Restrained and external-emotional eating patterns in young overweight children-results of the Ulm Birth Cohort Study

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

External food cue responsiveness and emotional eating in adolescents: A multimethod study

Eating in response to external food cues (i.e., external eating) and internal emotional experiences (i.e., emotional eating) are associated with obesity. While external and emotional eating co-occur, little is known about how external food cue responsiveness may interact with internal emotional cues to influence eating episodes in adolescents. The current study examined how trait-level external food cue responsiveness modulates momentary associations between affective states and eating in adolescents. Participants were drawn from a prior study of siblings (N = 78; ages 13-17) who completed an ecological momentary assessment protocol to assess eating episodes and affective states. External food cue responsiveness was determined by comparing energy consumption following presentation of an appetizing food (pizza) on one day and a control activity (reading) on another day. Generalized linear mixed models examined positive and negative affective states, cue responsiveness, and their interactions as predictors of the likelihood of eating. The relationship between affective states and likelihood of eating was stronger among adolescents with higher versus lower external food cue responsiveness. Among adolescents with higher cue responsiveness, endorsing negative affect was associated with a lower likelihood of eating, whereas endorsing positive affect was associated with a higher likelihood of eating (within-person effects). Findings suggest that high sensitivity to external food cues and greater proclivity for emotional eating may be likely to coincide such that any cue, internal or external, is likely to disrupt sensitivity to internal hunger and satiety signals. Future studies are needed to elucidate how sensitivities to internal and external cues may interact to influence obesity risk.

Polish Adaptation of the Dutch Eating Behaviour Questionnaire (DEBQ): The Role of Eating Style in Explaining Food Intake-A Cross-Sectional Study

Knowledge of associations between emotional, external, and restrained eating with food choices is still limited due to the inconsistent results of the previous research. The aim of the study was to adopt the Dutch Eating Behavior Questionnaire (DEBQ) and then to examine the relationship between emotional, external, and restrained eating styles and dietary patterns distinguished on the basis of intake of fruit and vegetables (fresh and processed separately), fruit and/or vegetable unsweetened juices, sweets and salty snacks, and the adequacy of fruit and vegetable intake. The cross-sectional study was conducted in 2020, in a sample of 1000 Polish adults. The questionnaire consisted of the Dutch Eating Behavior Questionnaire, questions on selected food groups intake, and metrics. DEBQ structure was tested using both exploratory and confirmatory factor analysis (EFA, CFA) and structural equation modelling (SEM), while multi-group analysis was used to test measurement invariance. Logistic regression was applied to investigate the association between eating styles and dietary patterns, identified with the use of K-means cluster analysis. EFA, CFA and SEM revealed a three-factor, 29-item tool with satisfactory psychometric parameters. Restrained eating (ResEat) and external eating (ExtEat) were found to decrease chances of low intake of both favorable (fruit, vegetables, and unsweetened juices) and unfavorable (sweets and salty snacks) foods and increased the chances of their moderate intake. ResEat increased the probability of the high intake of favorable and moderate or high intake of unfavorable foods. ResEat and ExtEat were predisposed to adequate intake of fruit and vegetables while emotional eating had the opposite effect. Gender, education, and BMI were also found to determine food intake. Our results provide evidence that both eating styles and sociodemographic characteristics should be taken into account while explaining food intake as they may favor healthy and unhealthy eating in different ways.

The Impact of Chronic Stress and Eating Concern on Acylated Ghrelin Following Acute Psychological Stress in Healthy Men

Stress, mood, and eating behavior play an important role in appetite and weight regulation. In particular, ghrelin, as the only known orexigenic hormone, has been suggested to be an influential mediator in food intake responses to stress. The exact role of ghrelin in the hypothalamic–pituitary–adrenal axis is still unknown and further challenged by the psychological aspects of stress and eating behavior. This study aimed to assess the effect of chronic stress and subjective concern about eating on acute stress-induced changes in acylated ghrelin. In a 2-day study, sixteen healthy male participants were confronted with a stressful situation as well as a control situation. Additional measurements of heart rate, subjective hunger ratings, and subjective mood ratings were made to assess successful acute stress induction. The linear mixed model approach revealed a significant effect of acute stress on acylated ghrelin for a study-day*chronic-stress interaction (p < 0.001). Concern about eating did not affect acylated ghrelin levels after acute stress exposure. The significant interaction showed that lower chronic stress exposure was associated with a stronger acylated ghrelin response after acute stress exposure versus control condition. At the same time, participants with higher chronic stress exposure showed a blunted acylated ghrelin response after acute stress exposure compared to the control situation. Our findings indicate that chronic stress exposure can influence acylated ghrelin response after acute stress encounters, possibly affecting subsequent food intake and explaining the often diverse outcome in measurements of acute stress responses.

Psychometric properties of the Turkish version of the Child Three-Factor Eating Questionnaire for primary and secondary school students

OBJECTIVE

This study aims to evaluate the validity and reliability of the Turkish version of the Child Three-Factor Eating Questionnaire for primary and secondary school students.

DESIGN

A methodological, descriptive and correlational study design was adopted.

SETTING

The study was conducted in the western and central regions of Turkey.

PARTICIPANTS

This methodological-descriptive-correlational study was conducted with 351 children between July 2018 and August 2018. The mean age of children is 10·74 ± 1·79 (8-14).

RESULTS

The scale consists of seventeen items and three sub-dimensions (restraint, uncontrolled eating and emotional eating), which explained 52·88 % of the total variance. All the factor loadings were >0·40 in both exploratory factor analysis and confirmatory factor analysis (CFA). In CFA, all of the fit indices were >0·85, and root mean square error of approximation was <0·08. For the whole of the scale, Cronbach's α was 0·81 and it was found that Cronbach's α values of all sub-dimensions were >0·70.

CONCLUSIONS

The results of the study show that the Child Three-Factor Eating Questionnaire for primary and secondary school students is a valid and reliable measurement tool for Turkish sampling.

Laparoscopic adjustable gastric banding in adolescents with severe obesity: Psychological aspects, decision makers of surgery, and 2-year outcomes. A case series

BACKGROUND

The results of medical treatment of severe obesity in the adolescent population (balanced diet and physical activity) are often unsatisfactory, and bariatric surgery is questioned. The psychological determinants for requesting bariatric surgery in these adolescents are unclear. The objective of this study was to report the psychiatric and psychological aspects as well as the determinants of the medical decision for surgery in a cohort of obese adolescents requesting bariatric surgery by laparoscopic adjustable gastric banding.

METHODS

Thirty-five adolescents (12.3-17.7 years of age), were recruited from January 2007 to December 2012. Semistructured interviews were conducted.

RESULTS

Fifty-four percent of the adolescents had a psychiatric history and 85% had psychiatric comorbidities. In adolescents undergoing surgery, excess weight loss was 46% after 1 year and 51% after 2years. For patients not receiving surgery, excess weight loss was 0.43% after 1 year (P=0.001). Compliance with medical treatment was the only significant element contributing to the decision to perform surgery. Results in terms of satisfaction and perception 1 and 2years after surgery were encouraging.

CONCLUSION

Bariatric surgery is feasible in young patients and produces good results in terms of excess weight loss. We argue that compliance with medical treatment is probably one of the most important elements for making the decision to perform bariatric surgery and in excess weight loss after surgery. We probably need to focus on the compliance of young patients and evaluate how this can be improved.

Prediction of BMI at age 11 in a longitudinal sample of the Ulm Birth Cohort Study

Obesity is one of the greatest public health challenges in the world with childhood prevalence rates between 20-26% and numerous associated health risks. The aim of the current study was to analyze the 11-year follow-up data of the Ulm Birth Cohort Study (UBCS), to identify whether abnormal eating behavior patterns, especially restrained eating, predict body mass index (BMI) at 11 years of age and to explore other factors known to be longitudinally associated with it. Of the original UBCS, n = 422 children (~ 40% of the original sample) and their parents participated in the 11-year follow-up. BMI at age 8 and 11 as well as information on restrained eating, psychological problems, depressive symptoms, lifestyle, and IQ at age 8 were assessed. Partial Least Squares Structural Equation Modeling (PLS-SEM) was used to predict children's BMI scores at age 11. PLS-SEM explained 68% of the variance of BMI at age 11, with BMI at age 8 being the most important predictor. Restrained eating, via BMI at age 8 as well as parental BMI, had further weak associations with BMI at age 11; no other predictor was statistically significant. Since established overweight at age 8 already predicts BMI scores at age 11 longitudinally, obesity interventions should be implemented in early childhood.

Eating behaviours in preadolescence are associated with body dissatisfaction and mental disorders - Results of the CCC2000 study

Preadolescence is a key period in the early stages of eating disorder development. The aim of the present study was, firstly, to investigate restrained, emotional and external eating in a general population-based sample of 11-12 year olds. Secondly, we sought to explore how these eating behaviours are associated with possible predictors of eating disorders, such as body dissatisfaction, weight status and mental disorders. A subsample of 1567 children (47.7% boys; 52.3% girls) from the Copenhagen Child Cohort (CCC2000) completed web-based questionnaires on eating behaviours and body dissatisfaction using The Eating Pattern Inventory for Children (EPI-C) and The Children's Figure Rating Scale. Mental disorders were assessed using the online version of the Development and Well-Being Assessment (DAWBA) based on parental replies with final DSM-IV diagnoses determined by experienced child- and adolescent psychiatrists. Height and weight were measured at a face-to-face assessment. The results showed that restrained eating was significantly associated with overweight, body dissatisfaction and emotional disorders in both genders. Emotional eating showed similar associations with overweight and body dissatisfaction in both genders, but was only associated with mental disorders in girls. External eating was significantly associated with body dissatisfaction and neurodevelopmental disorders in both genders, but was only associated with overweight in girls. Our findings show that problematic eating behaviours can be identified in preadolescence, and co-exist with weight problems and mental disorders. Thus restrained, emotional and external eating was, in different ways, associated with overweight, body dissatisfaction and mental disorders. Our findings point to significant eating behaviours in preadolescence, which could constitute potential predictors of later eating disorder risk.

The association of eating styles with weight change after an intensive combined lifestyle intervention for children and adolescents with severe obesity

The main purpose of this prospective intervention study was to determine whether eating styles after an intensive, partly inpatient, one year combined lifestyle intervention are associated with weight change in the following year in severely obese children and adolescents. A total of 120 participants (8-19 years) with an average SDS-BMI of 3.41 (SD = 0.38) was included. Measurements were conducted at baseline (T0), at the end of treatment (T12) and at the end of follow up two years after baseline (T24). The primary outcome measurement was the ΔSDS-BMI between T12 and T24. As primary determinant of weight change after treatment, the participants eating styles were evaluated with the Dutch Eating Behavior Questionnaire - child report that measures external, emotional and restraint eating. The association between outcome and determinant was assessed in linear regression analyses. Complete data were available for 76 of the 120 participants. This study shows that for girls a higher score on restraint eating at T12 and a higher score on external eating at T12 were associated with more weight (re)gain in the year after treatment. No statistically significant association with emotional eating at T12 was found. In addition for girls a higher score on external eating at T0 was associated with more weight (re)gain in the year after treatment. Furthermore, the observed changes in eating styles suggest that on average it is possible to influence these with treatment, although the detected changes were different for girls and boys and for the different eating styles. More generally, this study indicates that for girls the levels of restraint and external eating after treatment were associated with the weight change during the following year.

TRIAL REGISTRATION

Netherlands Trial Register (NTR1678, registered 20-Feb-2009).