Appetitive behaviours of children attending obesity treatment

Appetitive and psychological phenotypes of pediatric patients with obesity

BACKGROUND

Obesity is a heterogeneous disease with variable treatment response. Identification of the unique constellation of contributors to obesity may allow for targeted interventions and improved outcomes.

OBJECTIVE

Identify empirically derived phenotypes of pediatric patients with obesity based on appetitive and psychological correlates of obesity.

METHODS

This cross-sectional study included patients aged 5-12 years who were treated in a weight management clinic and completed standard intake questionnaires including Child Eating Behavior Questionnaire (CEBQ), Vanderbilt ADHD Scale and Pediatric Symptom Checklist. Phenotypes were elicited using latent profile analysis of 12 indicators: eight CEBQ subscales, inattention, hyperactivity/impulsivity, internalizing and externalizing symptoms.

RESULTS

Parents/guardians of 384 patients (mean age 9.8 years, mean BMI 30.3 kg/m2 ) completed the intake questionnaires. A 4-phenotype model best fits the data. Hedonic Impulsive phenotype (42.5%) exhibited high food enjoyment and hyperactivity/impulsivity. Inattentive Impulsive phenotype (27.4%) exhibited overall low food approach and high food avoid behaviours, and highest inattention. Hedonic Emotional phenotype (20.8%) scored the highest on food enjoyment, internalizing and externalizing symptoms. Picky Eating phenotype (9.3%) scored the lowest on food approach, inattention, hyperactivity/impulsivity, internalizing and externalizing symptoms.

CONCLUSION

Appetitive traits and psychological symptoms appear to cluster in distinct patterns, giving rise to four unique phenotypic profiles, which, if replicated, may help inform the development of tailored treatment plans.

Identifying an avid eating profile in childhood: Associations with temperament, feeding practices and food insecurity

This study aimed to identify distinct eating behaviour profiles in young children and examine how other key predictors of children's eating behaviour, including child temperament, the experience of food insecurity, or parental feeding practices, may vary by identified profiles. An online survey was conducted with 995 parents/carers living in England and Wales (N = 995, Mage = 35.4 years, 80% female, 88% White). Participants reported on their child's eating behaviour using the Child Eating Behaviour Questionnaire and completed measures of child temperament, household food security and parental feeding practices. Latent Profile Analysis (LPA) was carried out to identify distinct eating profiles amongst the children (36-72 months, Mage = 48.8 months, 52% female). Four eating profiles emerged from the sample of children: (a) avid eating, (b) avoidant eating, (c) happy eating, and (d) typical eating. Avid eating (21.9% of children) was characterised by higher levels of food responsiveness, enjoyment of food, and emotional over-eating in combination with lower satiety responsiveness, slowness in eating and food fussiness. Children with an avid eating profile were reported to be more surgent and experienced greater food insecurity than all other eating profiles. Parents of children belonging to the avid eating profile showed significantly greater use of food for emotional regulation, varied and balanced food provision, restriction of food for health, and restriction of food for weight feeding practices than the three other eating profiles.

Appetitive traits and food groups consumption in school-aged children: prospective associations from the Generation XXI birth cohort

PURPOSE

Appetite can influence children's dietary choices; however, this relationship in school-aged children is still unclear. We aimed to explore the prospective associations between child appetitive traits at age 7 and food consumption at 10 years of age.

METHODS

The study included 3860 children from the Generation XXI birth cohort, recruited in 2005/2006 in Porto, Portugal. The Children's Eating Behaviour Questionnaire was used to evaluate children's appetitive traits at 7 years. Food consumption was measured at 10 years through a validated Food Frequency Questionnaire. Logistic regression models were performed and adjusted for possible confounders.

RESULTS

Children with greater Enjoyment of Food at 7 years were 36% more likely to eat fruits ≥ 2 times/day and 54% more likely to eat vegetables > 2.5 times/day at 10 years compared to those with less frequent consumption. Children who ate more in response to negative emotions had higher odds of consuming energy-dense foods (OR = 1.33; 99% CI 1.13-1.58) and salty snacks (OR = 1.28; 99% CI 1.08-1.51) 3 years later. Those with less ability to adjust intake (higher Satiety Responsiveness) and more selective about foods (higher Food Fussiness) at 7 years were less likely to consume vegetables frequently, and were more likely to consume energy-dense foods and sugar-sweetened beverages.

CONCLUSIONS

Children's appetitive traits at 7 years were associated with the consumption of several food groups at 10 years of age. Eating more in response to negative emotions (Emotional Eating), with less ability to adjust intake (Satiety Responsiveness) and more food selectivity (Food Fussiness) were associated with worse dietary choices (in general, lower fruit and vegetables, and higher energy-dense foods and sugar-sweetened beverages consumption).

LEVEL OF EVIDENCE

Level III: Evidence obtained from well-designed cohort or case-control analytic studies.

Eating Behavior and Obesity in a Sample of Spanish Schoolchildren

From the point of view of prevention, it is convenient to explore the association between eating behavior and the obese phenotype during school and adolescent age. The aim of the present study was to identify eating behavior patterns associated with nutritional status in Spanish schoolchildren. A cross-sectional study of 283 boys and girls (aged 6 to 16 years) was carried out. The sample was evaluated anthropometrically by Body Mass Index (BMI), waist-to-height ratio (WHtR) and body fat percentage (%BF). Eating behavior was analyzed using the CEBQ "Children's Eating Behavior Questionnaire". The subscales of the CEBQ were significantly associated with BMI, WHtR and %BF. Pro-intake subscales (enjoyment of food, food responsiveness, emotional overeating, desire for drinks) were positively related to excess weight by BMI (β = 0.812 to 0.869; p = 0.002 to <0.001), abdominal obesity (β = 0.543-0.640; p = 0.02 to <0.009) and high adiposity (β = 0.508 to 0.595; p = 0.037 to 0.01). Anti-intake subscales (satiety responsiveness, slowness in eating, food fussiness) were negatively related to BMI (β = -0.661 to -0.719; p = 0.009 to 0.006) and % BF (β = -0.17 to -0.46; p = 0.042 to p = 0.016).

Appetitive traits and body mass index in Chinese adolescents: An 18-month longitudinal study with latent growth curve analyses

A longitudinal approach with Latent Growth Curve Modeling (LGCM) was adopted to explore the trajectories of appetitive traits corresponding to BMI in Chinese adolescents. Within a large sample of adolescents (N = 2566, 45.9% boys) aged from 11 to 17 years (M = 13.80, SD = 1.56) at the baseline survey, our results indicated that appetitive traits of emotional overeating, food fussiness, and hunger increased significantly over time while enjoyment of food decreased over time. Slowness in eating and satiety responsiveness significantly increased in girls, while emotional undereating significantly decreased in boys. Moreover, the growth parameters of emotional undereating and satiety responsiveness were significantly and negatively related to BMI in girls. Our findings evidence that certain appetitive traits could change over time in adolescence and these changes relate to weight status. Gender differences are suggested in the design of future intervention and treatment of overweight/obesity in Chinese adolescents.

Stress and eating responses in adolescent females predisposed to obesity: A pilot and feasibility study

OBJECTIVE

To explore how chronic stress, reactivity to acute stress, and obesogenic eating are linked in adolescent females predisposed to obesity.

METHODS

Participants included 21 adolescent females (m_age = 14.57 years) and their biological mothers with obesity (body mass index [BMI] ≥ 30 kg/m²). The pilot and feasibility study involved adolescent self-report of chronic stress, an acute stress-induction paradigm (Trier Social Stress Task, TSST), salivary cortisol collection to assess stress reactivity, and both subjective (self-report) and objective (snack buffet) measures of obesogenic eating.

RESULTS

Adolescent females reporting high chronic stress were significantly more likely to engage in self-reported emotional and external eating and to have higher food cravings (p's < .05) compared to adolescents with low chronic stress. Effect size estimates suggested a blunting effect of cortisol in the high chronic stress group. Blunted cortisol reactivity significantly predicted higher self-reported food cravings for the high chronic stress group (p = .04). Associations among chronic stress, cortisol, and self-reported and objective obesogenic eating reflected medium to large effect sizes.

CONCLUSIONS

This study built on limited extant research on stress and eating to demonstrate that chronic stress was associated with self-reported obesogenic eating patterns in adolescent females predisposed to obesity. Different patterns of cortisol reactivity and eating emerged depending on chronic stress group (low versus high). Understanding these eating patterns in the context of chronic stress can inform interventions to reduce obesity risks in adolescence.

Examining the validity and consistency of the Adult Eating Behaviour Questionnaire-Español (AEBQ-Esp) and its relationship to BMI in a Mexican population

PURPOSE

Appetitive traits in adults and their associations with weight can be measured using the Adult Eating Behaviour Questionnaire (AEBQ). The aim of this study was to confirm the factor structure of the Spanish AEBQ (AEBQ-Esp) in a Mexican sample and explore associations between the eight traits with body mass index (BMI).

METHOD

A sample of 1023 adults, mean age of 36.8 ± 12.8 years, was recruited from Guadalajara, Mexico. Researchers weighed and measured participants, and they completed the AEBQ-Esp either online or in paper format and reported sociodemographic data. To test two alternative factor structures (eight factors including Hunger; seven factors excluding Hunger), confirmatory factor analysis (CFA) was used. Internal reliability was assessed using Cronbach's alpha; test-retest reliability was assessed using intra-class correlation coefficients. Multivariate linear regressions were used to test for associations between the AEBQ subscales and BMI, adjusted for age, sex, format of AEBQ responses, education, marital and employment status.

RESULTS

A seven-factor structure was the best model fit using CFA, excluding the Hunger subscale but similar to the original AEBQ. Internal reliability was good for all subscales (Cronbach's α = 0.70-0.86), and the intra-class correlation coefficient (0.70-0.91) reflected good test-retest reliability. In the fully adjusted models, Satiety Responsiveness [β = - 0.61; (- 1.01, - 0.21)] and Slowness in Eating [β = - 0.70; (- 1.01, - 0.39)] were negatively associated with BMI, and Emotional Over-Eating [β = 0.94; (0.62, 1.27)] was positively associated with BMI.

CONCLUSIONS

The AEBQ-Esp (excluding Hunger) appears to be a valid and reliable psychometric questionnaire for measuring appetitive traits in a Mexican Spanish-speaking population. Some traits appear to be associated with BMI in adulthood and warrant further exploration.

LEVEL OF EVIDENCE

Level III evidence obtained from well-designed cohort or case-control analytic studies. Although this was just an observational study, it was well designed and provided new evidence.

Body Mass and Emotional Eating: Emotional Eater Questionnaire (EEQ) in the Polish Adolescents' COVID-19 Experience (PLACE-19) Study

Stress caused by the Coronavirus Disease 2019 (COVID-19) pandemic may lead to emotional eating which may have a negative impact on the weight status. This study aimed to analyze the association between emotional eating and body mass, as well as changes in body mass during the COVID-19 pandemic, within the Polish Adolescents’ COVID-19 Experience (PLACE-19) Study. A total of 1126 Polish adolescents, aged 15–20, were included. A random quota sampling was performed within a national sample, and emotional eating was assessed using Emotional Eater Questionnaire (EEQ). Based on the declared height and weight before and during the pandemic, the respondents were categorized according to their body mass (malnourished, normal weight, overweight, obese) and changes in body mass during the COVID-19 pandemic (lost weight, no body mass change, gained weight). Higher EEQ scores were achieved by female respondents compared with males (p < 0.0001), respondents who stated that they gained weight during the pandemic compared with those who stated either weight loss or no body mass change (p < 0.0001), and overweight and obese respondents compared with those who had normal weight and who were malnourished (p < 0.0001). A higher share of emotional eaters and very emotional eaters was found among female respondents, respondents stating weight gain during the pandemic, and overweight and obese respondents, compared with the other ones (p < 0.0001). Based on the findings, it may be concluded that among Polish adolescents gender, body mass, and body mass change during the COVID-19 pandemic are the major determinants of emotional eating behaviors and that female individuals, obese individuals, and those gaining weight are especially vulnerable to emotional eating behaviors. The results of the study suggest that the issue of emotional eating should be addressed in general public health policy and appropriate education should be provided to vulnerable groups such as female and obese adolescents.

How do young children eat after an obesity intervention? Validation of the Child Eating Behaviour Questionnaire using the Rasch Model in diverse samples from Australia and Sweden

Child eating behaviours have consistently been linked to child weight status. Yet, changes in child eating behaviours during early obesity treatment are rarely evaluated. Psychometric evaluation of the Child Eating Behaviour Questionnaire (CEBQ) is common, but results are sample-dependent and included items may not capture the full range of the underlying traits. Rasch analysis can overcome these disadvantages. The aim of this paper was to assess child eating behaviours measured by the CEBQ after a 12-month obesity intervention applying the Rasch model for the validation of the CEBQ. The Rasch-based fit statistics were applied in children from two samples, Australian and Swedish (n = 1724). Changes in eating behaviours amongst children aged 4-6 years were examined in the More and Less RCT for obesity treatment (n = 177), which compared a parenting programme (with and without boosters) against standard treatment. Parents completed the CEBQ at four time points over 12-months. Linear mixed models were applied to estimate treatment effects on the CEBQ, refined according to Rasch, over time. We found that the validity of CEBQ was confirmed after removing 4 items (item fit statistics outside range 0.5-1.5). When the refined CEBQ was used in the assessment of the RCT, there were no differences in parental reports of changes in children's eating behaviours between the parenting programme and standard treatment (group-by-time interactions p > 0.05). However, in the total sample food approach behaviours decreased while fussy eating behaviours increased (p < 0.05). In conclusion, the refined CEBQ proved to be a valid tool for examining parent-reported child eating behaviours. Early obesity treatment may decrease eating behaviours associated with higher child weight. Future research should address the associations between changes in child weight status and eating behaviours.

Eating in the absence of hunger in 18-month-old children in a home setting

BACKGROUND

Eating in the absence of hunger (EAH), the susceptibility to eat despite satiety, may increase overweight. While EAH has been established in school-aged children, less is known about it during toddlerhood.

OBJECTIVES

This study assessed to what extent 18-month-old children eat in the absence of hunger, the stability of this behaviour at 24 months and the association of child eating behaviours with EAH.

METHODS

Children were presented with four palatable finger foods (total 275 kcal) after dinner. Univariate GLM's assessed the association between EAH, child satiety and eating behaviours and energy intake of dinner at 18 and 24 months (n = 206 and 103, respectively). Another GLM was run to assess the association between EAH at both time points.

RESULTS

Mean (±SD) energy intakes from dinner and finger foods were 240 kcal (±117) and 40 kcal (±37), respectively. No association was found between energy intake of dinner and finger foods. Enjoyment of food was significantly related to intake of finger foods (P = .005). EAH at 18 months predicted EAH at 24 months.

CONCLUSION

Eighteen-month-old children ate in the absence of hunger, irrespective of satiety. Thus, preceding energy intake was not compensated for. Other factors, for example, enjoyment of food seem to determine finger food intake.

The association between childhood adiposity and appetite assessed using the Child Eating Behavior Questionnaire and Baby Eating Behavior Questionnaire: A systematic review and meta-analysis

This systematic review and meta-analysis aimed to quantify associations between Child Eating Behavior Questionnaire (CEBQ) and Baby Eating Behavior Questionnaire (BEBQ) appetitive traits (food approach: Food Responsiveness [FR], Enjoyment of Food [EF], Emotional Overeating [EOE], and Desire to Drink [DD]; food avoidant: Satiety Responsiveness [SR], Slowness in Eating [SE], Emotional Undereating [EUE], Food Fussiness [FF]) and measures of child adiposity. Searches of six databases up to February 2019 identified 72 studies (CEBQ, n = 67; BEBQ, n = 5), and 27 met the meta-analysis criteria. For cross-sectional studies reporting unadjusted correlations with body mass index z-scores (BMIz) (n = 19), all traits were associated with BMIz in expected directions (positive: FR, EF, EOE, and DD; negative: SR, SE, EUE, and FF). Pooled estimates ranged from r = 0.22 (FR) to r = -0.21 (SR). For cross-sectional studies reporting regression coefficients (n = 10), three traits (FR, EF, and EOE) associated positively, and three traits (SR, SE, and EUE) negatively, with BMIz (β = -0.31 [SR] to β = 0.22 [FR]). Eleven studies reported prospective relationships from appetite to adiposity measures for six scales (positive: FR, EF, EOE, and DD; negative: SR and SE). Five studies reported relationships from adiposity measures to appetite for five traits (positive: FR, EF, and EOE; negative: SR). All BEBQ traits were consistently cross-sectionally associated with adiposity measures. Overall, CEBQ/BEBQ-assessed appetitive traits show consistent cross-sectional relationships with measures of child adiposity.

The relationship between parental food parenting practices & child eating behavior: A comparison of mothers and fathers

The objective of this study was to compare the relationships between food parenting practices and child eating behavior among mothers and fathers of young children. This cross-sectional study recruited mothers (n = 127) and fathers (n = 118) of children (4.2 ± 1.3 years old) to complete surveys (face-to-face and online). Each parent completed the Comprehensive Food Parenting Questionnaire, Children's Eating Behavior Questionnaire, and demographic questions. Linear regressions were used to compare the relationships between parental food parenting practices and children's eating behaviors with parent sex as a moderator. Child age and sex served as control variables in each regression. Parent sex was a significant moderator in several relationships between parent food parenting practices and child eating behavior. In the relationship between parental restriction for health (ß = -.14, p = .014) and monitoring (ß = -.13, p = .028) and child slowness in eating, the slope of the interaction was significantly higher for mothers, meaning that when mothers and fathers use the same level of restriction for health and monitoring, child slowness in eating is higher for children of mothers. When mothers and fathers used the same level of restriction for weight, child food responsiveness (ß = .13, p = .003) and emotional overeating (ß = .12, p = .046) was significantly higher for children of fathers. There may be differences in how mothers and fathers implement food parenting practices and/or differences in how these practices impact children. Specifically, for fathers, it seems that the use of restriction for weight is more detrimental for children's eating behaviors compared to when mothers use the same level of restriction for weight.

Validity of the Adult Eating Behavior Questionnaire for adolescents treated in a weight management clinic

BACKGROUND

The Child and Adult Eating Behavior Questionnaires (CEBQ, AEBQ) are established measures of eating behaviors. However, no similar measure is available for adolescents. Prior research has validated the AEBQ in adult samples, and one study has explored using the measure with adolescents. However, no studies to date have examined the validity of the AEBQ in adolescent clinical populations. Furthermore, no studies have examined associations between the AEBQ and indicators of health status in adolescents.

METHODS

A total of 280 adolescents (12-17 years old, 60% female) seen in a pediatric weight management clinic completed the AEBQ at intake. Confirmatory factor analysis (CFA) was conducted with AEBQ items to evaluate the model fit of one-, two-, seven-, and eight-factor structures. Intercorrelations between scale scores from AEBQ Food Approach and Food Avoidance domains were calculated. Associations of AEBQ scales with body mass index (BMI) and binge-eating behaviors were examined using Spearman Rho correlations and independent t-tests.

RESULTS

CFAs revealed that the best fitting model was a seven-factor structure excluding the Hunger scale, although overall model fit was only marginally acceptable (X² = 980.94, CFI = 0.925, TLI = 0.915, RMSEA = 0.074). Intercorrelation analyses indicated that all Food Approach scales were significantly associated with one another (r = 0.243-0.654); Food Avoidance scales were inconsistently correlated (r = 0.034-0.439). No AEBQ scales were correlated with BMI (r = -0.101-0.082). Stronger links were found with binge eating; higher frequency binge-related behaviors were associated with higher Food Approach scores.

CONCLUSIONS

The seven-factor structure of AEBQ demonstrates a marginally acceptable fit for treatment-seeking adolescents with obesity. The Food Approach scales demonstrated more convergent validity than the Food Avoidance scales. The Food Approach scales also exhibited some clinical utility for identifying patients with increased risk for binge eating, which is a common target for behavioral intervention. Implications for maximizing the AEBQ's potential for assessing eating behaviors in adolescents with obesity are discussed.

Caregiver Influences on Eating Behaviors in Young Children: A Scientific Statement From the American Heart Association

A substantial body of research suggests that efforts to prevent pediatric obesity may benefit from targeting not just what a child eats, but how they eat. Specifically, child obesity prevention should include a component that addresses reasons why children have differing abilities to start and stop eating in response to internal cues of hunger and satiety, a construct known as eating self‐regulation. This review summarizes current knowledge regarding how caregivers can be an important influence on children's eating self‐regulation during early childhood. First, we discuss the evidence supporting an association between caregiver feeding and child eating self‐regulation. Second, we discuss what implications the current evidence has for actions caregivers may be able to take to support children's eating self‐regulation. Finally, we consider the broader social, economic, and cultural context around the feeding environment relationship and how this intersects with the implementation of any actions. As far as we are aware, this is the first American Heart Association (AHA) scientific statement to focus on a psychobehavioral approach to reducing obesity risk in young children. It is anticipated that the timely information provided in this review can be used not only by caregivers within the immediate and extended family but also by a broad range of community‐based care providers.

Associations between appetitive traits, dietary patterns and weight status of children attending the School Kids Intervention Program

BACKGROUND

The nexus between appetitive traits, dietary patterns and weight status has predominantly been studied in a mixed sample (healthy weight, overweight and obese sample).

AIM

This cross-sectional study examined associations between overweight/obese children's appetitive traits, dietary patterns and weight status.

METHODS

We studied children (N = 58, body mass index z-score: 2.25±0.46), 4-12 years attending the School Kids Intervention Program. Children's appetitive traits and dietary patterns were measured with the Child Eating Behaviour Questionnaire and Children's Dietary Questionnaire, respectively. Children's height and weight were used to compute body mass index z-score; waist circumference was also measured and waist-to-height ratio was calculated.

RESULTS

After controlling for children's age and gender, hierarchical linear regression analyses showed that lower scores for slowness in eating were associated with higher body mass index z-scores in children (β = -0.31, p = 0.01). Higher scores for emotional overeating were associated with higher waist-to-height ratio in children (β = 0.48, p = 0.01). Higher scores for fussiness were correlated with lower scores for fruits and vegetables (β = -0.59, p < 0.001) and higher scores for non-core foods (β = 0.26, p = 0.04).

CONCLUSION

Results observed in the current sample of overweight and obese children are consistent with previous studies examining healthy-weight children. Slowness in eating may foster an obesity 'protective' effect, whereas emotional overeating may promote susceptibility to weight gain. Fussy eating may impair diet quality by lower consumption of vegetables and fruits and higher intake of non-core foods. This evidence will support dietitians to consider children's appetitive traits when providing dietary consultation to support obesity management among overweight/obese children.

Incorporating Appetite Awareness Training Within Family-Based Behavioral Treatment of Pediatric Obesity: A Randomized Controlled Pilot Study

Objective

To assess additive effects of incorporating appetite awareness training (AAT), a strategy to encourage eating in response to hunger and satiety cues, within a family-based behavioral treatment (FBT) for childhood obesity.

Methods

Total 84 families with a child with obesity in the age range of 8-12 years, Body Mass Index Standard Deviation Score (BMI-SDS)  ≥ 2, and a participating parent were randomly allocated to two conditions; standard FBT was compared with FBT incorporating AAT strategies (FBT-AAT). Treatment consisted of group therapy sessions (held separately for children and parents) as well as single-family (parent-child dyad) sessions (24 sessions total) delivered over 18 weeks at a tertiary care outpatient clinic. One booster session was provided 1-year posttreatment and a final follow-up assessment was conducted at 2 years. The primary outcome was change in child standardized body mass index (BMI-SDS).

Results

The two conditions did not differ significantly at posttest, but the FBT-AAT group was at a significantly lower weight compared with FBT at both the first-year, F(1, 82) = 4.150, p<.05, and the second-year follow-ups, F(1, 82) = 14.912, p <.001. It was notable that over the second-year of follow-up, the FBT-AAT group continued to show improvement, whereas the FBT group did not.

Conclusions

Incorporating specific self-regulatory training in attending to hunger and fullness signals during a standardized family-based treatment may have enhanced the long-term maintenance of treatment effects. Findings are promising and warrant further study.

Confirmation of the Factor Structure and Reliability of the 'Adult Eating Behavior Questionnaire' in an Adolescent Sample

Introduction

Appetitive traits, including Food Responsiveness, Enjoyment of Food, Satiety Responsiveness, Emotional Over- and Under-Eating, Food Fussiness and Slowness in Eating, have been captured across childhood using the Children’s Eating Behavior Questionnaire (CEBQ). The Adult Eating Behavior Questionnaire (AEBQ) has explored these traits in adults, but not adolescents. This study aimed to test the factor structure and reliability of the AEBQ in a sample of UK adolescents, and explore demographic differences.

Materials and Methods

Confirmatory factor analysis (CFA) tested an 8-factor and a 7-factor AEBQ, based on valid, completed AEBQ responses (n = 913) from adolescents aged 11–18 recruited from four London secondary schools. Test–retest reliability was analyzed in a subsample (n = 106) 2-weeks later, and 492 participants completed the Dutch Eating Behavior Questionnaire (DEBQ) to assess convergent validity. Demographic differences were explored using a multiple indicator multiple cause (MIMIC) model.

Results

The CFA revealed an adequate model fit for a 7-factor structure without Hunger [RMSEA = 0.038 (90% CI:0.035,0.041); CFI = 0.926, TLI = 0.916; and χ²(df = 595) = 8502.69, p < 0.001]. These seven subscales showed acceptable internal consistency (Cronbach’s α > 0.70). The ICC for the test–retest was above 0.70. Comparisons with the DEBQ supported the convergent validity of the AEBQ. Older age was associated with greater Food Responsiveness and Enjoyment of Food (all p-values < 0.005). Females reported higher levels of Emotional Over-Eating, Satiety Responsiveness, and Slowness in Eating than males (all p-values ≤ 0.003).

Conclusion

This study supports the use of the 7-factor AEBQ as a reliable measure of appetitive traits in adolescents.

Validation of the Children's Eating Behavior Questionnaire in 5 and 6 Year-Old Children: The GUSTO Cohort Study

Revised subscales of the Children’s Eating Behavior Questionnaire (CEBQ) have been proposed to be more appropriate for assessing appetitive traits in Singaporean 3 year-olds, but the CEBQ has not yet been validated in older children in this population. The current study aimed to validate the CEBQ at ages 5 (n = 653) and 6 (n = 449) in the ethnically diverse GUSTO cohort. Confirmatory factor analysis (CFA) examined whether the established eight-factor model of the CEBQ was supported in this sample. Overall, the CFA showed a poor model fit at both ages 5 and 6. At both ages 5 and 6, an exploratory factor analysis revealed a six-factor structure: food fussiness, enjoyment of food, slowness in eating, emotional undereating, emotional overeating and desire to drink. Cronbach’s alpha estimates ranged from 0.70 to 0.85 for all subscales. Criterion validity was tested by correlating subscales with the weight status of 6 years of age. At age 5 and 6, lower scores of slowness of eating while higher scores of enjoyment of food was associated with child overweight. At age 6, higher scores of desire to drink was also associated child overweight. In conclusion, a revised six factor-structure of the CEBQ at ages 5 and 6 were more appropriate for examining appetitive traits in this sample.

Longitudinal Analysis Between Maternal Feeding Practices and Body Mass Index (BMI): A Study in Asian Singaporean Preschoolers

Bidirectional studies between maternal feeding practices with subsequent child weight are limited, with no studies in Asian populations. In longitudinal analyses, we assessed the directionality of the associations between maternal feeding practices and body mass index (BMI) in preschoolers. Participants were 428 mother child dyads from the GUSTO (Growing Up in Singapore Toward healthy Outcomes) cohort. Feeding practices were assessed using the Comprehensive Feeding Practices Questionnaire (CFPQ) at age 5 y. Child BMI was measured at ages 4 and 6 y. BMI and maternal feeding practices subscales were transformed to SD scores and both directions of their associations examined with multivariable linear regression and pathway modeling. Higher BMI at age 4 was associated with lower encouragement of balance and variety (β = −0.33; 95%CI: −0.53, −0.13), lower pressure to eat (β = −0.49; −0.68, −0.29) and higher restriction (β = 1.10; 0.67, 1.52) at age 5, adjusting for confounders and baseline feeding practices at 3 years. In the reverse direction, only pressure and restriction at age 5 were associated with lower and higher child BMI at age 6 years, respectively. After the adjustment for baseline BMI at age 5, the association with pressure was attenuated to non-significance (β = 0.01 (−0.01, 0.03), while the association with restriction remained significant (β = 0.02; 0.002, 0.03). Overall, associations from child BMI to maternal restriction for weight control and pressure feeding practices was stronger than the association from these maternal feeding practices to child BMI (Wald's statistics = 24.3 and 19.5, respectively; p < 0.001). The strength and directionality suggests that the mothers in the Asian population were likely to adopt these feeding practices in response to their child's BMI, rather than the converse.

Clinical Trial Registry Number and Website 

This study was registered at clinicaltrials.gov as NCT01174875 (www.clinicaltrials.gov, NCT01174875).

Multi-behavioral obesogenic phenotypes among school-aged boys and girls along the birth weight continuum

Evidence shows that extremes of birth weight (BW) carry a common increased risk for the development of adiposity and related cardiovascular diseases, but little is known about the role of obesogenic behaviors in this process. Moreover, no one has empirically examined whether the relationship between BW, obesogenic behaviors and BMI along the full low-to-high birthweight continuum reflects the U-shape pattern expected from common risk at both BW extremes. Our objective was to characterize physical activity, screen time, and eating behavior and their relationship to BMI as a function of BW among school-aged boys and girls. In this cross-sectional study, 460 children aged 6 to 12 years (50% boys) from Montreal, Canada provided information on sleeping time, screen time, physical activity levels, eating behavior (emotional, external and restrained eating) and anthropometrics (height, weight, BW) through parent reported questionnaires. BMI was normalized using WHO Standards (zBMI), and BW expressed as ratio using Canadian population standards (BW for gestational age and sex). Analyses were conducted using generalized linear models with linear and quadratic terms for BW, stratified by sex and adjusted for age, ethnicity and household income. In boys, physical activity and screen time showed U-shaped associations with BW, while physical activity had an inverted U-shaped in girls. Emotional and restrained eating had positive linear relations with BW in boys and girls. Sleep time and external eating were not associated with BW. A U-shaped relationship between BW and zBMI was found in boys but no association was found in girls. Only sleep (in boys and girls), and emotional eating (girls only) were related to zBMI and mediation of the BW-zBMI relationship was only supported for emotional eating. In conclusion, BW relates to obesogenic behaviors and BMI in both non-linear and linear ways, and these associations differed by sex.

Updates in the treatment of eating disorders in 2018: A year in review in eating disorders: The Journal of Treatment & Prevention

Current evidence suggests that the majority of patients with eating disorders will not fully recover during treatment, and little doubt can exist around the urgent need for improved treatment outcomes across the field of eating disorders. While empirical efforts are underway to optimize outcomes, this article reviews treatment-related research findings published in Eating Disorders: The Journal of Treatment & Prevention during 2018. Importantly, this review encapsulates research addressing (i) barriers to access and the uptake of empirically supported treatments, (ii) research assessing the delivery of empirically supported treatments across the full spectrum of patient care, and (iii) research aiming to isolate treatment mechanisms and optimize treatment outcomes across a transdiagnostic array of eating disorders. Ultimately, while much ground has been covered in 2018, further research is needed to enhance the accessibility and uptake existing treatments, since only a fraction of those with eating disorders are currently engaged in treatment. Further, with the expanding scope of non-outpatient eating disorder treatment settings, further research is required to adapt and assess the implementation of empirically supported treatments in higher levels of patient care. Lastly, in aiming to optimize patient outcomes, treatment outcome research must seek to identify (i) mechanisms that underlie illness eating disorder psychopathology, and (ii) the active mechanisms of existing treatments.

Does social capital moderate the association between children's emotional overeating and parental stress? A cross-sectional study of the stress-buffering hypothesis in a sample of mother-child dyads

Parental stress has been shown associated with children's eating behaviors. The stress-buffering hypothesis suggests that social resources, i.e., resources accessed via one's social networks, may prevent or attenuate the impact of stress on health. Prior research on the stress-buffering hypothesis has found evidence for the protective effects of social support (emotional, instrumental, or informational resources available in a person's life); less is known about social capital (resources available through one's social networks) as a stress buffer. Further, these studies have often examined the association between a person's direct access to social resources and their health; less research has examined whether the benefits of social resources may extend two degrees from parents to their children. Using data from a community-based birth cohort of mother-child dyads, this study examined whether mother's social capital moderated the association between maternal stress and children's emotional overeating (EO). Mothers completed health questionnaires on an annual basis and a one-time social network questionnaire in 2011-2012. EO was measured using the Children's Eating Behavior Questionnaire. Maternal stress was measured using the 18-item Parental Stress Scale. Social capital was measured using a position generator and based on the number of occupations to which a mother had access. Poisson regression analysis was used. Results showed that mother's social capital moderated the positive association between greater maternal stress and children's EO, such that maternal stress was associated with children's EO in only those mothers with low social capital. This study suggests that social capital may disrupt the transmission of maternal stress from parent to child, thereby playing a potential role in the production and reproduction of health inequalities.

Pathways to eating in children and adolescents with obesity

BACKGROUND

Paediatric obesity management remains generalised to dietary and exercise modifications with an underappreciation for the contributions of eating behaviours and appetitive traits in the development of obesity.

OBJECTIVES

To determine whether treatment-seeking children and adolescents with obesity cluster into phenotypes based on known eating behaviours and appetitive traits ("eating correlates") and how socio-demographic and clinical characteristics associate with different phenotypes.

METHODS

A cross-sectional, multi-centre questionnaire was administered between November 2015 and March 2017 examining correlates of eating in children and adolescents attending weight-management programmes in Canada. Latent profile analysis was used to cluster participants based on seven eating correlate scores obtained from questionnaires. Analysis of variance (ANOVA) was used to determine phenotype differences on socio-demographic and clinical characteristics. Multinomial logistic regression models assessed relative risk of specific characteristics associating with a disordered eating phenotype.

RESULTS

Participants were 247 children and adolescents (45.3% male, mean BMI z-score = 3.4 ± 1.0 kg/m²) from six paediatric weight management centres in Canada. Seven eating correlates clustered into three distinct phenotypes: (1) loss of control eating, emotional eating, external eating, hyperphagia, impulsivity ("Mixed-Severe"; n = 42, 17%), (2) loss of control eating, emotional eating, external eating, hyperphagia ("Mixed-Moderate"; n = 138, 55.9%), and (3) impulsivity ("Impulsive"; n = 67; 27.1%). Social functioning scores and body esteem were significantly different across groups, with the Mixed-Severe participants having the poorest social functioning and lowest body esteem. Low body esteem indicated a greater risk of being in a multi-correlate group compared to the Impulsive group, while poor social function had a greater risk of clustering in the Mixed-Severe than Impulsive phenotype.

CONCLUSIONS

Distinct eating phenotypes were found in treatment-seeking children and adolescents with obesity. Empirical evidence is needed, but these data suggest that tailored treatment approaches could be informed by these classifications to improve weight-management outcomes.

Eating behavior and body composition across childhood: a prospective cohort study

Background

Although many cross-sectional studies reported that children with overweight or obesity show more food approaching and less food avoidant eating behaviors, there is a lack of replication in longitudinal studies. Therefore, the question remains whether healthcare professionals should target eating behaviors in childhood obesity interventions and prevention. We aimed to examine the longitudinal and possible bi-directional associations between eating behavior and body composition across childhood.

Methods

Data was included from 3331 children participating in the Generation R Study. At 4 and 10 years, mothers reported on the Child Eating Behavior Questionnaire including the subscales Food Responsiveness, Enjoyment of Food, Emotional Overeating and Satiety Responsiveness, and children’s BMI was measured. Body composition, consisting of Fat Mass Index and Fat Free Mass Index was measured at 6 and 10 years with Dual-energy-X-ray-Absorptiometry scans.

Results

Cross-lagged models including both directions of the BMI – eating behavior association showed that a higher BMI at the age of 4 years predicted more food responsiveness and enjoyment of food and less satiety responsiveness at 10 years (e.g. satiety responsiveness:β = − 0.10, 95% CI = − 0.14, − 0.07), but no associations were found in the opposite direction. For emotional overeating, however, a bi-directional association was found with BMI predicting more emotional eating and vice versa. Multivariable linear regression analyses showed that associations were stronger for Fat Mass Index than for Fat Free Mass Index.

Conclusions

Results showed that a higher BMI, and particularly higher fat mass, at pre-school age predicted more food approaching and less food avoidant eating behaviors at the age of 10 years, rather than the hypothesized reverse direction. This suggests that increased adiposity in early childhood might upregulate appetite and related eating behaviors.

Electronic supplementary material

The online version of this article (10.1186/s12966-018-0725-x) contains supplementary material, which is available to authorized users.

Attentional Conflict Moderates the Association Between Anxiety and Emotional Eating Behavior: An ERP Study

Emotional eating is an attempt to avoid, control, or cope with negative emotions through eating a large amount of calorie dense sweet and/or high fat foods. Several factors, including various attentional mechanisms, negative affect, and stress, impact emotional eating behavior. For example, attentional narrowing on negative events may increase attentional stickiness and thereby prevent the processing of more peripheral events, such as eating behavior. This study contributes to the extant literature by examining the neural correlates underlying the attentional conflict between processing negative events and regulating behavior within a task that emulates how negative life experiences might contribute to unrestrained eating behavior. We explore this question within a normative sample that varies in their self-reported anxiety symptoms. Dense-array EEG was collected while participants played the attentional blink game—a task in which excessive attentional resource allocated to one event (e.g., negative picture) interferes with the adequate attentional processing of a second event that requires action. To assess the attentional conflict, we measured N2 activation, an event-related potentials (ERPs; averaged EEG) associated with conflict processing. Results revealed that N2 activation moderates the association between anxiety and emotional-eating behavior. Thus, increased anxiety combined with more negative N2 activation can contribute to emotional-eating behavior. These results are discussed in the context of ineffective conflict processing contributing to poor emotion regulation.

Validation of a Shortened Version of the Children's Eating Behavior Questionnaire and Associations with BMI in a Clinical Sample of Latino Children

OBJECTIVE

To examine the validity of the Children's Eating Behavior Questionnaire (CEBQ) through the associations of its 3 subscale scores (food responsiveness, slowness in eating, and satiety responsiveness) with body mass index (BMI).

DESIGN

Cross-sectional study of baseline data from a clinic-based obesity prevention and control randomized controlled trial.

PARTICIPANTS

Latino pediatric patients (n = 295) aged 5-11 years from a federally qualified health center in San Diego County, CA, with BMI percentiles ranging from 75.5 to 99.0.

MAIN OUTCOME MEASURE

Child BMI-for-age percentile computed using the standardized program for the 2000 Centers for Disease Control and Prevention growth charts.

ANALYSIS

Principal components analysis and multivariate linear regressions.

RESULTS

Principal components analysis showed a factor structure relatively similar to that of the original 3 CEBQ subscales, with acceptable internal consistency and between-subscale correlations. Analyses demonstrated the validity of the 3 subscales: child BMI was positively associated with food responsiveness (β = .336; P ≤ .001) and negatively associated with slowness in eating (β = -.209; P ≤ .001) and satiety responsiveness (β = -.211; P ≤ .001).

CONCLUSIONS AND IMPLICATIONS

The 14-item CEBQ scale may be useful for assessing obesogenic eating behaviors of Latino children. Further study is needed to replicate these findings.

Parental feeding behavior in relation to children's tasting behavior: An observational study

Children's eating habits are shaped in part by parental feeding practices. While maladaptive practices have already received a lot of research attention, the effects of adaptive strategies, especially in elementary school aged children of different weight status, are less examined. This study examines how parents (1) model and (2) encourage their child to taste an unknown food. Thereby, attention is paid to the distinction between encouraging what (i.e. adaptive type of encouragement) and the amount (i.e. maladaptive type of encouragement) children eat/drink. Twenty-five families with a child with overweight and 30 families with a child of healthy weight (7-13 years) participated in a taste task. Both the child's tasting behavior and the parents' modelling and encouragement behavior were observed and related to the child's age and weight status. As 94.3% of the children tasted the unknown food, weight status differences between tasters and non-tasters could not be investigated. Only 26.9% of the parents used modelling to enhance tasting behavior; this was unrelated to age and weight status. 77.4% of the parents encouraged their children to taste (encouragement of what children eat/drink), and this was significantly more prevalent in parents of younger children and of healthy-weight children. 21.1% of the parents also encouraged their children to finish the juice (encouragement of amount children eat/drink) and this was also more prevalent in parents of the healthy-weight group. These results evidenced that parental modelling is not often used to enhance tasting behavior in children. In contrast, parental encouragement was frequently observed, especially in parents of younger children and of healthy-weight children. Encouragement, however, seems difficult to measure and more research on adaptive parental encouragement is needed.

An open trial targeting emotional eating among adolescents with overweight or obesity

Emotional eating is associated with obesity and disordered eating in adolescents, and thus, is an important target for treatment. We developed a program called PEER (Preventing Emotional Eating Routines), which incorporates emotion regulation skills with behavioral weight loss and parenting techniques for adolescents who are overweight or obese (OW/OB) and their parent. This open label trial evaluated the feasibility, acceptability, and initial efficacy of the PEER program. Thirty adolescents who were OW/OB (86.7% female; mean age = 14.6 years (SD = 1.2); Body Mass Index (BMI) = 34.0 kg/m² (SD = 5.6); 33.3% White non-Hispanic) and their parent (66.7% biological mother) participated in a 4-month treatment and 3-month follow-up. The PEER program was well accepted. Initial efficacy showed significant decreases in emotional eating, and there were trends towards weight loss and a decrease in emotion dysregulation. This trial provides preliminary evidence for the feasibility, acceptability, and initial efficacy of the PEER program among adolescents who are OW/OB and their parent. Further treatment development and randomized controlled studies are needed.

The Team to Address Bariatric Care in Canadian Children (Team ABC3): Team Grant Research Proposal

BACKGROUND

Severe obesity (SO) in Canadian children remains poorly understood. However, based on international data, the prevalence of SO appears to be increasing and is associated with a number of psychosocial, bio-mechanical, and cardiometabolic health risks. The purpose of our national Team to Address Bariatric Care in Canadian Children (Team ABC3) is to develop and lead a series of inter-related studies to enhance the understanding and management of SO in Canadian children and adolescents (0-18 years).

METHODS/DESIGN

From 2015 to 2019, Team ABC3 will conduct a series of projects at the regional, provincial, and national levels using multiple methods and study designs to respond to key knowledge gaps by (i) generating evidence on the prevalence of SO and its impact on health services utilization in children using existing Canadian data sources from primary care settings, (ii) exploring contemporary definitions of SO that link with health outcomes, (iii) comparing and contrasting health risks across the continuum of SO, (iv) understanding potential barriers to and facilitators of treatment success in children with SO, and (v) examining innovative lifestyle and behavioral interventions designed to successfully manage SO in children and their families. Furthermore, to examine the impact of innovative interventions on the management SO, we will (vi) evaluate whether adding a health coach, who provides support via text, email, and/or phone, improves children's ability to adhere to a web-based weight management program and (vii) test the feasibility and impact of a community-based weight management program for pre-school children with SO and their parents that combines group-based parenting sessions with in-home visits.

DISCUSSION

Our research aligns with national priorities in obesity research, brings together leading scientists, clinicians, and stakeholders from across Canada, and will inform health services delivery throughout the country to provide the best care possible for children with SO and their families.

Brain structure, executive function and appetitive traits in adolescent obesity

BACKGROUND

Children with obesity show differences in brain structure, executive function and appetitive traits when compared with lean peers. Little is known on the relationship between brain structure and these traits.

OBJECTIVES

To investigate the relationship between differences in brain structure and executive function and appetitive traits, in obese and lean adolescents.

METHODS

MRI was used to measure cortical thickness and subcortical volumes. Executive function was measured by a Stop Signal-and a Choice Delay Task. Appetitive traits were measured using the Child Eating Behaviour Questionnaire.

RESULTS

Adolescents with obesity had greater volumes of the pallidum; 1.78 mL (SE 0.03, p=0.014), when compared with controls; 1.65 mL (SE 0.02). In the group with obesity, greater pallidum volume was positively associated with the ability to delay reward in the Choice Delay Task (p=0.012).

CONCLUSION

The association between pallidum volumes and Choice Delay Task in obese adolescents supports the hypothesis that the pallidum plays an important role in executive dysfunction in obese children.

Subjective evaluation of psychosocial well-being in children and youths with overweight or obesity: the impact of multidisciplinary obesity treatment

PURPOSE

To investigate the effects of a multidisciplinary childhood obesity treatment programme on subjective evaluations of psychosocial well-being and quality of life.

METHODS

This longitudinal observational study included 1291 children, adolescents and young adults, 6-22 years of age, with overweight or obesity. At entry and after 2-82 months of obesity treatment, the patients evaluated the following domains of psychosocial well-being on a visual analogue scale: quality of life, mood, appetite, bullying, motivation for weight loss and body image satisfaction. The degree of overweight was calculated using a body mass index (BMI) standard deviation score (SDS) at each visit.

RESULTS

At entry, the mean BMI SDS was 2.81 (range: 1.35-6.65, 95% confidence interval (95% CI): 2.44-3.18). After a median of 14 months of treatment, the median reduction in BMI SDS was 0.29 (95% CI: 0.26-0.31, p < 0.0001). Improvements were observed in the domains of quality of life, mood, appetite, bullying and body image satisfaction (p < 0.0001). Larger reductions in BMI SDS were associated with greater improvements in the domains of quality of life (p = 0.001), mood (p = 0.04) and body image satisfaction (p < 0.0001), independent of BMI SDS at entry. However, improvements in psychosocial well-being were also observed in those increasing their BMI SDS (n = 315).

CONCLUSIONS

In a large group of children and youths, psychosocial well-being improved during a multidisciplinary childhood obesity treatment programme, irrespective of the degree of obesity at treatment entry. Greater reductions in BMI SDS were associated with greater improvements in psychosocial well-being, but even in the group increasing their BMI SDS improvements were observed.

Body composition impacts appetite regulation in middle childhood. A prospective study of Norwegian community children

Background

Research suggests a role for both fat mass and muscle mass in appetite regulation, but the longitudinal relationships between them have not yet been examined in children. The present study therefore aimed to explore the prospective relationships between fat mass, muscle mass and the appetitive traits food responsiveness and satiety responsiveness in middle childhood.

Methods

Food responsiveness and satiety responsiveness were measured using the parent-reported Children’s Eating Behavior Questionnaire in a representative sample of Norwegian 6 year olds, followed up at 8 and 10 years of age (n = 807). Body composition was measured by bioelectrical impedance.

Results

Applying a structural equation modeling framework we found that higher fat mass predicted greater increases in food responsiveness over time, whereas greater muscle mass predicted decreases in satiety responsiveness. This pattern was consistent both from ages 6 to 8 and from ages 8 to 10 years.

Conclusions

Our study is the first to reveal that fat mass and muscle mass predict distinct changes in different appetitive traits over time. Replication of findings in non-European populations are needed, as are studies of children in other age groups. Future studies should also aim to reveal the underlying mechanisms.

A Longitudinal Study of Maternal and Child Internalizing Symptoms Predicting Early Adolescent Emotional Eating

Objective

To examine maternal and child internalizing symptoms as predictors of early adolescent emotional eating in a longitudinal framework spanning three critical developmental periods (preschool, elementary school, and early adolescence).

Methods

Participants were 170 children recruited at preschool age for a longitudinal study. When children were 5.25 years, their mothers completed ratings of their own internalizing symptoms. During the spring of 4th grade, children completed measures of internalizing symptoms. In early adolescence, youth completed a measure of emotional eating.

Results

Maternal and child internalizing symptoms predicted adolescent emotional eating. The results indicated that child psychopathology moderated the association between maternal psychopathology (except for maternal anxiety) and early adolescent emotional eating. There was no evidence of mediation.

Conclusions

Pediatric psychologists are encouraged to provide early screening of, and interventions for, maternal and child internalizing symptoms to prevent children's emotional eating.

Emotional Feeding and Emotional Eating: Reciprocal Processes and the Influence of Negative Affectivity

Emotional eating, that is, eating more in response to negative mood, is often seen in children. But the origins of emotional eating remain unclear. In a representative community sample of Norwegian 4-year-olds followed up at ages 6, 8, and 10 years (analysis sample: n = 801), one potential developmental pathway was examined: a reciprocal relation between parental emotional feeding and child emotional eating. The results revealed that higher levels of emotional feeding predicted higher levels of emotional eating and vice versa, adjusting for body mass index and initial levels of feeding and eating. Higher levels of temperamental negative affectivity (at age 4) increased the risk for future emotional eating and feeding.

The mediating role of child self-regulation of eating in the relationship between parental use of food as a reward and child emotional overeating

Emotional eating, or eating in response to negative emotions rather than internal hunger cues, has been related to many maladaptive eating patterns that contribute to weight gain and obesity. The parent feeding practice of use of food as a reward is positively associated with children emotionally overeating, yet, little is known as to the potential behavioral mechanism linking these behaviors. The current study examined the mediating role of child self-regulation of eating in the relationship between parental use of food as a reward and child emotional overeating. Parents of preschool aged children (n = 254) completed online questionnaires targeting parent feeding practices, child eating behaviors, and child self-regulation in eating. Mediation was assessed with Hayes' PROCESS macros in SPSS. Results demonstrated that the relationship between parental use of food as a reward and child emotional overeating was partially mediated by child self-regulation in eating, even after controlling for parent and child gender, household income, and race/ethnicity. In summary, parental use of food as a reward leads to children's diminished ability to regulate intake, which then leads to increased emotional over eating. Results of this study have implications for both the prevention of disordered eating behaviors and childhood obesity prevention programs, suggesting the need to assist children in learning how to self-regulate in the presence of food.

Association of the dopamine D2 receptor rs1800497 polymorphism and eating behavior in Chilean children

OBJECTIVES

Studies have established a strong genetic component in eating behavior. The TaqI A1 polymorphism (rs1800497) has previously been associated with obesity and eating behavior. Additionally, this polymorphism has been associated with diminished dopamine D2 receptor (DRD2) density, higher body mass, and food reinforcement. The aim of this study was to evaluate the association between the DRD2 rs1800497 polymorphism and eating behavior in Chilean children.

METHODS

This was a cross-sectional study in which we selected 258 children (44% girls, 56% boys; ages 8-14 y) with a wide variation in body mass index. Anthropometric measurements were performed by standard procedures. Eating behavior was assessed using the Eating in Absence of Hunger Questionnaire (EAHQ), Child Eating Behavior Questionnaire, and the Food Reinforcement Value Questionnaire. Genotype of the rs1800497 was determined by polymerase chain reaction-restriction fragment length polymorphism. Association of the TaqI A1 variant (T allele) with eating behavior was assessed using nonparametric tests.

RESULTS

Compared with normal-weight children, the obese group demonstrated higher scores on the External Eating and Fatigue/Boredom subscales of the EAHQ. Higher scores were assessed in Food Responsiveness, Emotional Overeating, Enjoyment to Food and Desire to Drink subscales (P < 0.001) and lower scores of the Satiety Responsiveness and Slowness in Eating (P < 0.05). In the sex-specific analysis, the TaqI A1 allele was associated with higher scores on Satiety Responsiveness and Emotional Undereating subscales in obese girls, and higher scores of Enjoyment of Food subscale in boys.

CONCLUSION

The TaqI A1 polymorphism may be a risk factor for eating behavior traits that may predispose children to greater energy intake and obesity.

Depression, Anxiety, and Severity of Obesity in Adolescents: Is Emotional Eating the Link?

The purposes of this study were to characterize the impact of depression and anxiety on the severity of obesity among youth seeking weight management treatment and to determine the extent to which emotional eating mediates the relationship between depression and/or anxiety and degree of obesity. This cross-sectional, retrospective chart review of 102 adolescent patients from a weight management clinic analyzed demographics, body mass index, depression (Patient Health Questionnaire-9), and anxiety (Generalized Anxiety Disorder Scale-7) screens and the Child Eating Behavior Questionnaire, Emotional Over-Eating subscale. After adjusting for demographics and emotional eating, the odds of having severe obesity versus obesity were 3.5 times higher for patients with depression compared with those without (odds ratio [OR] = 3.5; 95% CI = 1.1, 11.3; P = .038) and nearly 5 times higher for those with anxiety (OR = 4.9; CI = 1.2, 20.9; P = .030). Emotional eating, however, was not a mediator between depression/anxiety and degree of adiposity.

Decreasing food fussiness in children with obesity leads to greater weight loss in family-based treatment

OBJECTIVE

Food fussiness (FF), or the frequent rejection of both familiar and unfamiliar foods, is common among children and, given its link to poor diet quality, may contribute to the onset and/or maintenance of childhood obesity. This study examined child FF in association with anthropometric variables and diet in children with overweight/obesity participating in family-based behavioral weight loss treatment (FBT). Change in FF was assessed in relation to FBT outcome, including whether change in diet quality mediated the relation between change in FF and change in child weight.

METHODS

Child (N = 170; age = 9.41 ± 1.23) height and weight were measured, and parents completed FF questionnaires and three 24-h recalls of child diet at baseline and post-treatment. Healthy Eating Index-2005 scores were calculated.

RESULTS

At baseline, child FF was related to lower vegetable intake. Average child FF decreased from start to end of FBT. Greater decreases in FF were associated with greater reductions in child body mass index and improved overall diet quality. Overall, diet quality change through FBT mediated the relation between child FF change and child body mass index change.

CONCLUSIONS

Children with high FF can benefit from FBT, and addressing FF may be important in childhood obesity treatment to maximize weight outcomes.

Psychometric properties of the Turkish version of the Emotional Eating Scale for children and adolescents

This methodological-descriptive-sectional study was performed to assess the validity and reliability of the "Emotional Eating Scale Adapted for Use in Children and Adolescents (EES-C)" scale in Turkey. The sample group of the study was composed of 576 children and adolescents. The data were obtained by using the demographic data collection form and "Emotional Eating Scale Adapted for Use in Children and Adolescents (EES-C)". Cronbach's alpha values for the scale and its subscales were 0.90, 0.86, 0.76 and 0.71; respectively. Item-total correlations for the scale changed between 0.57 and 0.99 (p<0.001). The indices of Model Fit were determined to be Root Mean Square Error of Approximation (RMSA)=0.051, Goodness of Fit Index (GFI)=0.91 and Comparative Fit Index (CFI)=0.97. According to our results, it has been shown that the scale is a valid/reliable instrument to detect the emotional eating of Turkish children and adolescents. EES-C is a convenient tool for professionals to manage and prevent the emotional eating problems.

Appetitive traits and relationships with BMI in adults: Development of the Adult Eating Behaviour Questionnaire

The Child Eating Behaviour Questionnaire (CEBQ) is a validated parent-report measure of appetitive traits associated with weight in childhood. There is currently no matched measure for use in adults. The aim of this study was to adapt the CEBQ into a self-report Adult Eating Behaviour Questionnaire (AEBQ) to explore whether the associations between appetitive traits and BMI observed in children are present in adults. Two adult samples were recruited one year apart from an online survey panel in 2013 (n = 708) and 2014 (n = 954). Both samples completed the AEBQ and self-reported their weight and height. Principal component analysis (PCA) was used to derive 35 items for the AEBQ in Sample 1 and confirmatory factor analysis (CFA) was used to replicate the factor structure in Sample 2. Reliability of the AEBQ was assessed using Cronbach’s α and a two week test-retest in a sub-sample of 93 participants. Correlations between appetitive traits measured by the AEBQ and BMI were calculated. PCA and CFA results showed the AEBQ to be a reliable questionnaire (Cronbach’s α > 0.70) measuring 8 appetitive traits similar to the CEBQ [Hunger (H), Food Responsiveness (FR), Emotional Over-Eating (EOE), Enjoyment of Food (EF), Satiety Responsiveness (SR), Emotional Under-eating (EUE), Food Fussiness (FF) and Slowness in Eating (SE)]. Associations with BMI showed FR, EF (p < 0.05) and EOE (p < 0.01) were positively associated and SR, EUE and SE (p < 0.01) were negatively associated. Overall, the AEBQ appears to be a reliable measure of appetitive traits in adults which translates well from the validated child measure. Adults with a higher BMI had higher scores for ‘food approach’ traits (FR, EOE and EF) and lower scores for ‘food avoidance’ traits (SR, EUE and SE).

Lunch-time food choices in preschoolers: Relationships between absolute and relative intakes of different food categories, and appetitive characteristics and weight

Children's appetitive characteristics measured by parent-report questionnaires are reliably associated with body weight, as well as behavioral tests of appetite, but relatively little is known about relationships with food choice. As part of a larger preloading study, we served 4-5year olds from primary school classes five school lunches at which they were presented with the same standardized multi-item meal. Parents completed Child Eating Behavior Questionnaire (CEBQ) sub-scales assessing satiety responsiveness (CEBQ-SR), food responsiveness (CEBQ-FR) and enjoyment of food (CEBQ-EF), and children were weighed and measured. Despite differing preload conditions, children showed remarkable consistency of intake patterns across all five meals with day-to-day intra-class correlations in absolute and percentage intake of each food category ranging from 0.78 to 0.91. Higher CEBQ-SR was associated with lower mean intake of all food categories across all five meals, with the weakest association apparent for snack foods. Higher CEBQ-FR was associated with higher intake of white bread and fruits and vegetables, and higher CEBQ-EF was associated with greater intake of all categories, with the strongest association apparent for white bread. Analyses of intake of each food group as a percentage of total intake, treated here as an index of the child's choice to consume relatively more or relatively less of each different food category when composing their total lunch-time meal, further suggested that children who were higher in CEBQ-SR ate relatively more snack foods and relatively less fruits and vegetables, while children with higher CEBQ-EF ate relatively less snack foods and relatively more white bread. Higher absolute intakes of white bread and snack foods were associated with higher BMI z score. CEBQ sub-scale associations with food intake variables were largely unchanged by controlling for daily metabolic needs. However, descriptive comparisons of lunch intakes with expected amounts based on metabolic needs suggested that overweight/obese boys were at particularly high risk of overeating. Parents' reports of children's appetitive characteristics on the CEBQ are associated with differential patterns of food choice as indexed by absolute and relative intake of various food categories assessed on multiple occasions in a naturalistic, school-based setting, without parents present.

Polygenic Risk, Appetite Traits, and Weight Gain in Middle Childhood: A Longitudinal Study

IMPORTANCE

Genome-wide association studies have identified genetic risks for obesity. These genetic risks influence development of obesity partly by accelerating weight gain in childhood. Research is needed to identify mechanisms to inform intervention. Cross-sectional studies suggest appetite traits as a candidate mechanism. Longitudinal studies are needed to test whether appetite traits mediate genetic influences on children's weight gain.

OBJECTIVE

To test whether genetic risk for obesity predicts accelerated weight gain in middle childhood (ages 4-8 years) and whether genetic association with accelerated weight gain is mediated by appetite traits.

DESIGN, SETTING, AND PARTICIPANTS

Longitudinal study of a representative birth cohort at the Trondheim Early Secure Study, Trondheim, Norway, enrolled at age 4 years during 2007 to 2008, with follow-ups at ages 6 and 8 years. Participants were sampled from all children born in 2003 or 2004 who attended regular community health checkups for 4-year-olds (97.2% attendance; 82.0% consent rate, n = 2475). Nine hundred ninety-five children participated at age 4 years, 795 at age 6 years, and 699 at age 8 years. Analyses included 652 children with genotype, adiposity, and appetite data.

MAIN OUTCOMES AND MEASURES

Outcomes were body mass index and body-fat phenotypes measured from anthropometry (ages 4, 6, and 8 years) and bioelectrical impedance (ages 6 and 8 years). Genetic risk for obesity was measured using a genetic risk score composed of 32 single-nucleotide polymorphisms previously discovered in genome-wide association studies of adult body mass index. Appetite traits were measured at age 6 years with the Children's Eating Behavior Questionnaire.

RESULTS

Of the 652 genotyped child participants, 323 (49.5%) were female, 58 (8.9%) were overweight, and 1 (0.2%) was obese. Children at higher genetic risk for obesity had higher baseline body mass index and fat mass compared with lower genetic risk peers, and they gained weight and fat mass more rapidly during follow-up. Each SD increase in genetic risk score was associated with a 0.22-point increase in BMI at age-4 baseline (for the intercept, unstandardized path coefficient B = 0.22 [95% CI, 0.06-0.38]; P = .008. Children with higher genetic risk scores also gained BMI points more rapidly from ages 4 to 6 years (B = 0.11 [95% CI, 0.03-0.20]; P = .01 ; β = 0.12) and from 6 to 8 years (B = 0.09 [95% CI, 0.00-0.19]; P = .05; β = 0.10), compared with their lower genetic risk peers. Children at higher genetic risk had higher levels of alleged obesogenic appetite traits than peers with lower genetic risk at age 6 years, but appetite traits did not mediate genetic associations with weight gain. The sum of the 5 indirect effects was B = -0.001 (95% CI, -0.02 -0.01); P = .86; β = 0.00.

CONCLUSIONS AND RELEVANCE

Genetic risk for obesity is associated with accelerated childhood weight gain. Interventions targeting childhood weight gain may provide one path to mitigating genetic risk. However, middle childhood appetite traits may not be a promising target for such interventions. Studies of early-childhood samples are needed to test whether appetite traits explain how genetic risks accelerate growth earlier in development.

Eating behaviours are different in youth with obesity and severe obesity

The study purposes were to: (i) Investigate eating behaviours among patients in a paediatric weight management clinical practice and (ii) Compare eating behaviour phenotypes between children with severe obesity and obesity. This was a retrospective cross-sectional study using data collected during clinical encounters. Participants were included if they were 2-12 years old, had a body mass index ≥95th percentile and if a parent or guardian completed the Child Eating Behaviour Questionnaire (CEBQ). Participants (n = 149) were children with severe obesity (n = 108) and obesity (n = 41). The mean Satiety Responsiveness score was significantly lower for children with severe obesity than for children with obesity. Girls with severe obesity had significantly higher Enjoyment of Food and significantly lower Satiety Responsiveness and Slowness in Eating than girls with obesity. The findings demonstrate the potential clinical utility of the CEBQ for informing tailored treatment strategies through identifying eating behaviour phenotypes.