was prevalent (75% and 68%, respectively). Top food contributors to snacks included fruit, salty snacks, candy, sweetened breads, and cookies. Among older children, whole milk as a snack was partially replaced with soda and sweetened fruit drinks.

CONCLUSION

Snacks represent an area for potential improvement in the diets of Mexican children, especially among those aged 6 to 13 y, for whom each additional snack or eating occasion was linked to even greater increases in total daily energy intake.

Implications of learning theory for developing programs to decrease overeating

Childhood obesity is associated with medical and psychological comorbidities, and interventions targeting overeating could be pragmatic and have a significant impact on weight. Calorically dense foods are easily available, variable, and tasty which allows for effective opportunities to learn to associate behaviors and cues in the environment with food through fundamental conditioning processes, resulting in measurable psychological and physiological food cue reactivity in vulnerable children. Basic research suggests that initial learning is difficult to erase, and that it is vulnerable to a number of phenomena that will allow the original learning to re-emerge after it is suppressed or replaced. These processes may help explain why it may be difficult to change food cue reactivity and overeating over the long term. Extinction theory may be used to develop effective cue-exposure treatments to decrease food cue reactivity through inhibitory learning, although these processes are complex and require an integral understanding of the theory and individual differences. Additionally, learning theory can be used to develop other interventions that may prove to be useful. Through an integration of learning theory, basic and translational research, it may be possible to develop interventions that can decrease the urges to overeat, and improve the weight status of children.

Parent/Adolescent Weight Status Concordance and Parent Feeding Practices

BACKGROUND

Previous studies have examined the independent influence of mother's weight status or child's weight status on parents' use of specific feeding practices (ie, food restriction, pressure-to-eat). However, studies have not examined the mutual influence of parents' and adolescents' weight status on parents' feeding practices. This study examines the relationship between parent and adolescent weight status concordance and discordance and parent feeding practices.

METHODS

Data from 2 linked population-based studies, Eating and Activity in Teens (EAT) 2010 and Families and Eating and Activity in Teens (F-EAT), were used for cross-sectional analysis. Parents (n = 3252; 63% female; mean age 42.6 years) and adolescents (n = 2153; 54% female; mean age 14.4 years) were socioeconomically and racially/ethnically diverse. Anthropometric assessments and surveys were completed at school by adolescents, and surveys were completed at home by parents.

RESULTS

Parents used the highest levels of pressure-to-eat feeding practices when parents and adolescents were both nonoverweight compared with all other combinations of concordant and discordant parent/adolescent weight status categories. Additionally, parents used the highest levels of food restriction when parents and adolescents were both overweight/obese compared with all other combinations of concordant and discordant parent/adolescent weight status categories. Sensitivity analyses with 2-parent households revealed similar patterns.

CONCLUSIONS

Results suggest that parents use feeding practices in response to both their adolescents' and their own weight status. Results may inform health care providers and public health interventionists about which parent/adolescent dyads are at highest risk for experiencing food restriction or pressure-to-eat parent feeding practices in the home environment and whom to target in interventions.

Higher weight status of only and last-born children. Maternal feeding and child eating behaviors as underlying processes among 4-8 year olds

Birth order has been associated with childhood obesity. The objective of this cross-sectional study was to examine maternal feeding and child eating behaviors as underlying processes for increased weight status of only children and youngest siblings. Participants included 274 low-income 4-8 year old children and their mothers. The dyads completed a videotaped laboratory mealtime observation. Mothers completed the Caregiver's Feeding Styles Questionnaire and the Children's Eating Behavior Questionnaire. Child weight and height were measured using standardized procedures. Path analysis was used to examine associations of birth order, maternal feeding behavior, child eating behavior, and child overweight/obese status. The association between only child status and greater likelihood of overweight/obesity was fully mediated by higher maternal Verbal Discouragement to eat and lower maternal Praise (all p values < 0.05). The association between youngest sibling status and greater likelihood of overweight/obesity was partially mediated by lower maternal Praise and lower child Food Fussiness (all p values < 0.05). Results provide support for our hypothesis that maternal control and support and child food acceptance are underlying pathways for the association between birth order and weight status. Future findings can help inform family-based programs by guiding family counseling and tailoring of recommendations for family mealtime interactions.

Mealtime behavior among siblings and body mass index of 4-8 year olds: a videotaped observational study

BACKGROUND

Being a last-born child and having a sister have been associated with higher body mass index (BMI). Encouragement to eat that overrides children's self-regulation has been reported to increase the risk of obesogenic eating behaviors. This study sought to test the hypothesis that encouragement to eat during mealtime from older siblings and sisters mediates associations of being last-born or having a sister with higher BMI.

METHODS

Children aged 4-8 years (n = 75) were videotaped while eating a routine evening meal at home with one sibling present. Encouragement to eat (defined as direct prompts to eat or general positive statements about food) delivered to the index child (IC) from the sibling was coded from the videotape. Path analysis was used to examine associations between IC's birth order, sibling's sex, encouragement counts, and IC's measured BMI z-score (BMIz).

RESULTS

Being the younger sibling in the sibling dyad was associated with the IC receiving more encouragements to eat from the sibling (β: 0.93, 95 % confidence interval (CI): 0.59, 1.26, p < 0.0001). The IC having a sister compared with a brother was not associated with the IC receiving more encouragements to eat from the sibling (β: 0.18, 95 % CI: -0.09, 0.47, p = 0.20). The IC receiving more encouragements to eat from the sibling was associated with lower IC BMIz (β: -0.06, 95 % CI: -0.12, 0.00, p = 0.05).

CONCLUSIONS

Children were more likely to receive encouragements to eat from older siblings than younger siblings. Being the recipient of encouragements to eat from a sibling was associated with lower, not higher, child BMIz, which may reflect sibling modeling of maternal behavior. Future longitudinal studies are needed to examine whether encouragements to eat from siblings lead to increase in BMI over time. Encouragements from siblings may be a novel intervention target for obesity prevention.

Functional MRI of Challenging Food Choices: Forced Choice between Equally Liked High- and Low-Calorie Foods in the Absence of Hunger

We are continuously exposed to food and during the day we make many food choices. These choices play an important role in the regulation of food intake and thereby in weight management. Therefore, it is important to obtain more insight into the mechanisms that underlie these choices. While several food choice functional MRI (fMRI) studies have been conducted, the effect of energy content on neural responses during food choice has, to our knowledge, not been investigated before. Our objective was to examine brain responses during food choices between equally liked high- and low-calorie foods in the absence of hunger. During a 10-min fMRI scan 19 normal weight volunteers performed a forced-choice task. Food pairs were matched on individual liking but differed in perceived and actual caloric content (high-low). Food choice compared with non-food choice elicited stronger unilateral activation in the left insula, superior temporal sulcus, posterior cingulate gyrus and (pre)cuneus. This suggests that the food stimuli were more salient despite subject’s low motivation to eat. The right superior temporal sulcus (STS) was the only region that exhibited greater activation for high versus low calorie food choices between foods matched on liking. Together with previous studies, this suggests that STS activation during food evaluation and choice may reflect the food’s biological relevance independent of food preference. This novel finding warrants further research into the effects of hunger state and weight status on STS, which may provide a marker of biological relevance.

He Said, She Said: Examining Parental Concordance on Home Environment Factors and Adolescent Health Behaviors and Weight Status

BACKGROUND

Few studies have examined concordance/discordance between caregivers to identify whether caregivers see familial and parental factors in the home environment similarly or differently and whether the agreement or disagreement is related to adolescent obesity risk. Answers to these questions are important and may inform whether family-based childhood obesity interventions need to target both parents.

OBJECTIVE

The main objective of the study was to examine whether and how parental concordance/discordance on factors in the home environment (eg, importance of family meals, parent feeding practices, encouraging child physical activity, and limit setting on child screen time) are associated with adolescent health behaviors and weight status.

DESIGN

Data from two linked population-based studies were used in cross-sectional analyses. Linear regression models examined associations between parental concordance/discordance on home environment factors and adolescents' health behaviors and weight status.

PARTICIPANT/SETTINGS

Racially/ethnically and socioeconomically diverse adolescents (n=1,052; 54% girls; mean age=14.3 years) and their parents (n=2,104; 52% women; mean age=41.0 years) from Minneapolis and St Paul, MN, participated in the study. Anthropometric assessments and surveys were completed at school by adolescents and surveys were completed at home by parents.

RESULTS

Parental concordance on home environment factors was high for some factors (eg, 68% concordance on not pressuring adolescent to eat) and low for other factors (eg, 2% concordance on parent engaging in physically activity with child 4+ hours per week). Parental concordance on positive home environment factors (eg, frequency of family meals) was associated with more adolescent healthful eating patterns and hours of physical activity (P<0.05), but not consistently. When parents were discordant, adolescents had higher consumption of fast food and more unhealthy weight control behaviors (P<0.05), but not consistently.

CONCLUSIONS

Results suggest there is some degree of parental concordance on home environment factors; however, the results were inconsistent and approximately one-third of parents were discordant on these factors. Future research is needed to further examine the role of parental concordance/discordance on adolescent health behaviors and weight status.

Maternal intuitive eating as a moderator of the association between concern about child weight and restrictive child feeding

Mothers who are concerned about their young child's weight are more likely to use restrictive feeding, which has been associated with increased food seeking behaviors, emotional eating, and overeating in young children across multiple prospective and experimental studies. In the present study, we examined whether mothers' intuitive eating behaviors would moderate the association between their concern about their child's weight and their use of restrictive feeding. In a sample of 180 mothers of young children, two maternal intuitive eating behaviors (i.e., eating for physical reasons, trust in hunger and satiety cues) moderated this association after controlling for maternal age, body mass index, years of education, race/ethnicity, awareness of hunger and satiety cues and perceptions of child weight. More specifically, concern about child weight was unrelated to restrictive feeding for mothers with higher levels of eating for physical reasons and trust in hunger and satiety cues. However, concern about child weight was positively related to restrictive feeding among mothers with lower or average levels of eating for physical reasons and trust in hunger and satiety cues. These findings indicate that it may be important address maternal intuitive eating within interventions designed to improve self-regulated eating in children, as mothers who attend these interventions tend to be highly concerned about their child's weight and, if also low in intuitive eating, may be at risk for using restrictive feeding behaviors that interfere with children's self-regulated eating.

A prospective study of adolescent eating in the absence of hunger and body mass and fat mass outcomes

OBJECTIVE

Eating in the absence of hunger (EAH) refers to the consumption of palatable foods in a sated state. It has been proposed that EAH promotes excess weight gain in youth; yet there are limited prospective data to support this hypothesis. We examined whether EAH at baseline predicted increases in body mass (BMI and BMIz) and fat mass (kg) 1 year later among adolescent boys and girls.

METHODS

EAH was assessed as adolescents' consumption of palatable snack foods following eating to satiety from an ad libitum lunch buffet. Parents also completed a questionnaire about their children's EAH. Body composition was assessed using air displacement plethysmography.

RESULTS

Of 196 adolescents assessed for EAH at baseline, 163 (83%) were re-evaluated 1 year later. Accounting for covariates, which included respective baseline values for each dependent variable, race, height, age, sex, and pubertal stage, there were no significant associations between baseline observed or parent-reported EAH and change in adolescent BMI, BMIz, or fat mass. Results did not differ by sex, child weight status, or maternal weight status.

CONCLUSIONS

No evidence was found to support the hypothesis that EAH is a unique endophenotype for adolescent weight or fat gain.

Maternal Feeding Goals Described by Low-Income Mothers

OBJECTIVE

To identify maternal feeding goals and examine associations of number and type of goals with mother and child characteristics.

DESIGN

Qualitative interviews about child feeding and quantitative assessment of goal prevalence and associations with mother and child characteristics.

SETTING

Southeastern Michigan.

PARTICIPANTS

A total of 287 low-income mothers (31% Hispanic or non-white) and their children ages 4 to 8 years.

MAIN OUTCOME MEASURE

Maternal feeding goals.

ANALYSIS

Themes were generated using the constant comparative method, individual interviews were coded, and the prevalence of feeding goals was determined. Regression analyses examined associations of mother and child characteristics with the number and type of feeding goals.

RESULTS

Thirteen maternal feeding goals were identified. The most prevalent were to restrict less nutrient-dense food (60%), promote autonomy around eating (54%), prevent obesity (53%), and promote fruits or vegetables (52%). A child who was female and heavier with an older, non-Hispanic white, more educated mother with less chaos in the home predicted more maternal feeding goals (all P < .05). Specific maternal and child characteristics were associated with individual feeding goals.

CONCLUSIONS AND IMPLICATIONS

Depending on their current goals for child feeding, some mothers may benefit from interventions focused on goal development, whereas other mothers may benefit from interventions designed to facilitate goal implementation.

Executive functioning, emotion regulation, eating self-regulation, and weight status in low-income preschool children: how do they relate?

The purpose of the present study was to examine relationships between child eating self-regulation, child non-eating self-regulation, and child BMIz in a low-income sample of Hispanic families with preschoolers. The eating in the absence of hunger task as well as parent-report of child satiety responsiveness and food responsiveness were used to assess child eating self-regulation. Two laboratory tasks assessing executive functioning, a parent questionnaire assessing child effortful control (a temperament dimension related to executive functioning), and the delay of gratification and gift delay tasks assessing child emotion regulation were used to assess child non-eating self-regulation. Bivariate correlations were run among all variables in the study. Hierarchical linear regression analyses assessed: (1) child eating self-regulation associations with the demographic, executive functioning, effortful control, and emotion regulation measures; and (2) child BMI z-score associations with executive functioning, effortful control, emotion regulation measures, and eating self-regulation measures. Within child eating self-regulation, only the two parent-report measures were related. Low to moderate positive correlations were found between measures of executive functioning, effortful control, and emotion regulation. Only three relationships were found between child eating self-regulation and other forms of child self-regulation: eating in the absence of hunger was positively associated with delay of gratification, and poor regulation on the gift delay task was associated positively with maternal reports of food responsiveness and negatively with parent-reports of satiety responsiveness. Regression analyses showed that child eating self-regulation was associated with child BMIz but other forms of child self-regulation were not. Implications for understanding the role of self-regulation in the development of child obesity are discussed.

Firm maternal parenting associated with decreased risk of excessive snacking in overweight children

OBJECTIVE

To examine the relationship between parent feeding practices (restriction, monitoring, pressure to eat), general parenting behaviors (acceptance, psychological control, firm control), and aberrant child eating behaviors (emotional eating and excessive snacking) among overweight and normal weight children.

METHODS

Overweight and normal weight children between 8 and 12 years old and their mothers (n = 79, parent-child dyads) participated in this study. Mothers completed surveys on parent feeding practices (Child Feeding Questionnaire) and child eating behaviors (Family Eating and Activity Habits Questionnaire). Children reported on their mothers' general parenting behaviors (Child Report of Parent Behavior Inventory). Parent and child height and weight were measured and demographic characteristics assessed. Logistic regression models, stratified by child weight status and adjusting for parent BMI, were used to determine which parenting dimensions and feeding practices were associated with child emotional eating and snacking behavior.

RESULTS

Overweight children displayed significantly more emotional eating and excessive snacking behavior than normal weight children. Mothers of overweight children used more restrictive feeding practices and psychological control. Restrictive feeding practices were associated with emotional eating in the overweight group (OR = 1.26, 95 % CI, 1.02, 1.56) and excessive snacking behavior in the normal weight group (OR = 1.13, 95 % CI, 1.01, 1.26). When examining general parenting, firm control was associated with decreased odds of excessive snacking in the overweight group (OR = 0.51, 95 % CI, 0.28, 0.93).

CONCLUSION

Restrictive feeding practices were associated with aberrant child eating behaviors in both normal weight and overweight children. Firm general parenting however, was associated with decreased snacking behavior among overweight children. Longitudinal studies following children from infancy are needed to better understand the direction of these relationships.

Picky eating and child weight status development: a longitudinal study

BACKGROUND

Children's picky eating behaviour has been linked both to being overweight and underweight. However, the role of parenting practices in this relationship has rarely been investigated. The present study aimed to clarify the direction of the association between picky eating and weight status and to examine the moderating role of food parenting practices.

METHODS

The present study comprised a longitudinal study on the effects of picky eating on child weight status within the KOALA Birth Cohort Study, the Netherlands. Mothers and their children were included in the analyses. Children's picky eating behaviour and food parenting practices were assessed at baseline (child age 5 years). Their weight status was assessed repeatedly until age 9 years. Mixed effects linear and logistic regressions were used to compare picky eaters (n = 403) and non-picky eaters (n = 621) on changes in weight status over the years.

RESULTS

At baseline of age 5 years, picky eaters were slightly shorter, more often underweight and less often overweight than non-picky eaters, whereas energy intake in relation to body weight (kJ kg(-1)) was similar. Picky eaters with a normal weight at baseline had no increased risk of becoming underweight during follow-up until age 9 years, and were less likely to become overweight compared to non-picky eaters. There were no interactions with food parenting practices. The parents of picky eaters more often reported pressuring their child to eat and restrict unhealthy food intake compared to parents of non-picky eaters.

CONCLUSIONS

The association between picky eating and child weight status was not influenced by parenting practices.

Managing young children's snack food intake. The role of parenting style and feeding strategies

One major contributor to the problem of childhood overweight and obesity is the over-consumption of foods high in fat, salt and sugar, such as snack foods. The current study aimed to examine young children's snack intake and the influence of feeding strategies used by parents in the context of general parenting style. Participants were 611 mothers of children aged 2-7 years who completed an online questionnaire containing measures of general parenting domains and two particular feeding strategies, restriction and covert control. It was found that greater unhealthy snack intake was associated with higher restriction and lower covert control, while greater healthy snack intake was associated with lower restriction and higher covert control. Further, the feeding strategies mediated the association between parental demandingness and responsiveness and child snack intake. These findings provide evidence for the differential impact of controlling and positive parental feeding strategies on young children's snack intake in the context of general parenting.

Depressed affect and dietary restraint in adolescent boys' and girls' eating in the absence of hunger

Data suggest that depressed affect and dietary restraint are related to disinhibited eating patterns in children and adults. Yet, experimental research has not determined to what extent depressed affect acutely affects eating in the absence of physiological hunger (EAH) in adolescents. In the current between-subjects experimental study, we measured EAH in 182 adolescent (13-17 y) girls (65%) and boys as ad libitum palatable snack food intake after youth ate to satiety from a buffet meal. Just prior to EAH, participants were randomly assigned to view either a sad or neutral film clip. Dietary restraint was measured with the Eating Disorder Examination. Adolescents who viewed the sad film clip reported small but significant increases in state depressed affect relative to adolescents who viewed the neutral film clip (p < .001). Yet, there was no main effect of film condition on EAH (p = .26). Instead, dietary restraint predicted greater EAH among girls, but not boys (p < .001). These findings provide evidence that adolescent girls' propensity to report restrained eating is associated with their greater disinhibited eating in the laboratory. Additional experimental research, perhaps utilizing a more potent laboratory stressor and manipulating both affective state and dietary restraint, is required to elucidate how state affect may interact with dietary restraint to influence EAH during adolescence.

Breast is best: Positive mealtime interactions in breastfeeding mothers from Israel and the United Kingdom

We examined mealtime interactions to assess whether they varied according to maternal body mass index, country and mode of feeding in 41 Israeli and UK mother–infant dyads. Feeding behaviours were coded using the Simple Feeding Element Scale. Significantly, more UK mothers breastfed during the filmed meal compared to Israeli mothers. Mealtime interactions did not vary according to maternal body mass index or country. Women who breastfed (as opposed to those who bottle fed or fed solids) provided fewer distractions during the meal, a more ideal feeding environment and fed more responsively.

Correspondence between maternal determination of child fullness and young children's self-determined fullness level: results from a standardized laboratory protocol

BACKGROUND

This study examined maternal understanding and acceptance of young children's ability to self-assess fullness using a mixed-methods approach.

METHODS

Twenty low-income mothers of 5- to 7-year-olds participated in this semistructured laboratory study. After consumption of a buffet dinner meal, mothers were asked to indicate their perception of their child's fullness level, and children were also asked to self-assess their fullness level.

RESULTS

Five of the 20 mothers in the study were initially correct in their assessment of their child's level of fullness. Half of the incorrect mothers were willing to change their rating when informed that the child's fullness rating was different than her own.

CONCLUSIONS

Semistructured interview results provide suggestive evidence that some mothers believe they understand their child's fullness level better than their children. Given that mothers have the potential to override children's ability to self-regulate eating behavior, teaching mothers to understand and appreciate young children's ability to self-regulate eating is an important area for intervention.

All in the family: correlations between parents' and adolescent siblings' weight and weight-related behaviors

OBJECTIVE

To examine whether and how parents' and adolescent siblings' weight and weight-related behaviors are correlated. Results will inform which family members may be important to include in adolescent obesity prevention interventions.

METHODS

Data from two linked population-based studies, EAT 2010 and F-EAT, were used for cross-sectional analyses. Parents (n = 58; 91% females; mean age = 41.7 years) and adolescent siblings (sibling #1 n = 58, 50% girls, mean age = 14.3 years; sibling #2 n = 58, 64% girls, mean age = 14.8 years) were socioeconomically and racially/ethnically diverse.

RESULTS

Some weight-related behaviors between adolescent siblings were significantly positively correlated (i.e., fast food consumption, breakfast frequency, sedentary patterns, p < 0.05). There were no significant correlations between parents' weight and weight-related behaviors and adolescent siblings' same behaviors. Some of the significant correlations found between adolescent siblings' weight-related behaviors were statistically different from correlations between parents' and adolescent siblings' weight-related behaviors.

CONCLUSIONS

Although not consistently, adolescent siblings' weight-related behaviors were significantly correlated as compared with parents' and adolescent siblings' weight-related behaviors. It may be important to consider including siblings in adolescent obesity prevention interventions or in recommendations healthcare providers give to adolescents regarding their weight and weight-related behaviors.

Integrating fundamental concepts of obesity and eating disorders: implications for the obesity epidemic

Physiological mechanisms promote weight gain after famine. Because eating disorders, obesity, and dieting limit food intake, they are famine-like experiences. The development of the concept of meeting an ideal weight was the beginning of increasing obesity. Weight stigma, the perception of being fat, lack of understanding of normal growth and development, and increased concern about obesity on the part of health providers, parents, and caregivers have reinforced each other to promote dieting. Because weight suppression and disinhibition provoke long-term weight increase, dieting is a major factor producing the obesity epidemic. The integrated eating disorder-obesity theory included in this article emphasizes that, contrary to dieters, lifetime weight maintainers depend on physiological processes to control weight and experience minimal weight change.

A Boosting Algorithm for Estimating Generalized Propensity Scores with Continuous Treatments

In this article, we study the causal inference problem with a continuous treatment variable using propensity score-based methods. For a continuous treatment, the generalized propensity score is defined as the conditional density of the treatment-level given covariates (confounders). The dose-response function is then estimated by inverse probability weighting, where the weights are calculated from the estimated propensity scores. When the dimension of the covariates is large, the traditional nonparametric density estimation suffers from the curse of dimensionality. Some researchers have suggested a two-step estimation procedure by first modeling the mean function. In this study, we suggest a boosting algorithm to estimate the mean function of the treatment given covariates. In boosting, an important tuning parameter is the number of trees to be generated, which essentially determines the trade-off between bias and variance of the causal estimator. We propose a criterion called average absolute correlation coefficient (AACC) to determine the optimal number of trees. Simulation results show that the proposed approach performs better than a simple linear approximation or L2 boosting. The proposed methodology is also illustrated through the Early Dieting in Girls study, which examines the influence of mothers' overall weight concern on daughters' dieting behavior.

Differences in eating behaviour, well-being and personality between mothers following baby-led vs. traditional weaning styles

Baby-led weaning, where infants self-feed family foods in place of traditional spoon-feeding of purees, is continuing to grow in popularity. Evidence is emerging which suggests that the method may promote healthier eating behaviour and weight gain in children, but the research is in its infancy. One issue is the self-selecting nature of participants to the approach. Although those who follow a baby-led approach are known to have a higher education and more professional occupation, little is known about wider maternal characteristics, which might affect either adoption of or outcomes of the method. The aim of this study was to explore differences in maternal characteristics between those adopting a baby-led or traditional approach. Six hundred four mothers with an infant aged 6-12 months completed a questionnaire including a copy of the Dutch Eating Behaviour Questionnaire (DEBQ), Brief Symptom Inventory (BSI) (anxiety, obsessive-compulsive and depression scales) and Ten Item Personality Questionnaire (TIPQ) alongside details of weaning approach (baby-led vs. traditional). Mothers who adopted a baby-led weaning style scored significantly lower on restrained eating (DEBQ), anxiety and introversion (TIPQ) and anxiety and obsessive-compulsive symptoms (BSI). Mothers who currently adopt a baby-led approach are therefore significantly different in personality, eating behaviour and well-being characteristics compared with those adopting a traditional approach. These characteristics may affect likelihood of choosing a baby-led approach or indirectly affect outcomes for infants weaned using the approach. Further research exploring baby-led weaning in a wider population sample is needed.

Rationale and design of the Feeding Dynamic Intervention (FDI) study for self-regulation of energy intake in preschoolers

In 2011, the Institute of Medicine Early Childhood Prevention Policies Report identified feeding dynamics as an important focus area for childhood obesity prevention and treatment. Feeding dynamics includes two central components: (1) caregiver feeding practices (i.e., determining how, when, where, and what they feed their children) and (2) child eating behaviors (i.e., determining how much and what to eat from what food caregivers have provided). Although there has been great interest in overweight and obesity prevention and treatment in young children, they have not focused comprehensively on feeding dynamics. Interventions on feeding dynamics that reduce caregivers' excessive controlling and restrictive feeding practices and encourage the development of children's self-regulation of energy intake may hold promise for tackling childhood obesity especially in the young child but currently lack an evidence base. This manuscript describes the rationale and design for a randomized controlled trial designed to compare a group of mothers and their 3-to 5-year old children who received an intervention focused primarily on feeding dynamics called the Feeding Dynamic Intervention (FDI) with a Wait-list Control Group (WLC). The primary aim of the study will be to investigate the efficacy of the FDI for decreasing Eating in the Absence of Hunger (EAH) and improving energy compensation (COMPX). The secondary aim will be to examine the effect of the FDI in comparison to the WLC on maternal self-reported feeding practices and child satiety responsiveness.

Candy consumption patterns, effects on health, and behavioral strategies to promote moderation: summary report of a roundtable discussion

Nearly all Americans (97%) report eating candy at least once per year; yet, on a given day, only approximately one-fourth of the US population aged ≥2 y consumes candy. Among all Americans, candy contributes a relatively small proportion of calories, added sugars, and saturated fat to the total diet, and recent research suggests that current levels of candy consumption are not associated with risk of weight gain and cardiovascular disease in children and adults. Providing guidance for the consumption of candy in moderation requires an understanding of various behavioral health-related factors that influence candy consumption. A roundtable of behavioral nutrition experts, researchers, and nutrition educators met to discuss recent data on intakes of candy, health outcomes associated with usual candy intake, and the impact of behavioral strategies, including restriction, education, and environmental awareness, on modifying eating behaviors to achieve moderate intakes of candy. Restricting access to palatable foods, whether self-imposed or by parental control, may have potentially negative consequences. Techniques and insight into how to adopt "moderation" in candy consumption, from effective parental practices to environmental strategies that facilitate behavior change without a high degree of effort, were identified as important next steps toward sustainable dietary guidance related to the role of candy and other treats in a healthy lifestyle.

Design and implementation of a study evaluating extinction processes to food cues in obese children: the Intervention for Regulations of Cues Trial (iROC)

Obesity and its health sequelae affect a significant portion of children in the United States. Yet, the current gold-standard family-based behavioral weight-loss treatments are only effective for one-third of children long-term. Therefore, we developed iROC (Intervention for Regulation of Cues) to specifically target a method to decrease overeating in overweight children, based on learning theory, to inform and enhance interventions targeting diet and obesity in youth. This study will rigorously test extinction processes as a method of decreasing physiological and psychological responses to food cues in overweight and obese children. Through exposing children to their highly craved foods, and 'training the brain and body' to decrease overeating, we are hoping to produce longer-lasting weight loss or weight-gain prevention over time.

Association of obesity and eating in the absence of hunger among college students in a Mexican-USA border city

Few studies have examined disinhibited eating behaviors in Mexico. However eating in the absence of hunger (EAH), defined as eating in response to the presence of palatable foods in the absence of physiological hunger, is one of the more frequently examined behaviors. The purpose of this study was to assess the association between obesity and EAH among college students in a large Mexican-USA border city. Two-hundred and one sophomore college students completed the EAH questionnaire (EAH-C). Weight and height were measured. To assess reproducibility a test-retest was conducted in a subset sample (n = 20). Test-retest correlations ranged from ρ = 0.44 to 0.86, p < 0.01. Data obtained from the EAH-C were subjected to a principal components analysis with a varimax rotation. The mean age of participants was 21.0 ± 2.0 years, 52 % were female. The prevalence of overweight and obesity was 29 and 14 % respectively. The internal validity was assessed by Cronbach's alph. Internal consistency for all subscales was: external eating (α = 0.83), negative affect (α = 0.92) and fatigue/boredom (α = 0.86). Principal component analysis generated four subscales for the EAH-C: external eating, negative affect, fatigue and boredom. Comparing normal weight students versus obese students, normal weight students (57.1%) had higher scores on boredom subscale than obese students (p < 0.008). Female students had higher scores in the negative affect subscale than the males (p < 0.001). We conclude that the EAH-C had internal consistent subscales with good convergent validity. In this study population we found no association between EAH and obesity.

Getting my child to eat the right amount. Mothers' considerations when deciding how much food to offer their child at a meal

Feeding young children successfully requires parenting skills, trust that children will eat, and nutrition and child development knowledge to ensure that foods and the amounts offered are developmentally appropriate. Mothers are often responsible for determining how much food is offered to their children; however, the influences on mothers' decisions regarding how much to offer their children--their motivations, goals for feeding and child consumption--have not been investigated. Study aims included gathering qualitative data regarding mothers' decisional processes related to preparing a dinner meal plate for her preschooler. Low income mothers (n = 15 African American and n = 15 Latina mothers) were recruited from preschools in the Denver, CO metropolitan area to participate in semi-structured interviews. Mothers prepared a plate for their preschooler and were asked about influences on their decisions about portion sizes and their expectations for children's eating. Data were coded by 2 independent coders using a consensus coding process and analyzed by investigators. Three themes emerged: (1) portion sizes differ for children who are "good" eaters and "picky" eaters; (2) mothers know the "right amounts" to serve their child; and (3) mothers have emotional investments in their children's eating. Some influencing factors were child-centered (e.g. child's likes and dislikes, "picky" and "good" eaters, and foods previously eaten in the day) and some related to adult expectations and concerns (nutrient content and waste). Interventions focusing on portion size may be more effective if tailored to the mothers' perceptions regarding her child's eating characteristics.

Increased brain response to appetitive tastes in the insula and amygdala in obese compared with healthy weight children when sated

Objective

There is evidence of altered neural taste response in female adolescents who are obese, and in adolescents who are at risk for obesity. To further understand risk factors for the development of overeating and obesity, we investigated response to tastes of sucrose and water in 23 obese and healthy weight children.

Methods and design

Thirteen healthy weight (HW) and 10 obese (OB) 8–12 year old children underwent functional magnetic resonance imaging while tasting sucrose and water. Additionally, children completed an eating in the absence of hunger paradigm and a sucrose liking task.

Results

A region of interest analysis revealed an elevated BOLD response to taste (sucrose and water) within the bilateral insula and amygdala in OB children relative to HW children. Whole brain analyses revealed a group by condition interaction within the paracingulate, medial frontal, middle frontal gyri, and right amygdala: post hoc analyses suggested an increased response to sucrose for OB relative to HW children, whereas HW children responded more strongly to water relative to sucrose. In addition, OB children, relative to HW, tended to recruit the right putamen as well as medial and lateral frontal and temporal regions bilaterally.

Conclusion

This study showed increased reactivity in the amygdala and insula in the OB compared to HW children, but no functional differentiation in the striatum, despite differences in the striatum previously seen in older samples. These findings support the concept of the association between increased neural processing of food reward in the development of obesity, and raise the possibility that emotional and interoceptive sensitivity could be an early vulnerability in obesity.

Eating in the absence of hunger but not loss of control behaviors are associated with 16p11.2 deletions

OBJECTIVE

The ∼600-kb BP4-BP5 16p11.2 deletion has been consistently associated with obesity. We studied two heritable disinhibited eating behaviors, eating in the absence of hunger (EAH) and loss of control (LOC), to better characterize the relationship between the deletion and obesity.

METHODS

Our study population included ninety-three 16p11.2 CNV carriers (64 with deletions and 29 with duplications) and their families. We performed analyses using linear mixed models and focused on deletion carriers.

RESULTS

We confirmed previous associations between the 16p11.2 deletion and obesity (P < 0.0001) and between all EAH subscales and obesity (P < 0.05), after adjusting for confounders. We found significant associations between the deletion and EAH due to external cues (P = 0.004) and EAH due to boredom (P = 0.003), but not EAH due to fatigue/anxiety or negative affect. Conditioning BMI on the 16p11.2 deletion and each EAH behavior did not abolish the association between the deletion and obesity. LOC was underrepresented and not associated with the deletion.

CONCLUSIONS

We report evidence that the 16p11.2 deletion may influence specific obesity-associated disinhibited eating behaviors: EAH due to external trigger and EAH due to boredom. Prospective studies are needed to confirm the temporal order of EAH behaviors and obesity related to the deletion.

Right sizing prevention. Food portion size effects on children's eating and weight

Experimental findings provide consistent evidence that increasing the portion size of palatable, energy dense entrees relative to an age appropriate reference portion increases children's energy intake of the entree and the meal. Most of these studies have been conducted on preschool aged children between 2 and 6 years of age, in childcare or laboratory settings, using repeated measures designs. In these studies, children's intake is compared across a series of meals, where the size of the entrée portion is varied and other aspects of the meal, including the portion size of other items on the menu, are held constant. This paper provides an overview of what we know from this research, what is not known about the effects of portion size on children's intake and weight status, and points to some of the important unanswered questions and gaps in the literature. Lastly, we discuss how individual characteristics may make someone more or less susceptible to large portions of foods and how the palatability of foods may moderate observed associations among portion size, children's intake, and weight status. Future studies that address the gaps identified in this paper are needed to inform policy and to develop effective and efficient interventions to prevent childhood obesity.