Palatable food consumption in children: interplay between (food) reward motivation and the home food environment

From Reward to Anhedonia-Dopamine Function in the Global Mental Health Context

When "hijacked" by compulsive behaviors that affect the reward and stress centers of the brain, functional changes in the dopamine circuitry occur as the consequence of pathological brain adaptation. As a brain correlate of mental health, dopamine has a central functional role in behavioral regulation from healthy reward-seeking to pathological adaptation to stress in response to adversity. This narrative review offers a spotlight view of the transition from healthy reward function, under the control of dopamine, to the progressive deregulation of this function in interactions with other brain centers and circuits, producing what may be called an anti-reward brain state. How such deregulation is linked to specific health-relevant behaviors is then explained and linked to pandemic-related adversities and the stresses they engendered. The long lockdown periods where people in social isolation had to rely on drink, food, and digital rewards via the internet may be seen as the major triggers of changes in motivation and reward-seeking behavior worldwide. The pathological adaptation of dopamine-mediated reward circuitry in the brain is discussed. It is argued that, when pushed by fate and circumstance into a physiological brain state of anti-reward, human behavior changes and mental health is affected, depending on individual vulnerabilities. A unified conceptual account that places dopamine function at the centre of the current global mental health context is proposed.

Influence of Executive Function Training on BMI, Food Choice, and Cognition in Children with Obesity: Results from the TOuCH Study

BACKGROUND

Children with obesity have a higher risk of future health and psychological problems. Executive functions (EFs) play a key role in successful dietetic and exercise planning; therefore, new treatments aimed at improving EFs may optimize outcomes.

OBJECTIVES

This study evaluates the impact of EF training on body mass index (BMI), food choice, and cognition in children with obesity. We also examine their real-life executive functioning, emotional state, and quality of life.

METHODS

Randomized controlled double-blind trial. Forty-six children with obesity were randomly allocated into an executive functions training or a control task training group and attended 30-45 min of daily training (5/week over 6 weeks), with both groups receiving counseling on diet and wearing an activity/sleep tracker. Participants were evaluated at baseline and after treatment.

RESULTS

BMI decreased over time in the whole sample, although there were no differences between groups at post-training in BMI, food choice, and cognition. Both groups showed significant improvements in attention, speed, cognitive flexibility, and inhibitory control. Additionally, there were some benefits in real-life executive functioning and self-esteem. Over the 6 weeks, participants showed worse food choices in both groups.

CONCLUSIONS

EFs training showed a lack of significant effects. The executive function enhancement alone did not explain these changes, as there were no significant differences between the experimental groups. It might be that the control task training could also produce some benefits, and multi-component interventions might be useful for weight loss.

Food consumption habits, gestational age and birth weight are predictive for children with excess weight: An analysis based on artificial neural network

The relationship between body weight gain and the onset of obesity is linked to environmental and behavioral factors, and may be dependent on biological predisposing. Artificial neural networks are useful predictive tools in the field of artificial intelligence, and can be used to identify risk factors related to obesity. The aim of this study is to establish, based on artificial neural networks, a predictive model for overweight/obesity in children based on the recognition and selection of patterns associated with birth weight, gestational age, height deficit, food consumption, and the physical activity level, TV time and family context. Sample consisted of 149 children (72 = eutrophic and 77 = overweight/obese). Collected data consisted of anthropometry and demographic characteristics, gestational age, birth weight, food consumption, physical activity level, TV time and family context. The gestational age, daily caloric intake and birth weight were the main determinants of the later appearance of overweight and obesity. In addition, the family context linked to socioeconomic factors, such as the number of residents in the household, had a great impact on excess weight. The physical activity level was the least important variable. Modifiable risk factors, such as the inadequate food consumption, and non-modifiable factors such as gestational age were the main determinants for overweight/obesity in children. Our data indicate that, combating excess weight should also be carried out from a social and preventive perspective during critical periods of development, such as pregnancy, lactation and early childhood, to reach a more effective strategy to combat obesity and its complications in childhood and adult life.

Emotion Regulation Moderates the Associations of Food Parenting and Adolescent Emotional Eating

OBJECTIVE

To explore parental feeding practices and eating behavior as predictors of the child's emotional eating (EE) and child's emotion regulation (ER) as a potential moderator.

DESIGN

Parental eating behavior (emotional, external, and restrained eating), 9 parental feeding practices (restriction, food as reward, food as ER, monitoring, healthy modeling, healthy environment, child control, and child involvement), ER, and EE were analyzed cross-sectionally and 5 parental practices longitudinally (subsample, n = 115).

SETTING

Belgium.

PARTICIPANTS

Two hundred eighteen adolescents (aged 13.7 ± 1.77 years) and parent dyads.

MAIN OUTCOME MEASURES

Child's EE.

ANALYSIS

Linear regression and moderation (cross-sectional) and linear mixed models (longitudinal). Models adjusted for multiple testing with a false discovery rate of 10% (Benjamini-Hochberg), age, sex, body mass index, socioeconomic status, and cohort.

RESULTS

Cross-sectionally but not longitudinally, there was a positive association between predictors restriction and monitoring with the outcome child's EE (β = 0.19, P = 0.006; β = 0.17, P = 0.01, respectively). Restrained eating of the parent was negatively associated with the child's EE (β = -0.22, P = 0.003). The child's maladaptive ER significantly moderated the associations of 5 feeding practices and parental EE with the child's EE.

CONCLUSIONS AND IMPLICATIONS

Parents continue to play a role in the eating behavior of their adolescent offspring, not only through their feeding practices (restrictive parenting was most detrimental) but also by displaying restrained eating (beneficial). A child's ER appears as an important moderator of the established associations; however, more research is needed to better understand these observations.

Subtyping youngsters with obesity: A theory-based cluster analysis

Psychological mechanisms play a crucial role in explaining weight gain. Aim of the present study was to identify subtypes in youngsters with obesity in line with these mechanisms. Defining homogeneous clusters within this heterogeneous group provides relevant information for personalized treatments. Data were collected in N = 572 participants (51% boys, aged 7-19) with extreme obesity (%BMI M = 187.8; SD = 30.9) recruited in an inpatient treatment centre. Based on psychological models of overweight/obesity, the Affect Regulation Model, the Reward Deficiency Model and The Dual Pathway Model, cluster variables were selected assessing emotional eating, reward reactivity and regulative capacities. Youngsters reported on emotional eating (DEBQ Emotional Eating) and reward sensitivity (BAS), while parents reported on children's regulative Executive Functions (BRIEF). Characteristics of the different clusters were examined concerning weight variables (pre and post treatment) and variables indexing problematic eating (DEBQ External Eating, Ch-EDE), affect regulation (FEEL-KJ) and depressive symptoms (CDI). Hierarchical cluster analyses supported the presence of three clusters, further evaluated by K-means cluster analyses. The cluster solutions differed according to age and sex (boys 7-13, boys 14-19, girls 7-13, girls 14-19). In all four age and gender subsamples, an "Emotional Eating" cluster displaying a vulnerable profile (high depression, maladaptive emotion regulation, problematic eating) and a "Reward Deficiency" cluster displaying a more resilient profile were detected. In girls 7-13, a "Weak Executive Functioning" indicative of insufficient self-regulative capacities, showed moderate to high emotional problems and problematic eating. In the other subgroups, the "Mean Level Functioning" cluster also showed elevated emotional problems and problematic eating. Given that different clusters can be identified, and given that these clusters have different profiles on emotional problems and problematic eating, subtyping youngsters with severe obesity is indicated, setting the stage for personalized treatments.

Is there stress eating in children and adolescents? A first validation of the Dutch version of the Salzburg Stress Eating Scale

The recently developed Salzburg Stress Eating Scale (SSES) is the first to specifically address the relationship of stress experiences and coping failure on the one hand and increases or decreases in food intake on the other hand. The SSES demonstrated good psychometric properties in English and German speaking adult samples. However, it has not been applied to younger age groups, which may differ in their expression and reporting of stress related eating behavior. Therefore, the current study evaluated the psychometric properties and correlates of the SSES in a Dutch speaking community sample of adolescents (study 1; N = 244, 9-18 years, adjusted BMI range = 71-189%, M = 103%) and in an inpatient sample of adolescents with obesity (study 2; N = 100, 9-16 years, adjusted BMI range = 151-310%, M = 194.5%). Factor analysis confirmed the original one factor structure in both studies. Internal consistency was 0.85 in study 1 and 0.90 in study 2 (Cronbach's alpha). In both the obesity and community sample, SSES scores were positively correlated with other eating-related measures (e.g., emotional eating, external eating), and uncorrelated with non-eating-related wellbeing measures (e.g., perceived stress, depressive symptoms). Unexpectedly, however, no association with adjusted BMI was found in the community sample, obesity sample, or combined sample. The scores of the obesity sample were also compared to the community sample in an age and sex-matched subsample of study 1. Against our hypothesis, the obesity sample did not report higher SSES scores than the community sample. The good internal consistency and the evidence for convergent and discriminant validity indicate that the Dutch version of the SSES seems useful in examining this clinically important eating behavior in adolescents. However, validity with regard to stress eating and BMI remains to be further explored.

The Brain's Reward System in Health and Disease

Rhythmic gene expression is found throughout the central nervous system. This harmonized regulation can be dependent on- and independent of- the master regulator of biological clocks, the suprachiasmatic nucleus (SCN). Substantial oscillatory activity in the brain's reward system is regulated by dopamine. While light serves as a primary time-giver (zeitgeber) of physiological clocks and synchronizes biological rhythms in 24-h cycles, nonphotic stimuli have a profound influence over circadian biology. Indeed, reward-related activities (e.g., feeding, exercise, sex, substance use, and social interactions), which lead to an elevated level of dopamine, alters rhythms in the SCN and the brain's reward system. In this chapter, we will discuss the influence of the dopaminergic reward pathways on circadian system and the implication of this interplay on human health.

Emotional Eating After Manipulating Emotion Regulation: A Laboratory Study in Adolescents

It is often assumed that emotional eating occurs when an individual is unable to utilise emotion regulation (ER) to cope with stress. In this stress exposure study, we explored whether manipulating participants’ ER strategies (rumination or self-compassion) influenced their stress-related affect and food consumption. Fifty-three adolescents (Mage = 14.72) were included; half of the participants were instructed to use rumination as their ER strategy, and half were instructed to use self-compassion. We could not demonstrate that the ER strategies differently affected stress-related affect. However, we did find that increased Happiness following ER self-compassion predicted reduced High-Fat Sweet food consumption, whereas increased Happiness following ER rumination instead led to greater High-Fat Sweet food consumption. In participants who ruminated, food consumption reduced feelings of Frustration, but not Boredom or Happiness. Post-hoc exploration revealed that only ER self-compassion, not ER rumination, normalised levels of stress-related affect. The results highlight the need for more research into the complex relationship between ER strategies, affect states, and food types in their effect on emotional eating.

Does temperament make children differently susceptible to their home physical food environment? A cross-sectional DAGIS study on 3-6 year old Finnish children's food consumption

Consistently linked with children's food consumption are food availability and accessibility. However, less is known about potential individual differences among young children in their susceptibility to home food environments. The purpose of the study was to examine whether the association between home food availability and accessibility of sugar-rich foods and drinks (SFD) or fruits and vegetables (FV) and children's consumption of these foods differ according to their temperament. The study used two cross-sectional datasets collected as part of the Increased Health and Wellbeing in Preschools (DAGIS) study: 1) a cross-sectional data of 864 children aged 3-6 years old collected between fall 2015 and spring 2016, and 2) an intervention baseline data of 802 children aged 3-6 collected in fall 2017. Parents reported their children's temperament, consumption of FV and SFD, and home availability and accessibility of SFD and FV. Examination of whether associations between home availability and accessibility of FV and their consumption differ according to children's temperament involved using linear regression models. Similar models were used to examine association between home availability and accessibility of SFD and their consumption, and the moderating role of temperament. The association between home accessibility of SFD and their consumption frequency was dependent on the level of children's negative affectivity. More frequent consumption of SFD was observed with higher home accessibility of SFD. The association was stronger in children with higher scores in negative affectivity. No other interactions were found. Children with higher negative affectivity are possibly more vulnerable to food cues in the home environment than children with lower negative affectivity. Consideration of children's individual characteristics is necessary in supporting their healthy eating.

Does eating in the absence of hunger extend to healthy snacks in children?

OBJECTIVES

To assess if eating in the absence of hunger (EAH) extends to healthier snacks and examine the relationship between the home food environment and EAH in children with normal weight (NW) or overweight/obesity (OB) who are at low risk (LR) or high risk (HR) for obesity based on maternal obesity.

METHODS

EAH was assessed after lunch and dinner when children received either low energy dense fruit snacks or high energy dense sweet/savoury snacks. The availability of obesogenic foods in the home was assessed by the Home Food Inventory.

RESULTS

Data showed significant main effects of risk group (P=.0003) and snack type (P < .001). EAH was significantly greater in HR-OB (284±8 kcal) than LR-NW (249±9 kcal) or HR-NW (251±8 kcal) children. Serving fruit rather than sweet/savoury snacks reduced energy intake, on average, by 60% (223 kcal) across risk groups. For each unit increase in the obesogenic home food environment, EAH of sweet/savoury snacks decreased by 1.83 calories.

CONCLUSIONS

Offering low energy dense snacks after a meal can moderate EAH and increase children's intake of healthy foods. Increased access to obesogenic foods in the home may reduce the salience of high energy dense snacks when they become available in other settings.

Is cognitive training an effective tool for improving cognitive function and real-life behaviour in healthy children and adolescents? A systematic review

Computerised cognitive training (CCT) has been applied to improve cognitive function in pathological conditions and in healthy populations. Studies suggest that CCT produces near-transfer effects to cognitive functions, with less evidence for far-transfer. Newer applications of CTT in adults seem to produce certain far-transfer effects by influencing eating behaviour and weight loss. However, this is more unexplored in children and adolescents. We conducted a systematic review of 16 studies with randomised controlled design to assess the impact of CCT on cognitive functioning and real-life outcomes, including eating behaviour, in children and adolescents with typical development (PROSPERO registration number: CRD42019123889). Results show near-transfer effects to working memory, with inconsistent results regarding far-transfer effects to other cognitive functions and real-life measures. Long-term effects show the same trend. Far-transfer effects occurred after cue-related inhibitory control and attentional training, although effects seem not to last. CCT may be a potential weight-loss treatment option but more research is needed to determine the specific characteristics to enhance treatment outcomes.

Stress and Eating Behavior: A Daily Diary Study in Youngsters

Background: Overweight and obesity are growing problems, with more attention recently, to the role of stress in the starting and maintaining process of these clinical problems. However, the mechanisms are not yet known and well-understood; and ecological momentary analyses like the daily variations between stress and eating are far less studied. Emotional eating is highly prevalent and is assumed to be an important mechanism, as a maladaptive emotion regulation (ER) strategy, in starting and maintaining the vicious cycle of (pediatric) obesity. Objectives: The present study aims to investigate in youngsters (10 - 17 years) the daily relationship between stress and the trajectories of self-reported eating behavior (desire to eat motives; hunger eating motives and snacking) throughout 1 week; as well as the moderating role of emotion regulation and emotional eating in an average weight population. Methods: Participants were 109 average weighted youngsters between the age of 10 and 17 years (M _age = 13.49; SD = 1.64). The youngsters filled in a trait-questionnaire on emotion regulation and emotional eating at home before starting the study, and answered an online diary after school time, during seven consecutive days. Desire to eat motives, hunger eating motives and snacking were assessed daily for seven consecutive days. Results: Using multilevel analyses results revealed that daily stress is significantly associated with trajectories of desire to eat motives and hunger eating motives. No evidence was found for the moderating role of maladaptive ER in these relationships; marginally significant evidence was found for the moderating role of emotional eating in the trajectories of desire to eat and snacking. Discussion: These results stress the importance of looking into the daily relationship between stress and eating behavior parameters, as both are related with change over and within days. More research is needed to draw firm conclusion on the moderating role of ER strategies and emotional eating.

Unhealthy eating habits and participation in organized leisure-time activities in Czech adolescents

A healthy lifestyle habits in adolescents consist of healthy eating patterns and active ways of spending leisure time. This study aimed to examine the relationship between organized leisure-time activities (OLTA) and eating habits in adolescence. Data from the 2013/2014 Health Behaviour in School-aged Children (HBSC) study on 10,494 Czech adolescents aged 11-15 years was used. The associations of participation in OLTA with ten specific eating habits were analyzed using logistic regression. Involvement in any type of OLTA was associated with higher consumption of daily breakfast, fruit, and vegetables and a lower intake of soft drinks. Participants in non-sport and sport and other activity reported lower rates of unhealthy eating habits (e.g., lower rates of eating crisps and eating in front of the TV or computer). Participation only in sport was related to more frequent eating at fast food restaurants but less frequent snacking in front of the computer and intake of crisps.

CONCLUSION

Participation in OLTA was associated with healthier eating habits (e.g., consumption of fruit and vegetables) and a lower occurrence of unhealthy eating habits (e.g., consumption of soft drinks). Alternatively, our findings indicate that non-participation in OLTA can serve as an indicator of an unhealthy lifestyle in adolescence. What is Known • Unhealthy eating habits in youth tend to persist into adulthood and are related to adverse health consequences later in life. • The type of the leisure-time activity (participation in sport, non-sport, sport, and other activities) affects the strength of developmental outcomes in adolescents. What is New • Youth participating in non-sport activity and sport and other activity concurrently reported lower rates of unhealthy eating habits (e.g., eating junk food, eating in front of the TV/computer). • Non-participation in OLTA could be viewed as a potential risk factor for an unhealthy lifestyle in adolescents.