Specificity of the failure to inhibit responses in overweight children

Neural and Behavioral Correlates of Binge Eating in 9- to 10-Year-Old Children

OBJECTIVE

This observational study compared children with and without binge eating (BE) on biobehavioral measures of reward responsiveness, inhibitory control, and emotion processes, while accounting for the impact of weight.

METHOD

Children aged 9 to 10 years completed the baseline wave of the Adolescent Brain Cognitive Development Study (316 with BE; 7,681 without BE [no-BE]). The prevalence of binge-eating disorder in the BE group was 17.0%; clinically significant internalizing and externalizing symptoms were endorsed by 8.5% and 4.5% of the sample, respectively. The monetary incentive delay (MID) task, stop signal task (SST), and emotional N-Back (EN-Back) task were administered during neuroimaging. Analyses assessed effects of group (BE vs no-BE) on task performance and corresponding neural signal in regions of interest (ROIs). Weight status was evaluated as a covariate and as a moderator of effects.

RESULTS

Adjusting for weight status, the BE group (vs no-BE) group showed lower activation during anticipation of reward, specifically large reward (vs no reward), in the composite ROI consisting of the dorsal striatum, nucleus accumbens, orbital frontal gyrus, amygdala, and insula. Groups did not differ significantly in other behavioral or neural outcomes. No interactions between group and weight status were observed.

CONCLUSION

Blunted anticipatory responses to monetary reward were associated with binge eating during peri-adolescence and may play a role in binge eating pathophysiology. Results challenge prior findings in BE that may be confounded by weight, and highlight the importance of future prospective research across binge-eating disorder stage of illness.

A randomized controlled trial examining general parenting training and family-based behavioral treatment for childhood obesity: The ReFRESH study design

Family-based behavioral treatment (FBT) is one of the most effective treatments for childhood obesity. These programs include behavior change strategies and basic parenting training to help parents make healthy diet and physical activity changes for their children. While effective, not all families respond to this program. Additional training on how to effectively deliver these behavior change strategies may improve outcomes. The authoritative parenting style is associated with many positive academic and socio-emotional outcomes in children, and is characterized by displays of warmth and support while also being consistent with setting limits and boundaries. This parenting style has also been associated with normal weight status. Furthermore, parenting training programs that promote this parenting style for children with behavioral issues have shown unintended effects on decreasing child weight status. Therefore, our goal was to examine the effect of adding more intensive parenting training to FBT on child weight status. We randomized 140 children and their parent to either FBT or FBT + Parenting Training (FBT + PT). Assessments were conducted at baseline, mid-treatment (month 3), post-treatment (month 6), 6-month follow-up (month 12), and 12-month follow-up (month 18). Primary outcome was change in child weight status. Secondary outcomes were rates of drop-out, treatment adherence, and acceptability. If effective, this program may provide another alternative for families to help improve outcomes in childhood obesity management.

Sex-specific impulsivity, but not other facets of executive function, predicts fat and sugar intake two-years later amongst adolescents with a healthy weight: Findings from the ABCD study

During adolescence, processes that control food intake (executive functions [EF]) undergo extensive refinement; underlying differences in EF may explain the inability to resist overeating unhealthy foods. Yet, overeating fat and sugar also causes changes to EF and cognition but disentangling these relationships has been difficult, as previous studies included youth with obesity. Here, amongst youth initially of a healthy weight, we evaluate whether 1) sex-specific underlying variation in EF/cognition at 9/10-years-old predict fat/sugar two-years later (Y2) and 2) if these relationships are moderated by body mass index (BMI), using linear mixed effects models (controlled for puberty, caregiver education; random effect: study site). Data were leveraged from Adolescent Brain Cognitive Development Study (n = 2987; 50.4% male; 15.4% Latino/a/x; 100% healthy weight at baseline; 12.4% overweight/obese by Y2, data release 4.0). EF and cognition (e.g., inhibition, cognition, motor, memory, impulsivity) were assessed with the NIH toolbox, Rey Auditory Verbal Learning Task, Little Man Task, the BIS/BAS, and UPPS-P. A saturated fat/added sugar (kcals) composite score was extracted from the validated Kids Food Block Screener. For males, greater baseline impulsivity (e.g., Positive Urgency, Lack of Planning and Perseverance) and reward (e.g., Fun seeking, Drive) was related to greater Y2 intake. For both sexes, greater baseline Negative Urgency and higher BMI was related to greater Y2 intake. No other relationships were observed. Our findings highlight a phenotype that may be more at risk for weight gain due to overconsumption of fat/sugar. Thus, prevention efforts may wish to focus on impulsive tendencies for these foods.

Heightened sensitivity to high-calorie foods in children at risk for obesity: insights from behavior, neuroimaging, and genetics

Pediatric obesity is a major public health concern. Genetic susceptibility and increased availability of energy-dense food are known risk factors for obesity. However, the extent to which these factors jointly bias behavior and neural circuitry towards increased adiposity in children remains unclear. While undergoing fMRI, 108 children (ages 5-11y) performed a food-specific go/no-go task. Participants were instructed to either respond ("go") or inhibit responding ("no-go") to images of food or toys. Half of the runs depicted high-calorie foods (e.g., pizza) whereas the other half depicted low-calorie foods (e.g., salad). Children were also genotyped for a DNA polymorphism associated with energy intake and obesity (FTO rs9939609) to examine the influence of obesity risk on behavioral and brain responses to food. Participants demonstrated differences in behavioral sensitivity to high- and low-calorie food images depending on task demands. Participants were slower but more accurate at detecting high- (relative to low-) calorie foods when responding to a neutral stimulus (i.e., toys) and worse at detecting toys when responding to high-calorie foods. Inhibition failures were accompanied by salience network activity (anterior insula, dorsal anterior cingulate cortex), which was driven by false alarms to food images. Children at a greater genetic risk for obesity (dose-dependent model of the FTO genotype) demonstrated pronounced brain and behavioral relationships such that genetic risk was associated with heightened sensitivity to high-calorie food images and increased anterior insula activity. These findings suggest that high-calorie foods may be particularly salient to children at risk for developing eating habits that promote obesity.

Paediatric obesity and metabolic syndrome associations with cognition and the brain in youth: Current evidence and future directions

Obesity and components of the metabolic syndrome (MetS) are associated with differences in brain structure and function and in general and food-related cognition in adults. Here, we review evidence for similar phenomena in children and adolescents, with a focus on the implications of extant research for possible underlying mechanisms and potential interventions for obesity and MetS in youth. Current evidence is limited by a relative reliance on small cross-sectional studies. However, we find that youth with obesity and MetS or MetS components show differences in brain structure, including alterations in grey matter volume and cortical thickness across brain regions subserving reward, cognitive control and other functions, as well as in white matter integrity and volume. Children with obesity and MetS components also show some evidence for hyperresponsivity of food reward regions and hyporesponsivity of cognitive control circuits during food-related tasks, altered brain responses to food tastes, and altered resting-state connectivity including between cognitive control and reward processing networks. Potential mechanisms for these findings include neuroinflammation, impaired vascular reactivity, and effects of diet and obesity on myelination and dopamine function. Future observational research using longitudinal measures, improved sampling strategies and study designs, and rigorous statistical methods, promises to further illuminate dynamic relationships and causal mechanisms. Intervention studies targeted at modifiable biological and behavioural factors associated with paediatric obesity and MetS can further inform mechanisms, as well as test whether brain and behaviour can be altered for beneficial outcomes.

Associations of food reinforcement and food- related inhibitory control with adiposity and weight gain in children and adolescents

Some, but not all studies have reported that, among youth with disordered eating and high weight, the relative reinforcing value of food (RRV-F, i.e., how hard a person will work for a high-energy-dense food when another reward is available) is greater, and food-related inhibitory control (i.e., ability to withhold a response to food-related stimuli) is lower, compared to peers without disordered eating or overweight. In most studies, high RRV-F and low food-related inhibitory control have been studied separately, as independent factors, with each suggested to predict excess weight and adiposity (fat mass) gain. We hypothesized that the interaction of these factors would prospectively exacerbate risk for weight and adiposity (fat mass) gain three years later in a sample of healthy youth. At baseline, RRV-F was measured using a Behavior Choice Task with the rewards being standardized servings of chocolate candies, cheese crackers, or fruit snacks. Food-related inhibitory control was determined by performance in response to food and non-food stimuli during a Food Go/No-Go task. At baseline and 3-year visits, total body adiposity was measured by dual-energy X-ray absorptiometry (DXA) and body mass index (BMI) was obtained using measured weight and height. A linear regression was conducted with 3-year adiposity as the dependent variable. RRV-F, food-related inhibitory control, and the RRV-F x food-related inhibitory control interaction as independent variables. Baseline adiposity, age, height, sex, race/ethnicity, and days between visits were included as covariates for model predicting 3-year adiposity. Baseline BMI, age, sex, race/ethnicity, and days between visits were included as covariates for model predicting 3-year BMI. One-hundred and nine youth (mean 12.4±2.7y, mean 0.50±1.02 BMIz, 30.3% with overweight/obesity, 45.9% female, 51.4% non-Hispanic White), 8-17 years at baseline, were studied. Baseline food-related inhibitory control (βunstandardized = 0.33, p = .037, 95% CI [.02, 0.64]), but not baseline RRV-F (βunstandardized = -0.003, p = .914), 95% CI [-0.05, 0.05]) was significantly associated with 3-year adiposity such that those with the poorest food-related inhibitory control (great number of commision errors) had the greatest adiposity gain. The interaction between RRV-F and food-related inhibitory control did not predict 3-year adiposity (βunstandardized = -0.07, p = .648, 95% CI [-0.39, 0.25]). The pattern of findings was the same for models examining non-food related inhibitory control. Neither baseline food-related inhibitory control (βunstandardized = 2.16, p = .256, 95% CI [-1.59, 5.92]), baseline RRV-F (βunstandardized = 0.14, p = .660, 95% CI [-0.48, 0.75]), nor their interaction (βunstandardized = -1.18, p = .547, 95% CI [-5.04, 2.69]) were significantly associated with 3-year BMI. However, non-food related inhibitory control (βunstandardized = 0.54, p = .038, 95% CI [.22, 7.15]) was significantly associated with 3-year BMI. In summary, food-related inhibitory control but not RRV-F, was associated with changes in adiposity in a sample of children and adolescents. Among generally healthy youth, food-related inhibitory control may be a more relevant risk factor than food reinforcement for adiposity gain. Additional data are needed to determine how inhibitory control and reward systems, as well as other disinhibited eating behaviors/traits, may interact to promote excess weight gain over time in youth.

Neurobehavioral phenotypes of delay discounting and cognitive control in child attention-deficit/hyperactivity disorder and obesity: Shared or distinct?

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) and obesity have been independently associated with deficient cognitive control (CC) and heightened preference for immediate reward.

OBJECTIVES

We aimed to identify specific shared and distinct neurobehavioral phenotypes of child obesity and ADHD by simultaneously measuring CC and preference for immediate reward in children with and without ADHD who varied in body weight.

METHODS

This case-control study included 323 8-12 year olds (ADHD n = 215, typically developing (TD) screened for ADHD symptoms [TD] controls n = 108) varying in body weight. Children completed a go/no-go task (assessing CC), as well as a classical money delay discounting (DD) task and novel experiential game time DD task (assessing preference for immediate over delayed rewards).

RESULTS

For game time DD, there was a body mass index z-score (BMIz)*ADHD interaction, such that TD children with overweight/obesity showed game time DD levels that were greater than those of TD children without overweight/obesity and similar to those of children with ADHD. Only children with ADHD showed poorer CC compared to TD children, with no effects of body weight.

CONCLUSIONS

Heightened game time DD with delays and rewards experienced in real-time may represent a neurobehavioral phenotype that is shared between ADHD and overweight/obesity in childhood, whereas deficient CC may be specific to children with ADHD.

Modified cue exposure for adolescents with binge eating behaviour: study protocol of a randomised pilot trial called EXI(ea)T

INTRODUCTION

Binge eating (BE) behaviour is highly prevalent in adolescents, and can result in serious metabolic derangements and overweight in the long term. Weakened functioning of the behavioural inhibition system is one potential pathway leading to BE. Food cue exposure focusing on expectancy violation (CE_EV) is a short intervention for BE that has proven effective in adults but has never been tested in adolescents. Thus, the current randomised pilot trial evaluates the feasibility of CE_EV for adolescents and its efficacy in reducing eating in the absence of hunger (EAH) of binge food items.

METHODS AND ANALYSIS

The trial will include N=76 female adolescents aged between 13 and 20 years with a diagnosis of bulimia nervosa, binge eating disorder (BED) or their subthreshold forms based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Participants will be randomly assigned to two sessions of CE_EV or behavioural analysis (BA), a classical cognitive-behavioural therapy-based intervention. The primary endpoint is the change in EAH measured according to ad libitum consumption of personally preferred binge food in a bogus taste test at post-test based on the intention-to-treat population. Key secondary endpoints are changes in EAH of standardised binge food at post-test, in EAH at 3-month follow-up (FU) and in food craving after induction of food cue reactivity at post-test and FU. To identify further valid outcome parameters, we will assess effects of CE_EV compared with BA on global ED psychopathology, BE frequency within the last 28 days, body weight, response inhibition and emotion regulation abilities. Treatment groups will be compared using analysis of covariance with intervention as fixed factor and body mass index at baseline as covariate.

ETHICS AND DISSEMINATION

This clinical trial has been approved by the Ethics Review Committee of the Medical Association of Rhineland-Palatinate and the Medical Faculty of the Ruhr-University Bochum. The collected data will be disseminated locally and internationally through publications in relevant peer-reviewed journals and will be presented at scientific and clinical conferences. Participants data will only be published in an anonymised form.

TRIAL REGISTRATION NUMBER

DRKS00024009.

Reward and inhibition in obesity and cigarette smoking: Neurobiological overlaps and clinical implications

Cigarette smoking and obesity are the leading causes of premature morbidity and mortality and increase the risk of all-cause mortality four-fold when comorbid. Individuals with these conditions demonstrate neurobiological and behavioral differences regarding how they respond to rewarding stimuli or engage in inhibitory control. This narrative review examines the role of reward and inhibition in cigarette smoking and obesity independently, as well as recent research demonstrating an effect of increased body mass index (BMI) on neurocognitive function in individuals who smoke. It is possible that chronic smoking and overeating of highly palatable food, contributing to obesity, dysregulates reward neurocircuitry, subsequently leading to hypofunction of brain networks associated with inhibitory control. These brain changes do not appear to be specific to food or nicotine and, as a result, can potentiate continued cross-use. Changes to reward and inhibitory function due to increased BMI may also make cessation more difficult for those comorbid for obesity and smoking.

Design of the FRESH-DOSE study: A randomized controlled noninferiority trial evaluating a guided self-help family-based treatment program for children with overweight or obesity

Overweight and obesity affect 45% of children and increases the risk for several negative health sequelae. Family-Based Behavioral Treatment (FBT) is the most efficacious treatment for child weight management and consists of nutrition and physical activity education, behavior change skills and parenting skills training. FBT is time and staff intensive and can include 20, 60-min separate groups for parents and children, as well as 20-min behavior coaching sessions to help problem solve barriers to implementing the skills learned and individualize the program. Guided self-help (GSH) therapies involve providing families a manual to review independently and brief coaching sessions by an interventionist to facilitate adherence. We developed a GSH version of FBT (gshFBT) which provides a manual to both parents and children and includes 14, 20-min coaching sessions over 6-months. The current study randomized 150 children (mean age = 10.1 years (SD = 1.38); mean BMI% = 97.3% (SD = 2.84); mean BMIz = 2.09 (SD = 0.40); 49% female; 43% Hispanic) and one of their parents (mean age = 41.8 years (SD = 6.52); mean BMI = 32.0 (SD = 7.24); 87.3% female; 43% Hispanic) to either a group-based FBT program or a gshFBT program. Assessments are conducted at baseline, post-treatment (6 months), 6-month follow-up (12 months) and 12-month follow-up (18 months). Primary outcomes are child weight change (BMIz) and cost effectiveness. Recruitment occurred between May 2017 and October 2021 and follow-up assessments are underway. Given the public health concern for children with obesity and the low level of access to FBT, gshFBT could prove extremely useful to provide intervention to a greater proportion of the population.

Attention to food cues following media multitasking is associated with cross-sectional BMI among adolescents

Purpose

To measure attention to food cues following a multitask or a sustained attention single task, and further, to examine the associations with current weight status and excess consumption.

Methods

Ninety-six 13-to 17-year-olds were fed a standardized meal and then had their attention to food cues measured following completion of a single sustained attention task, media multitask, or a passive viewing control task. Participants then completed an eating in the absence of hunger paradigm to measure their excess consumption. Adolescents completed each condition on separate visits in randomized order. Attention to food cues was measured by computing eye-tracking measures of attention, first fixation duration, and cumulative fixation duration to distractor images while participants played the video game, Tetris. Participants also had their height and weight measured.

Results

Although not statistically significant, attention to food cues was greatest following a media multitask and weakest following a task that engaged sustained attention when compared to a control. First fixation duration was positively and statistically significantly associated with BMI-Z when measured following a multitask. Cumulative fixation duration was not associated with BMI-Z. There were no associations between BMI-Z and attention to food cues after the attention or control task, nor any association between attention to food cues and eating in the absence of hunger.

Conclusion

Among adolescents, we found that current adiposity was related to attention to food cues following a multitask. Multitasking may perturb the cognitive system to increase attention to food cues.

Overweight and executive functions, psychological and behavioral profile of Spanish adolescents

The prevalence of overweight and obesity among children and adolescents has risen dramatically increasing a major risk factor for non-communicable diseases and cognitive dysfunctions. This study aimed to analyze differences in the executive function´s development between overweight and normal-weight adolescents. As a secondary objective, we aimed to assess differences in adolescents' psychological and behavioral profiles between groups. In order to achieve the study's aim, 105 adolescent students (17.61 ± 7.43 years) completed an online questionnaire that analyzed variables regarding their executive functions' processes, their psychological and physical health as well as lifestyle habits. Results showed that executive functions development is associated with adolescent weight. A higher range of weight presents a lower ability to assess abstract reasoning and to shift cognitive strategies. Nevertheless, no differences were found between groups in the capacity to hold information in mind nor the ability to control impulsive responses. Furthermore, groups showed differences in the number of meals and gastritis, but no significant differences have been found in lifestyle variables such as mobile usage, smoking, physical activity, and hours of sleep per day. The results from the present study could be used to implement multidisciplinary programs to develop healthier habits.

Examining Associations Between Food Insecurity, Inhibitory Control, and Body Mass Index in Preschoolers

OBJECTIVE

This study examines relations between food insecurity, inhibitory control, and body mass index (BMI) in early childhood.

METHOD

The sample comes from an evaluation of a state-funded prekindergarten program and includes 126 children (mean age = 4.73 yrs, female = 42%) from families with low incomes. Parents reported on their child's food insecurity. Child inhibitory control was assessed using a performance-based task, and children's height and weight were objectively collected at the same time as the inhibitory control assessment. A regression model was used to test whether inhibitory control moderated the association between food insecurity and BMI. The model included a large battery of covariates and adjusted for clustering at the classroom level. Ad hoc analyses were conducted to examine the robustness of findings to different conceptualizations of food insecurity based on the US Department of Agriculture's categories for severity.

RESULTS

A significant interaction revealed that inhibitory control moderated the association between food insecurity and children's BMI percentile. Investigation of the simple slopes suggested that greater food insecurity was related to a higher BMI percentile among children who demonstrated stronger inhibitory control. In addition, results from ad hoc analyses examining categories of food insecurity indicated that experiencing very low food security was also related to a higher BMI among children with average and strong inhibitory control.

CONCLUSION

This study makes a unique contribution to the existing literature by examining relations among food insecurity, inhibitory control, and BMI during a critical period in children's physical and brain development. Findings have implications for public health efforts to address childhood obesity among populations with low incomes.

The Mediation Role of Health Behaviors in the Association between Self-Regulation and Weight Status among Preschool Children: A Sex-Specific Analysis

Previous studies have supported the link between children’s self-regulation (CSR) and weight status, but the potential pathways have not been elucidated yet. We aimed to investigate whether and to what extent health behaviors mediate this association, as well as to explore the sex effect. For this study, we recruited 3740 preschoolers in Wuhan, China. The height and weight of children were measured, and a body mass index of the ≥85th percentile was defined as overweight/obesity (OWO). We used the Children’s Behavior Questionnaire, with measured domains including inhibitory control, impulsivity, anger, and attentional focusing, to assess CSR. The primary caregivers’ SR (PSR) was assessed with the Self-Control Scale. Information on lifestyles collected from questionnaires was utilized to construct the health behavior index (HBI). We found that Children’s HBI was associated with both CSR and PSR, inhibitory control (OR = 0.81, p < 0.001), anger (OR = 1.23, p < 0.001), attentional focusing (OR = 0.70, p < 0.001), impulsivity (OR = 1.23, p < 0.001), and PSR (OR = 0.73, p < 0.001). Children’s impulsivity was associated with their OWO (OR = 1.11, p = 0.013) which was partly mediated by the HBI (direct effect: β = 0.092, p = 0.026; indirect effect: β = 0.011, p = 0.007). The sex-specific analysis indicated that this mediation effect was only significant in boys. These results indicated that impulsivity is associated with childhood weight status, which is partially mediated by health behaviors, especially in boys.

A Study of Response Inhibition in Overweight/Obesity People Based on Event-Related Potential

Objective

To investigate the characteristics of response inhibition of overweight/obese people, using behavior experiments combine with neural electrophysiological technology and discussing the difference in impulse level between obesity/overweight and normal-weight people through EEG data, questionnaire, and behavior experiment.

Method

(1) All participants completed the Go/Nogo task; meanwhile, behavior data and 64 channel EEG data were recorded. (2) Participants completed the Stop-Signal task and behavior date was recorded.

Results

(1) During Go/Nogo task, no significant differences were found in reaction time, omission errors of the Go task between the two groups, while commission errors of the Nogo task of the control group were significantly greater than the overweight/obesity group. (2) About SSRT during the Stop-Signal Task, the interaction of stimulus type (high-calorie food picture, low-calorie food picture) and group (control group, overweight/obesity group) was significant (p = 0.008). (3) No significant differences were found between the two groups in amplitude and latency of N2. About the amplitude of P3, the interaction of task type (Go task, Nogo task), electrode point (Cz, CPz, Pz), and groups were significant (p = 0.041), the control group P3 amplitude was significantly greater than overweight/obesity group during the Nogo task. Regarding about latency of P3, the interaction of group and electrode point were not significant (p = 0.582), but the main effect of task type was significant (p = 0.002).

Conclusion

(1) In terms of behavioral outcomes, overweight-obese subjects had lower dominant response inhibition and response cessation compared to normal-weight subjects. (2) In terms of EEG results, overweight-obese subjects showed no difference in processing speed and level of conflict monitoring for early inhibitory processing compared to normal-weight subjects, but there was a deficit in behavioral control for late inhibitory processing.

Aerobic Fitness, B-Vitamins, and Weight Status Are Related to Selective Attention in Children

There is an increasing prevalence of poor health behaviors during childhood, particularly in terms of physical activity and nutrition. This trend has occurred alongside a growing body of evidence linking these behaviors to cognitive function. B-vitamins are thought to be particularly important in the neural development that occurs during pregnancy, as well as in healthy cognitive aging. However, much less is known regarding the role of B-vitamins during childhood. Given that preadolescent childhood is a critical period for cognitive development, this study investigated the relationship between specific aspects of nutrition, particularly B-vitamins, and related health factors (e.g., body mass, fitness) on selective attention in children. Children (n = 85; 8-11 years) completed a selective attention task to assess inhibition. Participant's dietary intake was collected using the Automated Self-Administered 24-h dietary assessment tool. Correlations between specific nutrients, BMI, fitness, and task performance were investigated. After accounting for demographic variables and total caloric intake, increased B-vitamin intake (i.e., thiamin and folic acid) was associated with shorter reaction times (p's < 0.05), fitness was associated with greater response accuracy (p < 0.05), and increased BMI was related to increased variability in reaction times (p < 0.05). Together, these findings suggest that aspects of health may have unique contributions on cognitive performance. Proper physical health and nutrition are imperative for effective cognitive functioning in preadolescent children. Targeted efforts aimed at health education amongst this population could ensure proper cognitive development during school-age years, providing a strong foundation throughout life.

Young Children's Eating in the Absence of Hunger: Links With Child Inhibitory Control, Child BMI, and Maternal Controlling Feeding Practices

This study aimed to gain a better understanding of the associations between young children’s eating in the absence of hunger (EAH), inhibitory control, body mass index (BMI) and several maternal controlling feeding practices (food as reward, restriction for health, restriction for weight control). In addition, to more properly assess the relationship between children’s and maternal variables, the link between EAH and restriction was explored separately in two directionalities: “child to parent” or “parent to child.” To do this, mothers of 621 children aged 2.00–6.97years (51% boys, M=4.11years, SD=1.34) filled in a questionnaire with items from validated questionnaires. Structural equation modeling (SEM) was used to analyze the data. The results showed, whatever the directionality considered, a positive association between children’s eating in the absence of hunger and their BMI z-scores. Restriction for health and restriction for weight control were differently linked to EAH and to children’s BMI z-scores. Namely, low child inhibitory control, food as reward and restriction for health were identified as risk factors for EAH. Restriction for weight control was not linked to EAH, but was predicted by child BMI z-scores. Interventions aiming to improve children’s abilities to self-regulate food intake could consider training children’s general self-regulation, their self-regulation of intake, and/or promoting adaptive parental feeding practices.

Self-regulatory processes in early childhood as predictors of Hispanic children's BMI z-scores during the elementary school years: Differences by acculturation and gender

Over the last decade, longitudinal research has shown that children's general, top-down self-regulation during early childhood is negatively associated with children's weight status in elementary school. The samples in these previous studies have been primarily White, and no study to date has examined this issue in a sample of Hispanic children from low-income families-a population at high risk for childhood obesity. The present study followed 130 Hispanic children over a time period of three to just under five years, examining the degree to which multiple measures of general, top-down self-regulation, along with a measure of appetite regulation (eating in the absence of hunger), predicted children's BMI z-scores in the early elementary school years. Results showed that children's ability to delay gratification in the preschool years was negatively associated with later BMI z-scores and that children's eating in the absence of hunger was positively associated. In separate models by gender, these relationships were significant only for girls. Moreover, analyses run separately for children of mothers low or high on acculturation showed that the relationship between delay of gratification and later BMI z-scores was significant only for children whose mothers were low on acculturation. Possible socialization and environmental factors contributing to these findings are considered.

Can sweet food-specific inhibitory control training via a mobile application improve eating behavior in children with obesity?

OBJECTIVES

Consumption of excess sugar, a common energy-dense nutrient-poor food, is a risk factor for obesity in school-aged children. Food-specific inhibition training, where responses to palatable food stimuli, such as sweet foods, are consistently and repeatedly inhibited, reduces sweet food intake in adults. However, no studies have yet examined the effectiveness of inhibitory control training specifically targeting sweet foods among children with high sugar cravings. We examined whether sweet food-specific inhibitory control training (SF-ICT), administered via a mobile app, reduced choice and consumption of sweet foods, and weight in a sample of children aged 7-11 with overweight or obesity and who had high sugar cravings (N = 46).

DESIGN

This study was designed as a 2 × 3 between-within design.

METHODS

Participants were randomly allocated to a single-blind design with two conditions: they either received 7 sessions of active or control go/no-go training in which either sweet foods or non-food cues were paired with no-go signals. Participants' weight, sweet food choice, and consumption were measured pre and post-training, and at three-month follow-up.

RESULTS

The results revealed that participants in the active group showed a significant reduction in sweet food choice and intake from pre to post-training relative to the control group. The effects of the training on reducing sweet food intake persisted over the 3-month follow-up No significant changes in weight loss were observed.

CONCLUSIONS

These results provide preliminary evidence that sweet food-specific inhibitory control training (SF-ICT) via a mobile app is effective in modifying eating behavior among children with excessive consumption of sugary foods. Further research is required to clarify under what conditions the benefits of training would expand to weight loss.

Fluctuations in attentional bias for food and the role of executive control

Research has shown repeatedly that overweight and obesity are associated with more fluctuations in attentional bias (AB), as reflected in trial-level bias scores (TL-BS). More specifically, people with a high BMI more frequently alternate their attention towards and away from food over time. The current study proposed and tested a model on the mechanism behind the positive association between variability of AB for food and BMI. It was hypothesized that poor executive control (poor response inhibition and lower sustained attention) would be related to both higher BMI and more fluctuations in AB for food and this would, at least partly, explain the significant relationship between variability of AB for food and BMI. To test our hypotheses, 99 female participants completed both an online food dot-probe task and an online stop-signal task. It was found that response inhibition was significantly related to BMI, whereas, contrary to our hypotheses, variability of AB for food was not related to BMI nor to executive control. In conclusion, this study revealed a relation between poor inhibitory control and higher BMI. However, a role of executive control in fluctuations in attention for food could not be established.

Exploring the relationship between appetitive behaviours, executive function, and weight status among preschool children

OBJECTIVE

The goal was to conduct exploratory analysis to determine if executive functions (EFs) and food responsiveness/satiety responsiveness (appetitive behaviours that describe one's tendency to eat in the presence of food or food cues) interact to influence weight status among preschool children participating in a trial promoting self-regulation around energy-dense foods.

METHODS

At baseline, parents completed the Behaviour Rating Inventory of Executive Function-Preschool and the Child Eating Behaviour Questionnaire. Children completed anthropometric measurements at the preschool. Spearman's correlation, linear regression, and tests of interaction were conducted. The relationship between weight status and EFs among those who were high vs low in food responsiveness and satiety responsiveness was examined.

RESULTS

Children (n = 92) had a mean age of 5.1 years and body mass index (BMI) percentile of 57.6; half (54%) were male. There were significant correlations between food responsiveness and several EFs (emotional control, inhibitory control, working memory, and plan/organize). In the stratified analysis, children with high food responsiveness or low satiety responsiveness had higher BMI percentiles as emotional control skills worsened. BMI percentiles were not elevated among children with low food responsiveness and poor emotional control.

CONCLUSION

These results suggest that EFs may be more relevant to weight status if preschool children had high levels of food responsiveness or low levels of satiety responsiveness (ie, increased tendency to be influenced by environmental food cues). This analysis should be replicated with direct measures of executive function and appetitive behaviours in larger samples of young children to examine longitudinal impact on weight status.

Children's inhibitory control abilities in the presence of rewards are related to weight status and eating in the absence of hunger

The Reflective-Impulsive Dual Processes Model suggests that overeating occurs when the temptation to consume food overrides inhibitory control processes. However, how rewards interact with inhibitory control and their relation to children's weight status and food intake is not understood. Here, 7-to-11-year-old children (n = 66; 32 overweight/obese) completed two versions (baseline [i.e., non-reward incentivized/control] and reward incentivized [food, money, no reward]) of a Go/Nogo task. Intake of palatable foods in the absence of hunger (i.e., eating in the absence of hunger-EAH) was measured following a standardized meal. A drift diffusion model was used to characterize children's performance parameters on the Go/Nogo. On the baseline Go/Nogo, children with higher weight status responded more cautiously, but on reward trials for food/money children were more cautions and made more false alarms relative to the no reward condition. Energy intake during EAH positively correlated with FA errors for food and money vs. no reward, but sex moderated this effect such that FA positively associated with EAH in girls but not boys. Independent of sex, FA for money vs. no reward and food vs. money were both positively associated with energy consumed during EAH. These results suggest that the presence of food and money rewards impair inhibitory control processing, especially in children with higher weight status. Further, increased inhibitory control impairment in response to food rewards, specifically, may be a risk factor for disinhibited eating in girls. Though preliminary, results may be useful in the development of targeted treatments to help moderate excess consumption in children.

Food-related inhibitory control training reduces food liking but not snacking frequency or weight in a large healthy adult sample

Inhibitory control training has recently been used as an intervention to aid healthy eating and encourage weight loss. The aim of this pre-registered study was to explore the effects of training on food liking, food consumption and weight loss in a large (n = 366), predominantly healthy-weight sample. Participants received four training sessions within a week, in which they had to inhibit their responses to either energy-dense foods (active group) or non-food images (control group). Subjective food ratings, food consumption frequency and weight were measured pre- and post-training. At two-weeks post-training, the active group reported a greater reduction in liking for energy-dense foods, compared to the control group. Active participants also reported a significantly greater increase in healthy food liking, immediately post-training, relative to the control group. There was no statistically significant difference between groups for the change in consumption of trained foods or for weight loss. These findings are partially consistent with previous research conducted in smaller, more overweight samples. Exploratory analyses suggest that some effects of training may be driven by awareness effects. Methodological differences across findings and avenues for future investigation are discussed.

Effect of obesity on inhibitory control in preadolescents during stop-signal task. An event-related potentials study

Preadolescence is a period in which structural and functional changes occur in brain network reorganization that relate to the development of executive control functions, particularly in the areas of attention and cognitive inhibition. Obesity has been associated with a deficit in executive functions and behavioral and electrophysiological differences using the go/no-go task (proactive inhibition), but no study has assessed brain-electrical activity using the stop-signal task (reactive inhibition) in this population. Therefore, we hypothesized that obese preadolescents would show less efficiency in reactive inhibition than their same-age non-obese peers. To test this hypothesis, event-related potentials (ERPs) were collected during a stop-signal task and compared between 27 obese preadolescents (mean BMI = 25.9; 9.65 years old) and 29 normal-weight preadolescents (mean BMI = 17.5; 9.60 years old). No significant differences between groups were observed in behavioral responses. As for ERPs, the obese group had an electrophysiological pattern associated with less efficient conflict monitoring during the "no-go" condition (i.e., less modulation of N200 latency based on the experimental condition), differences in attentional allocation in the "go" condition (less modulation of P300a latency based on experimental condition), and difficulties in rule retrieval from working memory associated with the trial-type in both experimental conditions (smaller P300b amplitude). We conclude that obese preadolescents displayed less ability to modulate conflict-monitoring in the "no-go" condition and attention allocation in the "go" condition, evidencing differences between groups in the development of attention and inhibitory control.

A Dual-Pathway Perspective on Food Choices in Adolescents: The Role of Loss of Control Over Eating

Introduction

One in three adolescents frequently consume unhealthy snacks, which is associated with negative developmental outcomes. To date, it remains unclear how intrapersonal factors account for food choices in adolescents. Guided by the dual-pathway model, the current study aimed to: (1) examine the joint contribution of inhibitory control and attentional bias in predicting unhealthy food choices in adolescents, and (2) determine whether this mechanism is more pronounced in adolescents who experience loss of control over eating (LOC).

Materials and Methods

A community sample of 80 adolescents (65% female; 10–17 years old, M_age = 13.28, SD = 1.94) was recruited. Based on a self-report questionnaire, 28.7% of this sample reported at least one episode of LOC over the past month. Food choice was assessed using a computerized food choice task. Both inhibitory control and attentional bias were measured with behavioral tasks (go/no-go and dot probe task, respectively). Binary logistic regressions were conducted to address the research questions.

Results

Inhibitory control and attentional bias did not significantly interact to predict unhealthy food choices. However, there was a significant three-way interaction between inhibitory control, attentional bias and LOC. For adolescents without LOC, the combination of poor inhibitory control and low attentional bias was significantly associated with unhealthy food choice. Surprisingly, for adolescents with LOC, there was no significant association between unhealthy food choice and inhibitory control or attentional bias.

Discussion

Dual-pathway processes do not seem to add to the explanation of food choice behavior for adolescents with LOC. For adolescents who do not experience LOC, those with poor inhibitory control combined with low attentional bias might be at particular risk for making unhealthy food choices.

Preserved Inhibitory Control Deficits of Overweight Participants in a Gamified Stop-Signal Task: Experimental Study of Validity

Background

Gamification in mental health could increase training adherence, motivation, and transfer effects, but the external validity of gamified tasks is unclear. This study documents that gamified task variants can show preserved associations between markers of behavioral deficits and health-related variables. We draw on the inhibitory control deficit in overweight populations to investigate effects of gamification on performance measures in a web-based experimental task.

Objective

This study tested whether associations between inhibitory control and overweight were preserved in a gamified stop-signal task (SST).

Methods

Two versions of an adaptive SST were developed and tested in an online experiment. Participants (n=111) were randomized to 1 of the 2 task variants and completed a series of questionnaires along with either the gamified SST or a conventional SST. To maximize its possible effects on participants’ inhibitory control, the gamified SST included multiple game elements in addition to the task itself and the stimuli. Both variants drew on the identical core mechanics, but the gamified variant included an additional narrative, graphical theme, scoring system with visual and emotional feedback, and the presence of a companion character. In both tasks, food and neutral low-poly stimuli were classified based on their color tone (go trials), but responses were withheld in 25% of the trials (stop trials). Mean go reaction times and stop-signal reaction times (SSRT) were analyzed as measures of performance and inhibitory control.

Results

Participants in the gamified SST had longer reaction times (803 [SD 179] ms vs 607 [SD 90] ms) and worse inhibitory control (SSRT 383 [SD 109] ms vs 297 [SD 45] ms). The association of BMI with inhibitory control was relatively small (r=.155, 95% CI .013-.290). Overweight participants had longer reaction times (752 [SD 217] ms vs 672 [SD 137] ms) and SSRTs (363 [SD 116] ms vs 326 [SD 77] ms). Gamification did not interact with the effect of overweight on mean performance or inhibitory control. There were no effects of gamification on mood and user experience, despite a negative effect on perceived efficiency.

Conclusions

The detrimental effects of heightened BMI on inhibitory control were preserved in a gamified version of the SST. Overall, the effects of overweight were smaller than in previously published web-based and laboratory studies. Gamification elements can impact behavioral performance, but gamified tasks can still assess inhibitory control deficits. Although our results are promising, according validations may differ for other types of behavior, gamification, and health variables.

Reward-related neural correlates in adolescents with excess body weight

The functional and connectivity reward processing in adults with excessive body weight is well documented, though is relatively less researched during adolescence. Given that reward and inhibition may be highly malleable during adolescence, it is unknown how impulsive behaviors, potentially stemming from impaired inhibitory control and heightened sensitivity to rewarding cues, relate to increases in body weight in adolescents. Adolescents (N = 76; mean age = 14.10 years, SD = 1.92) with varied body mass index (BMI) performed a child-friendly monetary incentive delay task during functional magnetic resonance imaging, to study reward processing during the anticipation of rewards (cue) and reactions to feedback about rewards (feedback). Our results show that adolescents with greater BMI z-score show neural activation and ventral striatum connectivity alterations in networks implicated in reward, salience detection, and inhibitory control. These bottom-up reward and top-down inhibitory control networks, as well as interactions between these networks were prevalent during the anticipation period (when the cue is presented) as well as when receiving feedback about whether one has received a reward. Specifically, our results were mainly driven by failure to receive a reward in the feedback period, and the anticipation of a potential reward in the anticipation period. Overall, we provide evidence for heightened reward salience as well as inhibitory control deficits that, in combination, may contribute to the impulsive behaviors that lead to higher BMI in adolescents.

Emotional reactivity, suppression of emotions and response inhibition in emotional eaters: A multi-method pilot study

OBJECTIVE

Emotional eating has been associated with high emotional reactivity, suppression of negative emotions and inhibitory control difficulties. The current study aimed to address the association of these factors and their combined effect on emotional eating.

METHOD

Twenty-eight participants conducted an emotional Go/Nogo task including pictures of neutral, negative and positive scenes and an additional emotion suppression condition. Electroencephalographic (EEG) activity was recorded continuously. Emotional eating and habitual emotion suppression were assessed through questionnaires. Emotional reactivity to affective pictures was measured through a visual analogue scale and the amplitude of the electrophysiological late positive potential (LPP). Inhibition parameters were assessed behaviorally (i.e., commission errors) and through event-related potentials of the EEG (i.e., N2/P3-amplitudes).

RESULTS

The trait questionnaire data revealed that emotional eating was not correlated with habitual emotion suppression. During the emotional Go/Nogo paradigm, higher emotional eating scores were positively related to higher LPP amplitudes in response to negative affective scenes. Inhibitory control capacities were not related to emotional eating while watching neutral or negative pictures, but higher emotional eating scores were associated with more commission errors when negative emotions were suppressed.

DISCUSSION

Emotional eating tendencies seem to be related to higher reactivity when confronted with negative affective information and inhibitory control deficits may arise especially when an effort is made to suppress these negative emotions. Therefore, a focus on adaptive emotion regulation in treatments of emotional eating seems to be important; solely targeting inhibitory control capacities may not be sufficient in order to help people with emotional eating to regulate their food intake.

Facets of Impulsivity in Relation to Diet Quality and Physical Activity in Adolescence

Although the construct of impulsivity has generally been found to be associated with obesity and health behaviors in adults, research among adolescents is more limited and studies have yet to elucidate which facets of impulsivity may be most salient with regard to different eating and physical activity behaviors. Therefore, the present cross-sectional study assessed facets of impulsivity, measured by the UPPS-P questionnaire, in relation to health behaviors among adolescents. A sample of 2797 high school students from Los Angeles, California completed self-report measures during the ninth grade. The UPPS-P subscales (i.e., (lack of) premeditation, sensation seeking, (lack of) perseverance, negative urgency, positive urgency) were examined as predictors of unhealthy diet quality (i.e., frequency of consumption of high-fat foods and sweet food and drinks, measured by the National Cancer Institute (NCI) Quick Food Scan) and frequency of vigorous physical activity (measured by the Youth Risk Behavior Surveillance System). Greater sensation seeking, positive urgency, and negative urgency was associated with greater unhealthy diet quality (ps < 0.001). Greater negative urgency and lack of perseverance was associated with less frequent vigorous physical activity, whereas greater sensation seeking, lack of premeditation, and positive urgency was associated with more frequent vigorous physical activity (ps < 0.05). While negative urgency (i.e., impulsivity in the context of negative emotions) was consistently associated with poor health behaviors, other facets of impulsivity may potentiate vigorous physical activity in youth. Together these findings underscore the importance of considering the multidimensional nature of impulsivity in relation to adolescents’ health behaviors and highlight areas for future longitudinal research.

Improving Treatment Outcome in Children With Obesity by an Online Self-Control Training: A Randomized Controlled Trial

Background: Currently available treatment programs for children with obesity only have modest long-term results, which is (at least partially) due to the poorer self-control observed within this population. The present trial aimed to determine whether an online self-control training, training inhibition, and redirecting attentional bias, can improve the short- and long-term treatment outcome of (in- or outpatient) child obesity treatment programs. Methods: In this double-blind multi-center randomized controlled trial (RCT), participants aged 8-18 years with obesity were allocated in a 1:1 ratio to receive an online self-control or sham training added to their in- or outpatient multidisciplinary obesity treatment (MOT) program. The primary endpoint was BMI SDS. Data were analyzed by linear mixed models and the main interactions of interest were randomization by time and randomization by number of sessions, as the latter was cumulatively expressed and therefore represents the effect of increasing dose over time. Results: One hundred forty-four inpatient (mean age 14.3 ± 2.2 years, BMI 2.7 ± 0.4 SDS, 42% male) and 115 outpatient children (mean age 11.9 ± 2.1 years, BMI 2.4 ± 0.4 SDS, 45% male) were included. Children's BMI lowered significantly during treatment in both the in- and outpatient treatment centers, p < 0.001. In a mixed model with BMI as dependent variable, randomization by time was non-significant, but the number of self-control trainings (randomization ^* number of sessions) interacted significantly with setting and with age (p = 0.002 and p = 0.047), indicating a potential effect in younger inpatient residents. Indeed, a subgroup analysis on 22 inpatient children of 8-12 years found a benefit of the number of self-control trainings on BMI (p = 0.026). Conclusions: The present trial found no benefit of the self-control training in the entire study population, however a subgroup of young, inpatient participants potentially benefited.

Inhibitory control and negative affect in relation to food intake among youth

Negative affect and poor inhibitory control are related to disinhibited eating behaviors in youth and may contribute to the development and/or maintenance of obesity. Although few studies have jointly examined these constructs in youth, it has been theorized that poor inhibitory control may be driven by negative affect. If supported, impaired inhibitory control, driven by negative affect, could represent a modifiable neurocognitive treatment target for disinhibited eating. The current study examined whether inhibitory control mediates the relationship between negative affect and eating among youth. Youth (8-17 years) participated in a Food Go/No-Go neurocognitive task to measure inhibitory control as the percentage of commission errors. A composite negative affect score was created from self-report measures of anxiety and depression. A laboratory buffet meal modeled to simulate disinhibited eating was used to measure total and snack food intake. Cross-sectional mediation models with bias-corrected bootstrap confidence intervals (CI) were conducted using negative affect as the independent variable, inhibitory control as the mediator, and intake patterns as dependent variables. One-hundred-eighty-one youths (13.2 ± 2.7y; 55% female; BMIz 0.6 ± 1.0) were studied. Total Go/No-Go commission errors mediated the relationship between negative affect and total intake (95%CI = [0.3, 31.6]), but not snack intake (95%CI = [-2.5, 7.3]). Commission errors for Food-Go blocks significantly mediated the relationship between negative affect and total intake (95%CI = [7.7, 44.4]), but not snack intake (95%CI = [-3.4, 9.5]). Commission errors on Neutral-Go blocks did not significantly mediate any of these relationships. Negative affect may lead to poorer inhibitory control as well as a stronger approach tendency toward food, increasing the likelihood of engaging in disinhibited eating. Future research should determine if, in combination with approaches to reduce negative affect, improved inhibitory control could help prevent overeating in youths with depressive or anxiety symptoms.

The role of BMI on cognition following acute physical activity in preadolescent children

BACKGROUND

There is an increasing prevalence of physical inactivity during childhood, concurrent with a rise in obesity rates, which is associated with a variety of health problems. However, the extent to which increased body mass index (BMI) influences acute physical activity (PA) benefits on cognition in childhood remains unknown. The aim of this study was to examine whether BMI influences the effects of acute PA on inhibitory control task performance.

METHODS

In a sample of 116 children pooled from four prior studies (ages 8-11; 51 females), demographic measures of age, sex, IQ, socioeconomic status, and aerobic fitness were considered along with BMI. Children participated in a counterbalanced, randomized crossover study, whereby they completed two different interventions; 20 minutes of treadmill walking (60-70% heart rate max) and restful reading (non-exercise control). Following each intervention, children performed a modified flanker task that manipulates inhibitory control demands. Correlations were conducted to determine the influence of demographic variables, fitness, and BMI on inhibitory control following each intervention. Subsequent hierarchical regression analyses were performed with significant demographic factors in the first step, aerobic fitness in the second step when significant, and BMI in the final step.

RESULTS

Analyses indicated that children exhibited improved task performance (p's ≤ 0.001) and decreased interference (p = 0.04) following the walking intervention compared to the restful reading control condition, indicating greater benefits following acute PA across task condition, with selectively greater benefits for the task condition requiring greater inhibitory control. Regression analyses revealed that greater BMI was related to decreased performance following acute PA (p = 0.001); an association not observed following restful reading (p's ≥ 0.11). These results suggest that BMI negatively influences the effect of acute exercise on performance.

CONCLUSION

Confirming previous studies, these findings indicate beneficial effects of acute PA on a flanker task that modulates inhibitory control requirements, but the effects are significantly greater for task conditions requiring greater amounts of inhibitory control. Further, these beneficial effects of PA appear to be blunted in children with higher BMI. These findings suggest that the acute benefits of PA on cognition may not be fully realized in children with higher BMI.

Promoting self-control in overweight and obese children

Introduction

Background and objective: impulsiveness might affect the ability of an individual to plan meals, eat regularly, and resist impulses to enjoy foods that are high in fat and sugars in a particular way. The objective of the present study was to evaluate the effectiveness of a fading strategy regarding a reinforcer dimension to promote the development of self-control and decrease impulsive choice among 14 overweight and obese children. Material and methods: to meet this objective, an experimental procedure of choice behavior was used to evaluate the impulsivity and self-control choices influenced by four reinforcer dimensions on a computer: reinforcement rate, reinforcer quality, immediacy of the reinforcement, and response effort. Results: the results indicate that the children's decisions were influenced primarily by the immediacy of the reinforcement and the reinforcement rate; therefore, the children's behavior can be classified as impulsive. Based on these results, a fading procedure was implemented for self-control training in which the immediacy values of the reinforcement and other influential dimensions that devalued the reinforcer were progressively increased. Conclusions: after this fading strategy, a change in preference was observed among the children with regard to the proportion of alternative responses that produced high rates of reinforcement or were of higher quality compared with the allocation of choices associated with immediate reinforcement, which required less effort and were of lower quality. It is possible to design strategies regarding the development of self-control based on the contrasting qualities of these dimensions and the gradual training of tolerance of restrictions on access to the reinforcer.

Study of disturbed eating behaviors in children with attention deficit hyperactivity disorder

Background

There is emergent evidence that disturbed eating behaviors, including emotional eating and obesity, co-occur with attention deficit hyperactivity disorder (ADHD) in children. The hypothesis that disturbed eating behaviors in ADHD children are related to ADHD symptom severity, so we aimed to examine the link between ADHD symptoms and eating behaviors.

Results

Fifty ADHD children were included, and they completed the Emotional Eating scale adapted for children (ESS-C) to evaluate eating in response to emotions. Parents completed the Children’s Eating Behavior Questionnaire (CEBQ) to assess children’s eating behavior. Multivariable regression analysis was used to detect the most independent factor for higher body mass index (BMI) risk. Higher rates of overweight/obesity were detected among ADHD children than among the normal population. Also, higher Conners global index was associated with higher BMI z scores. Both inattentive and combined types were linked to higher BMI, while hyperactive type with lower BMI. Regarding eating behaviors, a positive association between food approach and BMI, and a negative association between food avoidant and BMI z-scores was found. Similarly, there was a noteworthy positive relation between emotional overeating and BMI. Sixty-eight of ADHD children were high emotional eaters, mainly inattentive and combined types. Others, mainly hyperactive type, were low emotional eaters. Only ESS-C total score was confirmed as an independent factor for higher BMI risk.

Conclusion

Our findings provide evidence that emotional overeating and food approach eating behaviors are common among ADHD children with higher BMI associated with them. Future studies for a better understanding of this overlap will enhance potential interventions.

Wanting to eat matters: Negative affect and emotional eating were associated with impaired memory suppression of food cues

OBJECTIVE

Previous studies have linked emotional eating with negative affect and decreased inhibitory control. However, studies on inhibitory control have generally focused on motor inhibition. How to stop higher-level cognitive processes, such as food-related memory retrieval or voluntary thoughts, received few direct investigation in field of food intake or food-related decision making. The current study, adopting Anderson and Green's Think/No-Think paradigm, aimed to investigate the relationship between emotional eating, negative affect and food-related memory suppression.

METHOD

Sixty-one young females participated in the current study, during which they finished food specific Think/No-Think task. Their positive and negative affect and eating style were measured using Positive Affect and Negative Affect Schedule and Dutch Eating Behavior Question. The reward value of the food item used in the Think/No-Think task was measured using liking and wanting ratings.

RESULTS

As hypothesized, negative affect and emotional eating were associated with decreased memory suppression of palatable food cues. Further analysis showed that higher emotional eating was associated with greater wanting only among the food items which were previously suppressed however remembered later.

DISCUSSION

The current study presents the first evidence that negative affect and emotional eating were associated with impaired memory suppression of palatable food cues, and it provided insight into the interaction between reward valuation for the food cues and hippocampal memory mechanisms during retrieval suppression.

"Food" and "non-food" self-regulation in childhood: a review and reciprocal analysis

BACKGROUND

In developmental science, there is an extensive literature on non-food related self-regulation in childhood, where several domains relating to emotions, actions and cognitions have been identified. There is now growing attention to food related self-regulation in childhood, especially difficulties with ASR, and the consequences for weight gain and adiposity. The aim of this narrative review was to conduct a reciprocal analysis of self-regulation in the food and non-food domains in childhood (referred to as appetite self-regulation (ASR) and general self-regulation (GSR) respectively). The focus was on commonalities and differences in key concepts and underpinning processes.

METHODS

Databases and major journals were searched using terms such as self-regulation, appetite self-regulation, or self-regulation of energy intake, together with associated constructs (e.g., Executive Function, Effortful Control, delay-of-gratification). This was followed by backward and forward snowballing.

RESULTS AND DISCUSSION

The scholarship on GSR in childhood has had a focus on the role of the cognitively-oriented Executive Function (EF), the temperamentally-based Effortful Control (EC) and the recursive interplay between bottom-up (reactive, emotion driven, approach or avoidance) and top-down (cognitive, conscious decision-making) processes. "Hot" and "cool/cold" EF and self-regulation situations have been distinguished. There were some parallels between GSR and ASR in these areas, but uncertainty about the contribution of EF and EC to ASR in young children. Possible differences between the contribution to ASR-related outcomes of delay-of-gratification in food and non-food tasks were apparent. Unique elements of ASR were identified; associated with psychological, biological and neurological responses to food and bottom-up processes. A diverse number of situations or elements connected to ASR exist: for example, energy balance homeostasis, caloric compensation, hunger regulation, satiation, satiety, energy density of food, eating in the absence of hunger, emotional eating, etc. CONCLUSIONS: Self-regulation in food and non-food domains are amenable to a reciprocal analysis. We argue that self-regulation of appetite should be added as a domain under the umbrella of self-regulation in childhood along with the other non-food related domains. This could lead to a broader understanding of self-regulation in childhood, and generate novel lines of enquiry.

Adiposity is related to neuroelectric indices of motor response preparation in preadolescent children

OBJECTIVE

Event-related brain potentials (ERPs) have been utilized to study the cognitive implications of health-related behaviors, although many questions remain regarding the neural correlates underlying the cognition and adiposity relationship in childhood. Specifically, it is unknown whether excess fat mass is associated with the neural correlates of motor preparation and activation. The present work examined interrelationships between adiposity and ERPs that index inhibition, stimulus evaluation, and motor planning.

METHOD

To further elucidate the neural components of inhibitory control that are sensitive to adiposity, N2, P3, and response- and stimulus-locked Lateralized Readiness Potential (LRPs) were measured while preadolescent children completed an attentional inhibition task. Whole body percent adiposity was measured via dual-energy x-ray absorptiometry (DXA).

RESULTS

Adiposity was related to the response-locked LRP amplitudes and marginally to P3 amplitude during the incongruent trials, such that participants with less adiposity elicited larger LRP and P3 components. Furthermore, P3 was strongly related to participant reaction times, suggesting that while LRP is strongly associated with adiposity, P3 has a more direct relationship to behavioral task performance.

CONCLUSIONS

The results suggest that while different cognitive functions may be affected by health-related characteristics, stimulus evaluation and motor activation may be particularly sensitive to excess adiposity in children. These findings extend previous work implicating adiposity in cognitive health in the pediatric population.

STUDY IMPORTANCE

Clinical Registry Number: NCT02630667 at https://clinicaltrials.gov.

Genetic overlap between executive functions and BMI in childhood

BACKGROUND

Executive functions (EFs) comprise a group of cognitive processes that selectively control and regulate attention. Inverse relations have been reported between EFs and BMI. However, the mechanisms underlying this association are not well understood.

OBJECTIVES

We aimed to decompose the inverse relation between EFs and BMI into genetic and environmental components.

METHODS

We employed a cross-sectional analysis of data from 869 twins aged 7-15 y from the Texas Twin Project, who completed a neuropsychological test battery measuring 4 EFs (switching, inhibitory control, working memory, and updating); academic achievement (reading and mathematics); and general cognitive abilities (general intelligence/intelligence quotient; crystallized and fluid intelligence; and processing speed). Participants also had their height and weight measured.

RESULTS

After controlling for age, sex, and race/ethnicity, BMI was inversely associated with a general EF factor representing the capacity to control and regulate goal-oriented behaviors (r = -0.125; P = 0.01; Q = 0.04). This inverse BMI-EF association was due to a significant overlap in genetic factors contributing to each phenotype (genetic correlation, rA, = -0.15; P < 0.001). Shared genetic influences accounted for 80% of the phenotypic association.

CONCLUSIONS

Children with higher general EF have lower BMIs, and this association is primarily attributable to shared genetic influences on both phenotypes. The results emphasize that higher weight associates not only with physical sequelae, but also with important cognitive attributes. This work adds to a growing body of research suggesting there are sets of genetic variants common across physical health and cognitive functioning.

Verbesserung der Impuls- und Emotionsregulation bei Binge-Eating-Störungen

Zusammenfassung. Impulsivität beeinflusst die Verarbeitung von störungsspezifischen Reizen und die Handlungskompetenz hinsichtlich der Nahrungsaufnahme. Neuere Studien adressieren daher unterschiedliche Facetten impulsiven Erlebens und Verhaltens, um eine Reduktion von Essanfällen und des Körpergewichts bei der Binge-Eating-Störung (BES) zu erzielen. ImpulsE ist ein Therapieprogramm zur Verbesserung der Impuls- und Emotionsregulationsfertigkeiten, welches mit einem computergestützten nahrungsbezogenen Inhibitionstraining kombiniert und mit einer Standardbehandlung (TAU) verglichen wurde. N = 31 Personen mit BES nahmen teil (n = 22 ImpulsE, n = 9 TAU). Die Ergebnisse zeigten Verbesserungen in der nahrungsbezogenen Verhaltensinhibition und der allgemeinen Essstörungspathologie in beiden Gruppen, während sich die Anzahl von Essanfällen nur bei ImpulsE signifikant senkte. Die Ergebnisse stellen erste Hinweise auf die Wirksamkeit eines solchen Trainings dar. Eine Adaption an Jugendliche erscheint sinnvoll.

Toddlers' impulsivity, inhibitory control, and maternal eating-related supervision in relation to toddler body mass index: Direct and interactive effects

Previous studies have noted that child temperament characteristics, such as aspects of self-regulation, as well as parental feeding practices contribute to children's body mass index (BMI), and have implications for identifying children who may be at risk of being overweight or obese. While studies have considered children's temperament or maternal feeding practices separately, few have considered these correlates of children's BMI jointly or in interaction in relation to children's BMI. The current study included 179 mother-child dyads participating in a longitudinal study. Information on children's impulsivity and inhibitory control was collected when children were 24 months of age. Children's tendency to emotionally overeat, maternal supervision of children's eating, and toddler and maternal BMI were assessed when children reached 30 months of age. Higher toddler impulsivity and emotional overeating, as well as maternal BMI were positively associated with toddler BMI. Inhibitory control and maternal supervision of toddler eating were not directly associated with toddler BMI. However, the main effect of toddler impulsivity was qualified by a significant interaction with maternal supervision of toddler eating. For children high in impulsivity, there was a significant negative association between maternal eating supervision and toddler BMI. For children low in impulsivity, there was a trend level (p = .059) positive relation between maternal eating supervision and toddler BMI. These findings suggest that increased maternal supervision of children's eating may be beneficial for helping children maintain a healthy BMI when they exhibit high impulsivity.

Neuropsychological and Neurophysiological Indicators of General and Food-Specific Impulsivity in Children with Overweight and Obesity: A Pilot Study

Impulsivity, particularly towards food, is a potential risk factor for increased energy intake and the development and maintenance of obesity in children. However, neuropsychological and neurophysiological indicators of general and food-specific impulsivity and their association with children's weight status are poorly understood. This pilot study examined electroencephalography (EEG) frequency band profiles during eyes-closed and eyes-open resting state in n = 12 children with overweight or obesity versus n = 22 normal-weight controls and their link to child- and parent-reported and experimentally assessed impulsivity of children (e.g., risk-taking behavior, approach-avoidance behavior towards food). The main results indicated that children with overweight/obesity versus normal weight showed significantly increased delta and decreased alpha band activity during eyes-closed resting state. Across the total sample, EEG slow-wave band activity was particularly linked to self- and parent-reported impulsivity and greater risk-taking behavior, but not to approach behavior towards food, after controlling for children's age and weight status. The identification of specific EEG patterns in children with excess weight may provide a new basis for developing neurophysiological diagnostic and treatment approaches for childhood obesity. Future studies with larger samples and longitudinal designs are needed to replicate the present findings and test their stability over time.

Cluster randomized control trial promoting child self-regulation around energy-dense food

Children with lower inhibitory control have greater weight gain over time and consume more snack food. Our goal was to test whether a pilot program based on enhancing self-regulation in preschool children could decrease consumption of energy-dense foods. Ninety-two preschool children were randomized to the intervention or control group. The intervention was a three-week, play-based program that focused on enhancing executive function skills and decreasing consumption of energy dense snack foods. Controls met for a similar length of time, but focused on dental hygiene, good sleep habits/routines, and physical activity. Primary outcome included calories consumed during the post-intervention "Eating in the Absence of Hunger" paradigm, controlling for baseline calories consumed. Inhibitory control was assessed using the "Day/Night" and "Less is More" tasks. There were no differences in post-intervention calories consumed between groups (p = 0.42). However, post-hoc analysis revealed a significant interaction between group and weight status (p = 0.04). In the intervention group, overweight/obese and healthy weight children consumed a similar number of calories (118.0 kcals vs. 124.1 kcals respectively, p = 0.64). However, in the control group, overweight/obese children consumed more than normal weight children (155.9 kcals vs. 103.6 kcals respectively; p = 0.01). With regards to inhibitory control, post-hoc analysis revealed a significant interaction between group and age (p = 0.03), with younger children in the intervention group scoring higher than younger children in the control group (0.93 vs 0.78 respectively, p = 0.007). No differences were observed between groups among older children (0.93 vs 0.96, p = 0.42). These types of programs for preschool children may help to temper consumption of excess calories among overweight/obese children. Further development and investigation of pediatric programs that prevent consumption of excess calories are warranted. TRIAL REGISTRATION: Clinicaltrials.gov: NCT02077387.

WELCOME: improving WEight controL and CO-Morbidities in children with obesity via Executive function training: study protocol for a randomized controlled trial

BACKGROUND

Obesity is a widespread problem that not only leads to medical and psychological diseases in adults, but also in children and adolescents at an early stage in life. Because of its global burden on both the individual and society, it is necessary to develop effective evidence-based treatments. Current "Multidisciplinary Obesity Treatments" (MOT) already provide significant weight loss, but still leave room for more long-lasting improvements. In this protocol paper, we outline the research goals of the WELCOME trial, based on a substantial proof of concept.

METHODS

In this Randomized Controlled Trial (RCT) - conducted in both an inpatient and two outpatient treatment settings - existing MOT will be supplemented with an Executive Function (EF) training and compare effects on various parameters in an experimental versus an active control group of obese youngsters (8-18 years old). WELCOME aims to (a) train youngsters' executive functions to facilitate effects on weight loss, psychological and medical comorbidities, (b) to enhance the long-term effects by continuing the training in the daily home context with booster sessions, and (c) to investigate its effects until a 6-month follow-up. In comparison to the active control group, better progress is expected in the experimental group on following variables: weight, psychological comorbidities (unhealthy eating behavior, internalizing symptoms, impaired self-esteem) and medical comorbidities (metabolic syndromes, endothelia dysfunction, tonsillar hypertrophy and sleep obstruction).

DISCUSSION

It is stated that this EF-training for enhancing self-control abilities is necessary for a long-lasting effect of childhood obesity treatment interventions.

TRIAL REGISTRATION

The Study Procotol was registered on 10/05/2017 (n° ISRCTN14722584 ).

Executive and Reward-Related Function in Pediatric Obesity: A Meta-Analysis

OBJECTIVE

This study examined the effect of pediatric obesity on executive function and reward-related decision-making, cognitive processes that are relevant to obesogenic behaviors, and evaluated their association with sample (e.g., age, gender, intelligence, and socioeconomic status, SES) and study/task (e.g., categorical/continuous variable, food stimuli) characteristics.

METHODS

A random-effects meta-analysis was conducted using Hedge's g effect sizes of published studies from 1960 to 2016, limited to children younger than the age of 21 years without medical comorbidities. Analysis included estimation of heterogeneity (τ²), publication bias (funnel-plot symmetry and fail-safe N), and sensitivity analyses for sample and study/task characteristics.

RESULTS

Across 68 studies with 70 samples, obesity was associated with worse functioning overall (-0.24; 95CI: -0.30 to -0.19; p < 0.001) and for each component process (attention, switching, inhibition, interference, working memory, reward, delay of gratification: -0.19 to -0.38; p's < 0.017), except trait impulsivity (-0.06; 95CI: -0.18 to 0.07). Deficits increased with age and female composition of the sample for inhibition (p = 0.002). No other characteristics moderated effect of obesity.

CONCLUSIONS

Small-to-moderate negative associations with obesity were observed for executive and reward-related performance, but not on reported impulsivity in studies with children younger than the age of 21 years. These results were not moderated by IQ, SES, and study/task characteristics. Age and gender moderated association with inhibition, with a larger obesity-related deficit in older and predominantly female samples. These results suggest cognitive and demographic intervention targets for prevention and mitigation of obesogenic behavior.

Self-regulation and obesity: the role of executive function and delay discounting in the prediction of weight loss

Obesity rates are rising worldwide. Executive function and delay discounting have been hypothesized to play important roles in the self-regulation of behavior, and may explain variance in weight loss treatment success. First, we compared individuals with obesity (n = 82) to healthy weight controls (n = 71) on behavioral and self-report measures of executive function (working memory, inhibition and shifting) and delay discounting. Secondly, the individuals with obesity took part in a multidisciplinary weight loss program and we examined whether executive function and delay discounting predicted weight change. Individuals with obesity displayed weaker general and food-specific inhibition, and weaker self-reported executive function. Better behavioral working memory and better self-reported inhibition skills in daily life were predictive of greater weight loss. As findings are correlational, future studies should investigate the causal relationship between executive function and weight loss, and test whether intervening on executive function will lead to better prevention and treatment of obesity.