Naturalistic, multimethod exploratory study of sleep duration and quality as predictors of dysregulated eating in youth with overweight and obesity

Relations between forms of dietary restraint, restriction, and loss-of-control eating among adolescents seeking weight control: An ecological momentary assessment study

OBJECTIVE

This study aimed to: 1) compare rates of dietary restraint and restriction between adolescents with and without loss-of-control (LOC) eating who were seeking weight control and 2) examine temporal relations between restraint/restriction and LOC eating.

METHOD

37 adolescents seeking weight control (mean age: 15.4 ± 1.5; 62 % White; 57 % female; mean BMI percentile = 97.3 ± 3.1) completed a one-week ecological momentary assessment protocol and reported on dietary restraint/restriction and eating behavior prior to beginning a weight control intervention. Chi-square tests examined differences in frequency of restraint/restriction between participants with and without LOC eating. Multilevel models examined associations between dietary restraint/restriction and LOC eating at the next survey and on the next day.

RESULTS

Of 37 participants, 15 (41 %) reported engaging in LOC eating. Participants with LOC eating more frequently endorsed several forms of restraint and restriction versus participants without LOC eating. Attempting to avoid enjoyable foods and attempting to limit eating at one survey predicted greater likelihood of LOC eating at the next survey.

CONCLUSIONS

Findings suggest that attempted restraint, but not actual restriction, was associated with LOC eating. Research should explore additional factors that may influence these relationships, which could inform weight control treatments that address restraint/restriction.

Effects of Sleep on Adolescents' Appetite, Dietary Intake, and Weight

Introduction

Several factors have been associated with excess weight gain in adolescents, including loss of sleep.

Objective

The purpose of this study is to examine the effects of sleep factors on appetite, dietary intake, and the body weights of adolescent youth.

Methods

A prospective correlational study design was used. Male and female adolescents (N = 76) ages 12-18 years completed a 5-night study. Sleep was assessed using Fitbits (88.5% accuracy) and the Pittsburgh Sleep Quality Index (PSQI) (test-retest reliability = .81); appetite was assessed by a Visual Analog Scale (α = 0.84); dietary intake was assessed by the Block Kids Food Screener (reliability up to .88); sleep hygiene was assessed using the Adolescent Sleep Hygiene Practice Scale (α = .67).

Results

Poor sleep quality was reported by 39.5% of participants, and 75% of participants had inadequate sleep time (7.33 h). Participants' age significantly correlated with PSQI scores (r = .28, p < .05) and BMI (r = .37, p < .01). Participants' PSQI scores significantly correlated with sleep hygiene (r = .45, p = .05) and appetite (r = .3 3, p < .01). Sleep latency significantly correlated with sleep hygiene (r = .32, p < .05). Several sleep hygiene factors correlated significantly with the participants' sleep quality, quantity and latency scores and dietary intakes.

Conclusion

These findings suggest that changes in sleep hygiene practices may improve adolescent sleep quality and quantity as well as appetite and dietary intake.

The moderating role of sleep duration on momentary relations between negative affect and loss-of-control eating in children and adolescents

OBJECTIVE

Loss-of-control (LOC) eating is associated with eating disorders and obesity, and thus it is imperative to understand its momentary risk factors in order to improve intervention efforts. Negative affect has been proposed as a momentary risk factor for LOC eating, but the evidence for its effects in children and adolescents is mixed. Short sleep duration (which is very common in youth), may be one variable that moderates the relation between negative affect and subsequent LOC eating. As such, we aimed to examine the moderating role of within-person sleep duration on the momentary relations between negative affect and subsequent LOC eating.

METHOD

We recruited children (N = 30) with overweight/obesity ages 8-14, who completed a 2-week ecological momentary assessment protocol assessing negative affect and LOC eating several times per day, while also wearing a sleep actigraphy device and completing sleep diaries.

RESULTS

Consistent with hypotheses, within-person sleep duration moderated the next-day momentary relation between within-person negative affect and LOC eating, such that shorter sleep duration strengthened the positive relation between negative affect and loss-of-control eating.

CONCLUSIONS

Results suggest that, in children and adolescents, fluctuations in sleep duration may influence susceptibility to losing control over eating after experiencing negative affect. Future research should further investigate other metrics of sleep disturbance as they relate to emotion regulation and LOC eating. Such research will set the stage for augmenting paediatric interventions to better target maintenance factors for LOC eating.

Exploring the bidirectional relationships between night eating, loss of control eating, and sleep quality in Chinese adolescents: A four-wave cross-lagged study

OBJECTIVE

This study examined the bidirectional relationships between sleep quality, loss of control (LOC) eating, and night eating in Chinese adolescents using longitudinal data over an 18-month study period.

METHOD

Four-waves of data measurement (Waves 1-4), at 6-month intervals, were conducted with 2566 adolescents aged 11-17 years at baseline. A set of questionnaires were used to assess night eating, LOC eating, and sleep quality at each wave of data collection. Cross-lagged models were applied to analyze the bidirectional relationships between night eating, LOC eating, and sleep quality.

RESULTS

Results indicated that higher night eating scores consistently predicted poorer sleep quality and higher LOC eating scores at Waves 1, 2, and 3. Furthermore, poorer sleep quality predicted higher night eating scores at Wave 1 and Wave 3, and higher LOC eating scores predicted higher night eating scores at Wave 1 and Wave 2.

DISCUSSION

These findings highlight that night eating, LOC eating, and sleep quality were interrelated across time in Chinese adolescents. Improving sleep quality and reducing LOC eating might be promising in the prevention of night eating in adolescents. Similarly, reducing night eating might be promising in improving sleep quality and reducing LOC eating in adolescents.

PUBLIC SIGNIFICANCE

This study explored the bidirectional relationship between night eating, LOC eating, and sleep quality in Chinese adolescents using cross-lagged models. Findings indicate bidirectional relationships between these variables and highlight the potential utility in incorporating sleep, LOC eating, and night eating interventions in eating pathology prevention designs for adolescents.

Correlation between Frequency of Eating Out of Home and Dietary Intake, Sleep, and Physical Activity: A Survey of Young CDC Employees in China

Objectives: We aimed to investigate the correlation between the frequency of eating out of home and dietary intake, sleep, and physical activity among young employees from the Center for Disease Control and Prevention in China. Methods: Using the cluster sampling method, 6099 employees aged 40 years or below from the Center for Disease Control and Prevention (CDC) from 32 provinces in China were interviewed using an online questionnaire survey. The frequency of eating out of home, dietary intake, sleep, and physical activity of all participants was described, and correlation analysis was used to study the relationships between eating out of home frequency and related indicators. Results: A total of 5353 valid questionnaires were collected with the recovery rate of 87.77%. The results show that 85.8% of participants eat out of home one to five times per week, 10.1% eat out of home more than six times, and 4.1% never eat out. Correlation analysis showed that eating out of home is negatively correlated with a daily vegetable and fruit intake. The lower the intake of vegetables and fruits, the more obvious this tendency. Eating out of home is positively correlated with a daily intake of meat as well as a weekly intake of aquatic products. The higher the intake of meat and aquatic products, the more obvious this tendency. There was a negative correlation between eating out of home and sleep duration and physical activity. The lower the duration of sleep and physical activity, the more obvious this tendency. Conclusions: Based on existing survey data, young employees from the CDC eat out of home regularly, which may affect dietary intake, sleep, and physical activity. Targeted health education programs are urgently needed to assist in the promotion of a healthy lifestyle and reduce the potential risk of chronic disease.

Associations of sleep with food cravings and loss-of-control eating in youth: An ecological momentary assessment study

BACKGROUND

Inconsistent sleep patterns may promote excess weight gain by increasing food cravings and loss-of-control (LOC)-eating; however, these relationships have not been elucidated in youth.

OBJECTIVE

We tested whether sleep duration and timing were associated with food cravings and LOC-eating.

METHOD

For 14 days, youths wore actigraphy monitors to assess sleep and reported severity of food cravings and LOC-eating using ecological momentary assessment. Generalized linear mixed models tested the associations between weekly and nightly shifts in facets of sleep (i.e., duration, onset, midpoint, and waketime) and next-day food cravings and LOC-eating. Models were re-run adjusting for relevant covariates (e.g., age, sex, adiposity).

RESULTS

Among 48 youths (12.88 ± 2.69 years, 68.8% female, 33.3% with overweight/obesity), neither weekly nor nightly facets of sleep were significantly associated with food cravings (ps = 0.08-0.93). Youths with shorter weekly sleep duration (est. ß = -0.31, p = 0.004), earlier weekly midpoints (est. ß = -0.47, p = 0.010) and later weekly waketimes (est. ß = 0.49, p = 0.010) reported greater LOC-eating severity; findings persisted in adjusted models.

CONCLUSIONS

In youth, weekly, but not nightly, shifts in multiple facets of sleep were associated with LOC-eating severity; associations were not significant for food cravings. Sleep should be assessed as a potentially modifiable target in paediatric LOC-eating and obesity prevention programs.

Digital Phenotyping in Child and Adolescent Psychiatry: A Perspective

Digital phenotyping (DP) provides opportunities to study child and adolescent psychiatry from a novel perspective. DP combines objective data obtained from digital sensors with participant-generated "active data," in order to understand better an individual's behavior and environmental interactions. Although this new method has led to advances in adult psychiatry, its use in child psychiatry has been more limited. This review aims to demonstrate potential benefits of DP methodology and passive data collection by reviewing studies specifically in child and adolescent psychiatry. Twenty-six studies were identified that collected passive data from four different categories: accelerometer/actigraph data, physiological data, GPS data, and step count. Study topics ranged from the associations between manic symptomology and cardiac parameters to the role of daily emotions, sleep, and social interactions in treatment for pediatric anxiety. Reviewed studies highlighted the diverse ways in which objective data can augment naturalistic self-report methods in child and adolescent psychiatry to allow for more objective, ecologically valid, and temporally resolved conclusions. Though limitations exist-including a lack of participant adherence and device failure and misuse-DP technology may represent a new and effective method for understanding pediatric cognition, behavior, disease etiology, and treatment efficacy.

The case for investigating a bidirectional association between insomnia symptoms and eating disorder pathology

Many people with eating disorders (EDs) report symptoms of insomnia (i.e., frequent difficulty falling asleep, staying asleep, and/or early morning wakening) and sleep problems have been linked to alterations in eating behaviors; however, mechanisms of these bidirectional associations remain poorly understood and under researched. This is a problem because higher insomnia symptom severity is a risk factor for the onset and perpetuation of anxiety, mood, trauma, and substance use disorders and, potentially, ED symptoms. Furthermore, insomnia symptoms may hinder recovery and increase relapse rates following successful psychotherapy. In this article, we describe potential mechanisms underlying bidirectional associations between insomnia and eating psychopathology that may contribute to the etiology and maintenance of both disorders. We suggest novel directions for future research to characterize the association between dysregulated sleep and ED symptoms and to evaluate impacts of insomnia symptoms on relapse and recovery for people with co-occurring pathology. Finally, we discuss options for testing the incorporation of existing evidence-based treatments for insomnia disorder (e.g., Cognitive-Behavioral Therapy for Insomnia) with ED care. Overall, insomnia symptoms present a promising intervention point for ED treatment that has not been systematically tested, yet would be highly feasible to address in routine clinical care.

Loss of Control Eating and Health Indicators Over 6 Years in Adolescents Undergoing Metabolic and Bariatric Surgery

OBJECTIVES

The aim of this study was to assess associations between loss of control (LOC) eating and health outcomes among adolescents undergoing metabolic and bariatric surgery.

METHODS

A total of 234 adolescents were studied before and up to 6 years after surgery in a prospective, observational cohort design. Adolescents provided self-reports of LOC eating, pain severity, sleep quality, polycystic ovary syndrome, gastroesophageal reflux disease, and medication usage and objective measures of fasting glucose, serum insulin, glycohemoglobin A1c , cholesterol, triglycerides, and blood pressure. χ2 tests, Wilcoxon rank sums, and generalized linear mixed models were used to assess concurrent and prospective associations between LOC eating and health indicators.

RESULTS

LOC eating presented in 32.5% of adolescents before surgery and was positively associated with sleep disturbances and psychiatric medication usage. After surgery, LOC eating presented in 7.9% to 14.6% of participants and was correlated with improved low- and high-density lipoprotein cholesterol levels and greater back pain. LOC eating was inversely associated with low-density lipoprotein cholesterol at the next consecutive time point.

CONCLUSIONS

LOC eating was unexpectedly associated with improved low- and high-density lipoprotein cholesterol in adolescents undergoing metabolic and bariatric surgery. Deleterious effects of LOC eating on obesity-related health conditions, aside from back pain, were not detected. Metabolic and other weight-independent health benefits of surgery may persist postoperatively despite LOC eating and associated weight regain.