Childhood cumulative risk and obesity: the mediating role of self-regulatory ability

Associations of Longitudinal BMI-Percentile Classification Patterns in Early Childhood with Neighborhood-Level Social Determinants of Health

Background: Understanding social determinants of health (SDOH) that may be risk factors for childhood obesity is important to developing targeted interventions to prevent obesity. Prior studies have examined these risk factors, mostly examining obesity as a static outcome variable. Methods: We extracted electronic health record data from 2012 to 2019 for a children's health system that includes two hospitals and wide network of outpatient clinics spanning five East Coast states in the United States. Using data-driven and algorithmic clustering, we have identified distinct BMI-percentile classification groups in children from 0 to 7 years of age. We used two separate algorithmic clustering methods to confirm the robustness of the identified clusters. We used multinomial logistic regression to examine the associations between clusters and 27 neighborhood SDOHs and compared positive and negative SDOH characteristics separately. Results: From the cohort of 36,910 children, five BMI-percentile classification groups emerged: always having obesity (n = 429; 1.16%), overweight most of the time (n = 15,006; 40.65%), increasing BMI percentile (n = 9,060; 24.54%), decreasing BMI percentile (n = 5,058; 13.70%), and always normal weight (n = 7,357; 19.89%). Compared to children in the decreasing BMI percentile and always normal weight groups, children in the other three groups were more likely to live in neighborhoods with higher poverty, unemployment, crowded households, single-parent households, and lower preschool enrollment. Conclusions: Neighborhood-level SDOH factors have significant associations with children's BMI-percentile classification and changes in classification. This highlights the need to develop tailored obesity interventions for different groups to address the barriers faced by communities that can impact the weight and health of children living within them.

Associations of longitudinal BMI percentile classification patterns in early childhood with neighborhood-level social determinants of health

Background

Understanding social determinants of health (SDOH) that may be risk factors for childhood obesity is important to developing targeted interventions to prevent obesity. Prior studies have examined these risk factors, mostly examining obesity as a static outcome variable.

Methods

We extracted EHR data from 2012-2019 for a children's health system that includes 2 hospitals and wide network of outpatient clinics spanning 5 East Coast states in the US. Using data-driven and algorithmic clustering, we have identified distinct BMI-percentile classification groups in children from 0 to 7 years of age. We used two separate algorithmic clustering methods to confirm the robustness of the identified clusters. We used multinomial logistic regression to examine the associations between clusters and 27 neighborhood SDOHs and compared positive and negative SDOH characteristics separately.

Results

From the cohort of 36,910 children, five BMI-percentile classification groups emerged: always having obesity (n=429; 1.16%), overweight most of the time (n=15,006; 40.65%), increasing BMI-percentile (n=9,060; 24.54%), decreasing BMI-percentile (n=5,058; 13.70%), and always normal weight (n=7,357; 19.89%). Compared to children in the decreasing BMI-percentile and always normal weight groups, children in the other three groups were more likely to live in neighborhoods with higher poverty, unemployment, crowded households, single-parent households, and lower preschool enrollment.

Conclusions

Neighborhood-level SDOH factors have significant associations with children's BMI-percentile classification and changes in classification. This highlights the need to develop tailored obesity interventions for different groups to address the barriers faced by communities that can impact the weight and health of children living within them.

Impact Statement

This study demonstrates the association between longitudinal BMI-percentile patterns and SDOH in early childhood. Five distinct clusters with different BMI-percentile trajectories are found and a strong association between these clusters and SDOH is observed. Our findings highlight the importance of targeted prevention and treatment interventions based on children's SDOH.

Adolescent endocrine disrupting chemical exposure and academic achievement

BACKGROUND

Epidemiologic studies support associations of exposure to endocrine disrupting chemicals (EDCs), such as some phthalates, phenols, and parabens with a wide range of cognitive and behavioral traits. While many of these traits are associated with academic achievement, the relationship of EDC exposure specifically with academic achievement in adolescence has not yet been studied.

OBJECTIVE

We assessed the association of urinary biomarker concentrations of EDCs with academic achievement in adolescents as well as the potential for psychosocial factors to modify associations.

METHODS

We quantified urinary concentrations of select EDCs in 205 adolescent participants from the New Bedford Cohort (NBC), a prospective birth cohort of children born to mothers residing near the New Bedford Harbor Superfund site in Massachusetts, and estimated associations between EDCs and adolescent academic achievement assessed with the Wide Range Achievement Test (WRAT). Measures of socioeconomic status and the home environment were used to estimate psychosocial stress.

RESULTS

Urinary concentrations of antiandrogenic phthalates were inversely associated with Math Computation scores. For example, each doubling of the concentration of antiandrogenic phthalate metabolites in urine was associated with a 1.94 point decrease (95% CI: 3.84, -0.05) in Math Computation scores, indicating poorer performance. For the most part, associations were stronger in adolescents with more, as compared to less, social disadvantage, but most of these differences did not achieve statistical significance.

CONCLUSION

Our findings support the potential for adolescents' exposure to antiandrogenic phthalates to correlate with poorer academic achievement in math, particularly among participants with greater psychosocial stress.

Relation of BOLD response to food-specific and generic motor response inhibition tasks to body fat gain in adults with overweight and obesity

BACKGROUND

Low inhibitory control has been theorized to contribute to the development and maintenance of obesity. Knowledge on the neurobiological indicators of inhibitory control deficits predicting future weight gain is limited. The current study examined if individual differences in blood-oxygenation-level-dependent (BOLD) activity associated with food-specific and general motor response inhibition predict future body fat change in adults with overweight or obesity.

METHODS

BOLD activity and behavioral responses of adults with overweight or obesity (N = 160) were recorded while performing a food-specific stop signal task (n = 92) or a generic stop signal task (n = 68). Percent body fat was measured at baseline, posttest, 3-month, and 6-month follow-up.

RESULTS

Elevated BOLD activity in somatosensory (postcentral gyrus), and attention (precuneus) regions during successful inhibition in the food-specific stop signal task and elevated BOLD activity in a motor region (anterior cerebellar lobe) in the generic stop signal task predicted greater body fat gain over 6-month follow-up. Elevated BOLD activity in inhibitory control regions (inferior-, middle-, superior frontal gyri) and error monitoring regions (anterior cingulate cortex, insula) during erroneous responses in the generic stop signal task predicted body fat loss.

CONCLUSIONS

Results suggest that improving motor response inhibition and error monitoring may facilitate weight loss in adults with overweight and obesity.

Contextualizing the Neural Vulnerabilities Model of Obesity

In recent years, investigators have focused on neural vulnerability factors that increase the risk of unhealthy weight gain, which has provided a useful organizing structure for obesity neuroscience research. However, this framework, and much of the research it has informed, has given limited attention to contextual factors that may interact with key vulnerabilities to impact eating behaviors and weight gain. To fill this gap, we propose a Contextualized Neural Vulnerabilities Model of Obesity, extending the existing theory to more intentionally incorporate contextual factors that are hypothesized to interact with neural vulnerabilities in shaping eating behaviors and weight trajectories. We begin by providing an overview of the Neural Vulnerabilities Model of Obesity, and briefly review supporting evidence. Next, we suggest opportunities to add contextual considerations to the model, including incorporating environmental and developmental context, emphasizing how contextual factors may interact with neural vulnerabilities to impact eating and weight. We then synthesize earlier models and new extensions to describe a Contextualized Neural Vulnerabilities Model of Obesity with three interacting components-food reward sensitivity, top-down regulation, and environmental factors-all within a developmental framework that highlights adolescence as a key period. Finally, we propose critical research questions arising from the framework, as well as opportunities to inform novel interventions.

Common resilience factors among healthy individuals exposed to chronic adversity: a systematic review

OBJECTIVE

To identify common resilience factors against non-communicable diseases (dental caries, diabetes type II, obesity and cardiovascular disease) among healthy individuals exposed to chronic adversity.

MATERIALS AND METHODS

The databases MEDLINE (via PubMed), Scopus and CINAHL were searched. Observational studies in English assessing resilience factors among populations living in chronic adversity were included. Intervention studies, systematic reviews, non-original articles and qualitative studies were excluded. There were no restrictions regarding publication year or age. No meta-analysis could be done. Quality assessments were made with the Newcastle-Ottawa scale (NOS).

RESULTS

A final total of 41 studies were included in this systematic review. The investigated health resilience factors were divided into the following domains: environmental (community and family) and individual (behavioural and psychosocial). A narrative synthesis of the results was made according to the domains.

CONCLUSIONS

Individual psychosocial, family and environmental factors play a role as health resilience factors in populations living in chronic adversity. However, the inconclusive results suggest that these factors do not act in isolation but interplay in a complex manner and that their interaction may vary during the life course, in different contexts, and over time.

Social engagement and allostatic load mediate between adverse childhood experiences and multimorbidity in mid to late adulthood: the Canadian Longitudinal Study on Aging

BACKGROUND

Adverse childhood experiences (ACEs) are associated with multimorbidity in adulthood. This link may be mediated by psychosocial and biological factors, but evidence is lacking. The current study evaluates this mediation model.

METHOD

We analyzed data from the Canadian Longitudinal Study of Aging (N = 27 170 community participants). Participants were 45-85 years at recruitment, when allostatic load and social engagement data were collected, and 3 years older at follow-up, when ACEs and multimorbidity data were collected. Structural equation modeling was used to test for mediation in the overall sample, and in sex- and age-stratified subsamples, all analyses adjusted for concurrent lifestyle confounds.

RESULTS

In the overall sample, ACEs were associated with multimorbidity, directly, β = 0.12 (95% confidence interval 0.11-0.13) and indirectly. Regarding indirect associations, ACEs were related to social engagement, β = -0.14 (-0.16 to -0.12) and social engagement was related to multimorbidity, β = -0.10 (-0.12 to -0.08). ACEs were related to allostatic load, β = 0.04 (0.03-0.05) and allostatic load was related to multimorbidity, β = 0.16 (0.15-0.17). The model was significant for males and females and across age cohorts, with qualifications in the oldest stratum (age 75-85).

CONCLUSIONS

ACEs are related to multimorbidity, directly and via social engagement and allostatic load. This is the first study to show mediated pathways between early adversity and multimorbidity in adulthood. It provides a platform for understanding multimorbidity as a lifespan dynamic informing the co-occurrence of the varied disease processes represented in multimorbidity.

Enhancing Efficacy of a Brief Obesity and Eating Disorder Prevention Program: Long-Term Results from an Experimental Therapeutics Trial

Objective: Test whether the efficacy of Project Health, an obesity/eating disorder prevention program, is improved by delivering it in single-sex groups and adding food response inhibition and attention training. Method: High-risk young adults (N = 261; M age = 19.3, 74% female) were randomized to (1) single-sex or (2) mixed-sex groups that completed food response inhibition and attention training or (3) single-sex or (4) mixed-sex groups that completed sham training with nonfood images in a 2 × 2 factorial design. Results: There was a significant sex-composition by training-type by time interaction; participants who completed single- or mixed-sex Project Health groups plus food response and attention training showed significant reductions in body fat over a 2-year follow-up, though this effect was more rapid and persistent in single-sex groups, whereas those who completed single- or mixed-sex Project Health groups plus sham training did not show body fat change. However, there were no differences in overweight/obesity onset over the follow-up. The manipulated factors did not affect eating disorder symptoms or eating disorder onset, but there was a significant reduction in symptoms across the conditions (within-condition d = -0.58), converging with prior evidence that Project Health produced larger reductions in symptoms (within-condition d = -0.48) than educational control participants. Average eating disorder onset over the 2-year follow-up (6.4%) was similar to that observed in Project Health in a past trial (4.5%). Conclusions: Given that Project Health significantly reduced future onset of overweight/obesity in a prior trial and the present trial found that body fat loss effects were significantly greater when implemented in single-sex groups and paired with food response and attention training, there might be value in broadly implementing this combined intervention.

Associations between cumulative risk, childhood sleep duration, and body mass index across childhood

BACKGROUND

Although associations between cumulative risk, sleep, and overweight/obesity have been demonstrated, few studies have examined relationships between these constructs longitudinally across childhood. This study investigated how cumulative risk and sleep duration are related to current and later child overweight/obesity in families across the United States sampled for high sociodemographic risk.

METHODS

We conducted secondary analyses on 3690 families with recorded child height and weight within the Fragile Families and Child Well-Being Study. A cumulative risk composite (using nine variables indicating household/environmental, family, and sociodemographic risk) was calculated for each participant from ages 3-9 years. Path analyses were used to investigate associations between cumulative risk, parent-reported child sleep duration, and z-scored child body mass index (BMI) percentile at ages 3 through 9.

RESULTS

Higher cumulative risk experienced at age 5 was associated with shorter sleep duration at year 9, b = - 0.35, p = .01, 95% CI [- 0.57, - 0.11]. At 5 years, longer sleep duration was associated with lower BMI, b = - 0.03, p = .03, 95% CI [- 0.06, - 0.01]. Higher cumulative risk at 9 years, b = - 0.34, p = .02, 95% CI [- 0.57, - 0.10], was concurrently associated with shorter sleep duration. Findings additionally differed by child sex, such that only male children showed an association between sleep duration and BMI.

CONCLUSIONS

Results partially supported hypothesized associations between child sleep duration, cumulative risk, and BMI emerging across childhood within a large, primarily low socioeconomic status sample. Findings suggest that reducing cumulative risk for families experiencing low income may support longer child sleep duration. Additionally, child sleep duration and BMI are concurrently related in early childhood for male children.

The Effect of Financial Scarcity on Reinforcer Pathology: A Dyadic Developmental Examination

This study investigated the effects of experimentally manipulated scarcity on the reinforcing value of food (RRVfood) and delay discounting (DD), which, together, create reinforcer pathology (RP) among parents and offspring. A stratified sample of 106 families (53 parent/child aged 7−10 dyads & 53 parent/adolescent aged 15−17 dyads) from high- and low-income households visited our laboratory for three appointments. Each appointment included an experimental manipulation of financial gains and losses and DD and RRV tasks. The results showed that, regardless of food insecurity or condition, children had greater RP (β = 1.63, p < 0.001) than adolescents and parents. DD was largely unaffected by acute scarcity in any group, but families with food insecurity had greater DD (β = −0.09, p = 0.002) than food-secure families. Food-insecure parents with children responded to financial losses with an increase in their RRVfood (β = −0.03, p = 0.011), while food-secure parents and food-insecure parents of adolescents did not significantly change their responding based on conditions. This study replicates findings that financial losses increase the RRVfood among adults with food insecurity and extends this literature by suggesting that this is strongest for parents of children.

The effect of food insecurity and stress on delay discounting across families: a COVID-19 natural experiment

BACKGROUND

Delay Discounting is the extent to which one prioritizes smaller immediate rewards over larger, delayed rewards. The ability to prospect into the future is associated with better health decision-making, which suggests that delay discounting is an important intervention target for the prevention and treatment of chronic disease. Delay discounting decreases throughout development and stressful experiences, particularly those that accompany poverty, may influence this developmental trajectory. The current study leveraged the COVID-19 pandemic and resulting economic downturn as a natural experiment to understand how changes in food insecurity and psychological stress may associated with changes in delay discounting among parents, adolescents, and children.

METHODS

A stratified cohort of families (N = 76 dyads), established prior to the initial pandemic lockdowns, were asked to complete a follow-up survey in the summer of 2020, during reopening. Thirty-seven (49%) families had an older adolescent (aged 15 - 18 years) in the study and 39 (51%) had an elementary aged child (aged 7 - 12 years) in the follow-up study. Both data collection points included measurements of economic position, psychological stress, food security status, and delay discounting.

RESULTS

The results showed that pandemic food insecurity was associated with greater stress among parents (β = 2.22, t(65.48) = 2.81, p = 0.007). Parents, Adolescents, and children significantly differed in their response to psychological stress during the pandemic (β = -0.03, t(102.45) = -2.58, p = 0.011), which was driven by a trend for children to show greater delay discounting associated with an increase in psychological stress during the pandemic (β = -0.01, p = 0.071), while adolescents and parents showed no change.

CONCLUSIONS

These findings add to the evidence that food insecurity is uniquely stressful among parents with no effects on delay discounting. Despite this, we found no evidence that food insecurity was stressful for child or adolescents. A trend in our data suggested that childhood, as compared with adolescence, may be an important developmental period for the association between stress and delay discounting. Future research should continue the longitudinal investigation of childhood stress and the developmental trajectory of delay discounting to ascertain how these effects may persist in adulthood.

Efficacy of a food response and attention training treatment for obesity: A randomized placebo controlled trial

Elevated brain reward and attention region response, and weaker inhibitory region response to high-calorie foods has predicted future weight gain, suggesting that an intervention that reduces reward and attention region response and increases inhibitory region response to such foods might reduce overeating. We conducted a randomized controlled trial to test whether a multi-faceted food response and attention training protocol with personalized high- and low-calorie food images would reduce body fat and valuation and reward region response to high-calorie foods compared to a placebo control training protocol with non-food images in an effort to replicate findings from two past trials. Participants were community-recruited adults with overweight/obesity (N = 179; M age = 27.7 ± 7.0) who completed assessments at pretest, posttest, 3-month, 6-month, and 12-month follow-ups. Participants randomized to the food response inhibition and attention training showed significantly greater increases in palatability ratings of low-calorie foods than controls (d = 0.27) at posttest, but did not show body fat loss, reductions in palatability ratings and monetary valuation, or reward region response, to high-calorie foods. The lack of expected effects appears to be related to weaker learning compared to the learning in past trials, potentially because we used more heterogenous high-calorie and low-calorie food images in the present training.

Efficacy of a combined food-response inhibition and attention training for weight loss

This Current Opinion in Behavioral Sciences article reviews trials that evaluated an obesity treatment that combines response-inhibition training with high-calorie foods and training designed to reduce attention for high-calorie foods. Two randomized controlled trials suggest that food-response inhibition and attention training produced significant body-fat loss, along with a reduction in valuation of, and reward-region response to, high-calorie foods. However, these effects did not emerge in a third trial, potentially because this trial used more heterogeneous food images, which reduced inhibition learning and attentional learning. Collectively, results suggest that food-response inhibition and attention training can devalue high-calorie foods and result in weight loss, but only if a homogeneous set of high-calorie and low-calorie food images is used.

Longitudinal associations between early child weight gain, parent feeding, child self-regulation, and later child body mass index

BACKGROUND

Few longitudinal studies have examined associations of child weight trajectories, maternal demandingness and responsiveness during feeding, and child self-regulation.

OBJECTIVE

We examined if child weight-for-length trajectories from 6 weeks to 2 years of age were associated with maternal demandingness and responsiveness at child age 3 years old, and if maternal feeding dimensions predicted child BMI trajectories from 4.5 to 7.5 years among Mexican American children from low-income families. Child self-regulation was evaluated as a potential mechanism linking maternal feeding with child BMI.

METHOD

Child (N = 322) weight and length/height were assessed at 10 timepoints from 6 weeks through 7.5 years. Mothers completed the Caregiver Feeding Style Questionnaire when the child was 3 years of age.

RESULTS

A steeper slope of weight-for-length z scores from 6 weeks to 2 years (indicating more rapid weight gain) was associated with less maternal demands during feeding at 3 years. More maternal demandingness at child age 3 years predicted lower child BMI at 4.5 years, but not trajectories from 4.5 to 7 years. Child self-regulation was not associated with child BMI from 4.5 to 7.5 years.

CONCLUSION

The findings highlight how the relationship between mothers and children during feeding can be bidirectional and potentially influenced by the developmental stage.

The effect of acute and chronic scarcity on acute stress: A dyadic developmental examination

BACKGROUND

Food insecurity, obesity, and psychological stress are interrelated constructs which are thought to be connected through increased energy intake, but the underlying mechanisms for these relationships remain unclear. The current study used experimental methods to investigate how financial losses may influence acute stress in the context of food insecurity for both parents and offspring. This study also sought to examine the effect of acute stress related to financial losses on the reinforcing value of food (RRV_food) and delay discounting (DD).

METHODS

One hundred and six families stratified by both offspring age (53 children aged 7-10, 53 adolescents aged 15-17) and household financial resources, visited our laboratory for three separate appointments. Each appointment included the experimental manipulation of financial gains and losses, saliva samples for cortisol assay, continuous heart rate monitoring, self-rated tension, and computer-based DD and RRV_food tasks. Participants also completed surveys to report perceived life stress level and food insecurity status.

RESULTS

Among all participants, financial losses were related to decreased heart rates and increased self-rated tension. Among parents reporting food insecurity, acute financial losses resulted in an increase in cortisol levels. Changes in cortisol, heart rate, and tension were not related to RRV_food or DD.

CONCLUSION

Food insecure parents are sensitive to financial losses and respond with an increase in cortisol. However, we found no evidence for a relationship between cortisol and RRV_food or DD. This sensitivity to financial losses did not extend to children or adolescents.

Neural Vulnerability Factors That Predict Future Weight Gain

PURPOSE OF REVIEW

The current article discusses five neural vulnerability theories for weight gain and reviews evidence from prospective studies using imaging and behavioral measures reflecting neural function, as well as randomized experiments with humans and animals that are consistent or inconsistent with these theories.

RECENT FINDINGS

Recent prospective imaging studies examining predictors of weight gain and response to obesity treatment, and repeated-measures imaging studies before and after weight gain and loss have advanced knowledge of etiologic processes and neural plasticity resulting from weight change. Overall, data provide strong support for the incentive sensitization theory of obesity and moderate support for the reward surfeit theory, inhibitory control deficit theory, and dynamic vulnerability model of obesity, which attempted to synthesize the former theories into a single etiologic model. Data provide little support for the reward deficit theory. Important directions for future studies are delineated.

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.

Mindfulness and Behavior Change

Initiating and maintaining behavior change is key to the prevention and treatment of most preventable chronic medical and psychiatric illnesses. The cultivation of mindfulness, involving acceptance and nonjudgment of present-moment experience, often results in transformative health behavior change. Neural systems involved in motivation and learning have an important role to play. A theoretical model of mindfulness that integrates these mechanisms with the cognitive, emotional, and self-related processes commonly described, while applying an integrated model to health behavior change, is needed. This integrative review (1) defines mindfulness and describes the mindfulness-based intervention movement, (2) synthesizes the neuroscience of mindfulness and integrates motivation and learning mechanisms within a mindful self-regulation model for understanding the complex effects of mindfulness on behavior change, and (3) synthesizes current clinical research evaluating the effects of mindfulness-based interventions targeting health behaviors relevant to psychiatric care. The review provides insight into the limitations of current research and proposes potential mechanisms to be tested in future research and targeted in clinical practice to enhance the impact of mindfulness on behavior change.

Maternal stress during pregnancy and children's diet: Evidence from a population of low socioeconomic status

OBJECTIVES

This study examined the relationship between maternal exposure to stress during pregnancy and children's food preferences and diet in a population of low socioeconomic status.

METHODS

Indices of exposure to stress were constructed based on retrospective self-reported experience of stressful events during pregnancy (e.g., death of close family member, relationship difficulties, legal issues, health issues, financial issues, or other potentially stressful event[s]). Data were collected for >200 mothers of a low socioeconomic status with a child age 2 to 12 y. Data on mothers' body mass index, current exposure to stress, current diet, and diet during pregnancy were collected at the same time, as well as data on children's food preferences and current diet as reported by the mothers. Indices of the healthiness of food preferences and diet were constructed and used as outcome variables.

RESULTS

Maternal exposure to stress during pregnancy significantly predicts children's food and taste preferences, as well as their diet, in regression models controlling for maternal diet, current maternal stress, and demographic characteristics of both the child and mother. Higher average stress during pregnancy is linked with significantly less healthy food preferences and diet, as well as with weaker preferences for sour and bitter foods. This relationship is observed across different age groups.

CONCLUSIONS

Maternal exposure to stress during pregnancy could have long-term detrimental effects on dietary outcomes and thereby on health conditions related to diet. Prenatal care and preconception counseling could be critical to develop preventive strategies to improve public health.

Temporal discounting as a candidate behavioral marker of obesity

Although obesity is a result of processes operating at multiple levels, most forms result from decision-making behavior. The aim of this review was to examine the candidacy of temporal discounting (TD) (i.e. the reduction in the value of a reinforcer as a function of the delay to its receipt) as a behavioral marker of obesity. For this purpose, we assessed whether TD has the ability to: identify risk for obesity development, diagnose obesity, track obesity progression, predict treatment prognosis/outcomes, and measure treatment effectiveness. Three databases (Pubmed, PsycINFO, and Web of Science) were searched using a combination of terms related to TD and obesity. A total of 153 papers were reviewed. Several areas show strong evidence of TD's predictive utility as a behavioral marker of obesity (e.g., distinguishing obese from non obese). However, other areas have limited and/or mixed evidence (e.g., predicting weight change). Given the positive relationship for TD in the majority of domains examined, further consideration for TD as a behavioral marker of obesity is warranted.

Delay discounting and obesity in food insecure and food secure women

OBJECTIVES

The relation between food insecurity (FI) and delay discounting (DD) and probability discounting (PD) for food and money was tested in women. In addition, discounting was tested as a variable that mediates the relation between obesity and FI.

METHOD

Women recruited from a community sample (N = 92) completed questionnaires. They completed the food choice questionnaire, the monetary choice questionnaire, measures for food and money probability discounting (which quantify sensitivity to risk aversion), and demographic measures.

RESULTS

Women with FI had higher rates of obesity and higher food DD compared to food-secure women. However, DD for money or probability discounting for food or money did not significantly differ between FI and food secure groups when controlling for significant covariates. Neither DD or PD significantly mediated the relation between FI and obesity.

CONCLUSIONS

These results suggest that FI is associated with greater impulsive food choice, but its association with other monetary discounting and probability discounting for food and money appears contingent upon other demographic factors. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Linking Psychosocial Stress Events, Psychological Disorders and Childhood Obesity

There is scientific evidence that supports a strong association between early exposure to stressful life events and the presence of health complications throughout adulthood and, to a lesser extent, in adolescence and childhood. The aim of this study was to examine the accumulation of Psychosocial Stress Events (PSE) and the prevalence of mental disorders in children from 8 to 12 years. The association between these factors and child weight measurements was analysed. A cross-sectional study was conducted among 200 children classified by weight status (obesity, overweight and normal-weight). The assessment was carried out in primary care centres and primary schools. An experienced team carried out a structured medical-psychosocial history and a semi-structured interview aimed at identifying an early diagnosis of psychological disorders. Children filled out a questionnaire to evaluate PSE. The obesity group presented the greatest accumulation of PSE and highest prevalence of psychiatric diagnosis, compared to overweight and normal-weight children. To exceed four or more stressful events was positively associated with psychological problems and child body mass index (BMI z-score). A predictive model confirmed the interaction between a larger number of PSE and the occurrence of a psychiatric diagnosis as variables that predispose children by 26.2 times more to increased weight status. In conclusion, the accumulation of PSE in the family, school and social environments of the children was related to greater psychological distress. If not managed, the likelihood of suffering from other health complications, such as excess weight, may increase. It is important to monitor these variables to ensure positive health outcomes while specifically addressing childhood obesity. This is especially relevant for children from a disadvantaged social background and disharmonious family environments.

Having less and wanting more: an investigation of socioeconomic status and reinforcement pathology

BACKGROUND

In the United states obesity and socioeconomic status (SES), or one's standing in society based on income, education, and/or occupation, are strongly associated. The mechanisms for this relationship may include having high levels of motivation to get food (reinforcing value of food; RRV) and low levels of inhibitory control (delay discounting; DD) which, when combined, is referred to as reinforcement pathology (RP). We sought to examine the relationships among multiple measures of household SES, RP, and age-adjusted body mass index (zBMI) among adolescents.

METHODS

These data were collected as part of ongoing longitudinal study of risk factors for obesity in 244 adolescents. The adolescents and one parent/guardian had height and weight measured and completed surveys. The adolescents completed an adjusting amount DD task and a computer-based RRV task. Analyses consisted of correlations among measures of SES and RRV, DD, and BMI z-scores. In the case of significant associations, multiple regression models were created with theoretically informed covariates.

RESULTS

Household income, parent/guardian education, parent/guardian occupation, and food insecurity status were all related to one another. Among the adolescents, a significant portion of the variance in RRV was accounted for by household income after controlling for covariates. For DD, it was parent/guardian education that was most associated after controlling for covariates.

CONCLUSION

When low income and low parent/guardian education occur together, there may be an increased risk of RP. Separately, food insecurity was predictive of higher parent/guardian BMI. Future research should continue to explore the effects of low income and parent/guardian education on RP among youth by examining them over time.

Executive Function and BMI Trajectories Among Rural, Poor Youth at High Risk for Obesity

OBJECTIVE

The aim of this study was to identify longitudinal trajectories of conjoint development of executive function (EF) and obesity among a diverse sample of poor, rural youth and to evaluate individual differences in infant growth, parental BMI, and cumulative risk.

METHODS

Participants included 948 youth from the Family Life Project. Child anthropometrics were measured at 2 and 6 months and at 2, 3, 4, 5, 7, and 12 years. EF tasks were administered at 3, 4, and 5 years. Mothers reported youth birth weight, parental height and weight, and cumulative risk indicators.

RESULTS

Multidimensional growth mixture modeling identified three classes: "High EF - High Obesity Resilience"; "Low EF - Delayed-Onset Severe Obesity"; and "Low EF - Early-Onset Severe Obesity." Youth in the low-EF, early-onset class displayed higher birth weight and BMI at 6 months, whereas the low-EF, delayed-onset class had rapid weight gain during infancy, parents with class II obesity, and greater cumulative risk and was more likely to be Black and female.

CONCLUSIONS

Despite increased obesity risk among this sample, the majority of youth exhibited higher EF and some degree of obesity resilience. Youth with EF deficits displayed the greatest risk for severe obesity but had differing BMI trajectories and obesity risk profiles, which has implications for obesity intervention.

Challenges in researching the immune pathways between early life adversity and psychopathology

Exposure to childhood adversity is a critical risk factor for the development of psychopathology. A growing field of research examines how exposure to childhood adversity is translated into biological risk for psychopathology through alterations in immune system functioning, most notably heightened levels of inflammation biomarkers. Though our knowledge about how childhood adversity can instantiate biological risk for psychopathology is growing, there remain many challenges and gaps in the field to understand how inflammation from childhood adversity contributes to psychopathology. This paper reviews research on the inflammatory outcomes arising from childhood adversity and presents four major challenges that future research must address: (a) the measurement of childhood adversity, (b) the measurement of inflammation, (c) the identification of mediators between childhood adversity and inflammation, and (d) the identification of moderators of inflammatory outcomes following childhood adversity. We discuss synergies and inconsistencies in the literature to summarize the current understanding of the association between childhood adversity, a proinflammatory phenotype, and the biological risk for psychopathology. We discuss the clinical implications of the inflammatory links between childhood adversity and psychopathology, including possibilities for intervention. Finally, this review conclude by delineates future directions for research, including issues of how best to detect, prevent, and understand these “hidden wounds” of childhood adversity.

Improving Toddlers' Healthy Eating Habits and Self-regulation: A Randomized Controlled Trial

OBJECTIVES

In this study, we tested whether Recipe 4 Success, a preventive intervention featuring structured food preparation lessons, was successful in improving the following 4 protective factors related to overweight and obesity among families living in poverty: toddlers' healthy eating habits, toddlers' self-regulation, parents' responsive feeding practices, and parents' sensitive scaffolding.

METHODS

This randomized controlled trial was open to families enrolled in Early Head Start home visits and included 73 parents and their toddlers aged 18 to 36 months. Multimethod assessments were conducted at baseline and posttreatment.

RESULTS

Compared with toddlers in usual practice Early Head Start, toddlers in Recipe 4 Success consumed healthier meals and snacks (d = 0.57; P < .03; 95% confidence interval [CI]: 0.08-1.06) and displayed better self-regulation (d = 0.95; P < .001; 95% CI: 0.43-1.45). Compared with parents in usual practice Early Head Start, parents in Recipe 4 Success engaged in more responsive feeding practices (d = 0.87; P < .002; 95% CI: 0.34-1.40) and were better able to sensitively scaffold their toddlers' learning and development (d = 0.58; P < .04; 95% CI: 0.07-1.09).

CONCLUSIONS

This randomized controlled trial revealed medium to large intervention effects on 4 important protective factors that are related to overweight and obesity but are often compromised by living in poverty.

Preliminary Impact of an Adapted Emotion Regulation Intervention for Adolescents with Overweight and Obesity Attempting to Lose Weight

OBJECTIVE

This study examines the acceptability, feasibility, and preliminary impact of a program (HealthTRAC) combining 2 efficacious interventions (one targeting emotion regulation [TRAC] and the other a standardized behavioral weight management intervention [SBWC]) to improve weight management outcomes among a sample of adolescents with overweight and obesity.

METHOD

Adolescents with overweight or obesity (N = 38), ages 13 to 17 years, were enrolled and randomized into either the SBWC or HealthTRAC. Data were collected at baseline (before intervention), at the end of the 16-week intervention (postintervention), and 4 months after completing the intervention (4 months). Assessments included adolescent self-reports of intervention acceptability and reported emotion regulation (ER) abilities and caregiver report of adolescent ER skills. Body mass index (BMI) was used to examine the impact on adolescent weight outcomes. Analyses of covariance controlling for baseline values were used to evaluate study outcomes.

RESULTS

Eighty-four percent (n = 32) of participants completed the immediate postintervention and 4-month follow-up assessments. Adolescents in both conditions reported high treatment satisfaction. Adolescents randomized to HealthTRAC demonstrated greater reductions in BMI relative to SBWC and reported greater use of emotion regulation skills. Finally, caregivers of adolescents randomized to HealthTRAC also reported greater improvements in emotion regulation abilities among their adolescents at the 4-month follow-up.

CONCLUSION

Findings suggest that the HealthTRAC intervention was acceptable, feasible to deliver, and demonstrated a positive impact on BMI and emotion regulation abilities. These data suggest that ER is related to health decision-making and is relevant to most overweight/obese adolescents seeking to lose weight.

Adversity exposure and obesogenic food consumption in young children: The transgenerational role of emotion dysregulation

BACKGROUND

Childhood adversity is linked with unhealthy eating behaviours and obesity, but the mechanisms underlying this association are unclear, specifically the transgenerational behavioural precursors that develop in early childhood.

OBJECTIVE

To determine whether adversity predicts change in obesogenic food consumption through child emotion dysregulation, and whether caregiver emotion dysregulation modifies this association.

METHODS

Participants included 190 low-income caregiver-child dyads (mean child age = 4.31 years [SD = 0.85]). Cumulative lifetime adversity exposure was assessed via study-created measure. The Difficulties with Emotion Regulation Scale and Emotion Regulation Checklist assessed caregiver and child emotion dysregulation, respectively. Children's obesogenic food consumption was assessed at two time points 6 months apart using a caregiver-report measure: the Children's Eating Habits Questionnaire. Moderated mediation models were tested using autoregressive structural equation modelling.

RESULTS

Cumulative lifetime adversity was associated with child emotion dysregulation only when caregiver emotion dysregulation was high. Child emotion dysregulation in turn was associated with greater obesogenic food consumption 6 months later.

CONCLUSIONS

Among young children with caregivers high in emotion dysregulation, cumulative lifetime adversity was linked to an increase in obesogenic food consumption through child emotion dysregulation.

Pilot Intervention Enhances Preschoolers' Self-Regulation and Food Liking

OBJECTIVE

The goal of this study was to develop and evaluate a 5-week intervention that targeted self-regulation and healthy food liking through mindfulness and classroom-based games with exposure to fruits and vegetables.

METHODS

Children (mean age, 3.6 ± 0.05 years) in 1 Head Start center received the classroom-based intervention (n = 24) and children in a second did not (n = 15). Assessments of self-regulation and liking of fruits and vegetables were administered pre- and postintervention.

RESULTS

Children in the intervention, but not the comparison group, experienced significant improvements in behavioral regulation (P = 0.003) and liking of fruits and vegetables (P = 0.02).

CONCLUSIONS AND IMPLICATIONS

This study lays a foundation for future research that replicates findings with a larger sample using a randomized controlled design, incorporates more typical mindful eating practices, and includes additional, broader measures of food liking.

The Mediating Effect of Self-Regulation in the Association Between Poverty and Child Weight: A Systematic Review

Deficits in self-regulation (SR) have been proposed as a potential contributor to child overweight/obesity, a public health concern that disproportionately affects children living in poverty. Although poverty is known to influence SR, SR has not been considered as a potential mechanism in the association between poverty and child obesity. The aim of the current paper was to systematically review the current literature to determine whether SR is a viable mechanism in the relationship between child exposure to poverty and later risk of overweight/obesity. We systematically review and summarize literature in three related areas with the aim of generating a developmentally informed model that accounts for the consistent association between poverty and child weight, specifically how: (1) poverty relates to child weight, (2) poverty relates to child SR, and (3) SR is associated with weight. To quantify the strength of associations for each pathway, effect sizes were collected and aggregated. Findings from the studies included suggest small but potentially meaningful associations between poverty and child SR and between SR and child weight. The conceptualization and measurement of SR, however, varied across literature studies and made it difficult to determine whether SR can feasibly connect poverty to child obesity. Although SR may be a promising potential target for obesity intervention for low-income children, additional research on how SR affects risk of obesity is crucial, especially based on the lack of success of the limited number of SR-promoting interventions for improving children's weight outcomes.

Pathways to inflammation in adolescence through early adversity, childhood depressive symptoms, and body mass index: A prospective longitudinal study of Chilean infants

Early adversity, depression, and obesity are associated with increases in low-grade inflammation. However, there are few prospective and longitudinal studies to elucidate how these associations unfold in children. The present study used latent growth curve models to examine pathways between family adversity in infancy, depressive symptoms in childhood, body mass index (BMI) in childhood, and inflammation in adolescence (age = 16-18). The study is an adolescent follow-up of infants from working-class communities around Santiago, Chile, who participated in a preventive trial of iron supplementation at 6 months of age. Anthropometrics, stressful life events, maternal depression, socioeconomic status, and developmental assessments were measured at 12 months, 5 years, 10 years, and adolescence. In adolescence, participants provided blood samples for high-sensitivity C-reactive protein (hsCRP) assessment. Greater exposure to early adversity in the form of interpersonal conflict stress in infancy indirectly associated with increased hsCRP through its association to increased intercept and slope of childhood BMI. Depressive symptoms at any time were not directly or indirectly associated with increased hsCRP. These findings contribute to our understanding of how early family adversity and its associations with obesity and depressive symptoms across childhood are linked to low-grade, chronic inflammation in adolescence. The model identified as best capturing the data supported the pivotal role of childhood BMI in explaining how early-life adversity is associated with inflammation in adolescence.

Biobehavioral Dysregulation and its Association with Obesity and Severe Obesity Trajectories from 2 to 15 Years of Age: A Longitudinal Study

OBJECTIVE

This study aimed to identify obesity trajectories from childhood to adolescence (2-15 years of age) and investigate differences in behavioral, eating, and adrenocortical regulation by trajectory membership.

METHODS

A total of 1,077 households from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development were included. Anthropometrics were measured 11 times between ages 15 months and 15 years. Behavioral self-regulation was assessed at ages 3 and 4 years. Disordered eating behaviors and awakening cortisol were assessed at age 15 years.

RESULTS

Latent growth curve modeling identified four BMI trajectories: two nonoverweight trajectories based on average BMI at the 40th and 70th percentiles and overweight/obesity and severe obesity trajectories. Youth in the severe obesity trajectory exhibited lower behavioral self-regulation in early childhood and lower awakening cortisol at age 15 years compared with youth in the nonoverweight trajectories. Youth in the overweight/obesity and severe obesity trajectories showed higher levels of disordered eating behaviors at age 15 years.

CONCLUSIONS

Obesity trajectories were associated with biobehavioral markers of dysregulation in early childhood and adolescence. Dysregulation across biobehavioral domains was particularly apparent among youth who developed severe obesity. Further work is needed to better understand resilience factors that distinguish youth who develop obesity and severe obesity from those who do not.

Impact of Life Events on Short-Term Change in BMI in Early and Middle Childhood

OBJECTIVE

The accumulation of adverse events in childhood is linked to obesity, although the short-term (1 to 2 years) dynamics of weight change during life events has not been investigated.

METHODS

In the Eunice Kennedy Shriver National Institute of Child Health and Human Development Study of Early Child Care and Youth Development, mothers reported life events in the past year when their children were 54 months, 9 years, and 11 years old. Children's height and weight were measured, and BMI-for-age z scores were calculated at 36 and 54 months and at 7, 9, 10, and 11 years. The estimated 1- and 2-year change in BMI z score of being in the highest quartile of negative and total life events was modeled using linear regression accounting for repeated measures.

RESULTS

Analyses included 1,074 children. The highest quartile of negative life events was not statistically associated with BMI z score change at 2 years compared with those below the highest quartile (estimate: 0.069, 95% CI: -0.006, 0.144). Similarly, the highest quartile of total events was not related to BMI z score change (estimate: 0.029, 95% CI: -0.054, 0.114). The developmental period of the child did not moderate the association.

CONCLUSIONS

No significant change in BMI z score was observed in 1 to 2 years for children experiencing many life events.

Maternal body dissatisfaction in pregnancy, postpartum and early parenting: An overlooked factor implicated in maternal and childhood obesity risk

BACKGROUND

Current evidence indicates that to prevent the intergenerational transfer of overweight and obesity from parent to child, interventions are needed across the early life stages, from preconception to early childhood. Maternal body image is an important but often overlooked factor that is potentially implicated in both short- and long-term maternal and child health outcomes, including maternal gestational weight gain, postpartum weight retention, obesity, child feeding practices and early parenting.

AIM

The aim of this paper is to propose a conceptual model of the relationship between maternal body image (with a specific focus on body dissatisfaction) and maternal and child excess body weight risk across the pregnancy, postpartum and early childhood periods, as well as to highlight opportunities for intervention.

CONCLUSION

Our conceptual model proposes factors that mediate the associations between antenatal and postpartum maternal body dissatisfaction and maternal and childhood obesity risk. Pregnancy and postpartum present key risk periods for excess weight gain/retention and body dissatisfaction. Psychosocial factors associated with maternal body dissatisfaction, including psychopathology and disordered eating behaviours, may increase maternal and child obesity risk as well as compromise the quality of mother-child interactions underpinning child development outcomes, including physical weight gain. Our conceptual model may be useful for understanding modifiable psychosocial factors for preventing the intergenerational transfer of obesity risk from mothers to their children, from as early as pregnancy, and highlights next steps for multidisciplinary research focused on combatting maternal and child obesity during critical risk periods.

Adverse childhood experiences are associated with an increased risk of obesity in early adolescence: a population-based prospective cohort study

OBJECTIVE

To determine whether adverse childhood experiences were associated with weight gain and obesity risk in adolescence.

METHODS

We analyzed data from 6942 adolescents followed between 9 and 13 years of age in the Growing Up in Ireland cohort study. The main exposures were 14 adverse childhood experiences, 4 of which were included in the Adverse Childhood Experience (ACE) study. The primary outcome was incident overweight and obesity at 13 years. Secondary outcomes included prevalent overweight/obesity and weight gain.

RESULTS

More than 75% of the youth experienced an adverse experience and 17% experienced an ACE-specific experience before 9 years. At 13 years, 48% were female and 31.4% were overweight or obese. After adjusting for confounding, exposure to any adverse experience was associated with prevalent overweight/obesity (aOR: 1.56; 1.19-2.05) and incident overweight/obesity (adjusted IRR: 2.15; 95% CI: 1.37-3.39), while exposure to an ACE-specific exposure was associated weight gain (BMI Z score change = 0.202; 95% CI: 0.100-0.303). A significant interaction between income and adverse childhood experiences was observed for both incident overweight/obesity and weight gain (BMI Z change: -0.046; 95% CI: -0.092 to 0.000).

CONCLUSIONS

Adverse childhood experiences and low income interact and independently predict obesity risk in early adolescence.

Early mother-child dyadic pathways to childhood obesity risk: A conceptual model

Understanding the emotional quality of the mother-child dyadic relationship and parent-child feeding interactions may further clarify early developmental pathways to eating behaviours and obesity risk. The quality of parent-child relationships fosters all aspects of child development but has not yet been extensively examined in relation to childhood weight gain. The aim of this paper is to propose a conceptual model, which outlines early mother-child dyadic pathways linking parent-child feeding interactions to child body mass index, where parent-child relationships have a central role. It maps out individual and dyadic mother-child factors (i.e., attachment, child temperament and maternal mental health) that influence the nature and quality of parent-child feeding interactions from infancy to toddlerhood. Our model bridges the gap between research fields by bringing together key maternal and child factors implicated in child development. Understanding early parent-child feeding interactional patterns and their influence on child self-regulation and eating behaviours may be relevant to multidisciplinary approaches toward preventing childhood obesity. High quality quantitative and observational data capturing meaningful parent, child and dyadic level interactions around food contexts, attachment security, maternal mental health, child temperament and self-regulation will help to inform new, aetiologically important, targets for preventative intervention.

Time spent looking at food during a delay of gratification task is positively associated with children's consumption at ad libitum laboratory meals

Greater ability to delay gratification for an immediate food reward may protect against the development of obesity. However, it is not known if the behaviors children exhibit during a delay of gratification task are related to overeating in other contexts. The purpose of this analysis was to assess the relationship between observed child coping strategies during a delay of gratification task and laboratory intake from ad libitum test-meals. The sample consisted of 40, 7-9 year old children (40% (N = 16 with overweight/obesity). Across 5 laboratory visits, children consumed 3 identical test-meals presented after varying exposure conditions (i.e., no exposure, exposure to food commercials, exposure to toy commercials). On the first visit, children were recorded during a delay of gratification task which was coded for three behavioral themes: looking at vs. away from food, talking vs. staying silent, and fidgeting vs. sitting still. Pearson correlations and multiple regressions were run to look at the relationships between coping strategies and test-meal intake. Time spent looking away from food was negatively associated with ad libitum food consumption at the meals. Conversely, greater time spent looking at food was positively associated with ad libitum food consumption. These relationships were independent of covariates likely to influence intake (e.g., sex, age, weight status, parent income) and were more robust following food rather than toy commercial exposure. Children who spent more time looking at food and less time looking away during a delay of gratification task may be vulnerable to overeating in other contexts. Upon replication in larger samples, these behaviors could serve as modifiable targets in the development of childhood obesity prevention programs.

Neural vulnerability factors for obesity

Multiple theories identify neural vulnerability factors that may increase risk for overeating and weight gain. Early cross-sectional neuroimaging studies were unable to determine whether aberrant neural responsivity was a risk factor for or a consequence of overeating. More recent obesity risk, prospective, repeated-measures, and experimental neuroimaging studies with humans have advanced knowledge of etiologic processes and neural plasticity resulting from overeating. Herein, we review evidence from these more rigorous human neuroimaging studies, in conjunction with behavioral measures reflecting neural function, as well as experiments with animals that investigated neural vulnerability theories for overeating. Findings provide support for the reward surfeit theory that posits that individuals at risk for obesity initially show hyper-responsivity of reward circuitry to high-calorie food tastes, which theoretically drives elevated intake of such foods. However, findings provide little support for the reward deficit theory that postulates that individuals at risk for obesity show an initial hypo-responsivity of reward circuitry that motives overeating. Further, results provide support for the incentive sensitization and dynamic vulnerability theories that propose that overconsumption of high-calorie foods results in increased reward and attention region responsivity to cues that are associated with hedonic reward from intake of these high-calorie foods via conditioning, as well as a simultaneous decrease in reward region responsivity to high-calorie food tastes. However, there is little evidence that this induced reduction in reward region response to high-calorie food tastes drives an escalation in overeating. Finally, results provide support for the theory that an initial deficit in inhibitory control and a bias for immediate reward contribute to overconsumption of high-calorie foods. Findings imply that interventions that reduce reward and attention region responsivity to food cues and increase inhibitory control should reduce overeating and excessive weight gain, an intervention theory that is receiving support in randomized trials.

Associations between Childhood Disadvantage and Adult Body Mass Index Trajectories: A Follow-Up Study among Midlife Finnish Municipal Employees

OBJECTIVE

Childhood disadvantage is associated with a higher risk of adult obesity, but little is known about its associations with body mass index (BMI) trajectories during adulthood. This study aimed first to identify adulthood BMI trajectories, and second to investigate how childhood disadvantage is associated with trajectory group membership.

METHODS

Data from the Helsinki Health Study, a longitudinal cohort study of initially 40- to 60-year-old employees of the City of Helsinki in Finland, were used. The baseline survey was conducted in 2000-2002, and similar follow-up surveys in 2007, 2012, and 2017. Based on self-reported BMI, participants' (n =5,266; 83% women) BMI trajectories, including their retrospectively reported BMI at the age of 25 years, were examined. Data on childhood disadvantage, including parental education and 7 types of childhood adversity (their own serious illness; parental divorce, death, mental disorder, or alcohol problems; economic difficulties at home; and peer group bullying) before the age of 16 years, were obtained from the baseline survey. Group-based trajectory modeling was used to identify BMI trajectories, and multinomial logistic regression to analyze the odds for trajectory group membership for the disadvantage variables.

RESULTS

Four ascending BMI trajectories in women and men were found: persistent normal weight (trajectory 1; women 35% and men 25%), normal weight to overweight (trajectory 2; women 41% and men 48%), normal weight to class I obesity (trajectory 3; women 19% and men 23%) and overweight to class II obesity (trajectory 4; women 5% and men 4%). Compared to trajectory 1, women with multiple adversities and repetitive peer bullying in childhood had greater odds of belonging to trajectories 3 and 4, whereas men with parental alcohol problems had greater odds of belonging to trajectory 4. For women and men, a low level of parental education was associated with a higher-level BMI trajectory.

CONCLUSIONS

Low parental education for both genders, multiple adversities and repetitive peer bullying in childhood among women, and parental alcohol problems among men increased the odds of developing obesity during adulthood. Further studies are needed to clarify how gender differences modify the effects of childhood disadvantage on adult BMI trajectories.

Relation of neural response to palatable food tastes and images to future weight gain: Using bootstrap sampling to examine replicability of neuroimaging findings

Because understanding neural vulnerability factors that predict future weight gain may guide the design of more effective obesity prevention programs and treatments, we tested whether neural response to palatable food tastes and images predicted future weight gain. We recruited 135 initially healthy weight adolescents, to reduce the possibility that a history of overeating affected neural responsivity, had them complete fMRI paradigms examining neural response to tastes of milkshakes that varied in fat and sugar content and images of palatable foods, and assessed BMI annually over a 3-year follow-up. We used a novel bootstrapping analytic approach to investigate the replicability of the fMRI findings. Whole-brain analyses indicated that lower response in the pre-supplemental motor area to high-fat/low-sugar milkshake taste predicted future BMI gain in the full sample and in 5 out of the 10 bootstrap samples. Elevated response in the precentral gyrus/Rolandic operculum to images of appetizing foods predicted future BMI gain in the full sample and in 4 out of the 10 bootstrap samples. Other peaks that emerged in the full sample did not replicate in most of the bootstrap samples, suggesting they were not reliable. Region of interest analyses did not replicate the predictive effects of peaks reported in past papers that used similar paradigms, including the evidence that TaqIA polymorphism moderated the relation of striatal response to palatable food tastes to future weight gain. Results suggest that lower responsivity of a region implicated in motor processing in response to palatable taste was associated with greater BMI gain over time, and further that bootstrap sampling may be useful for estimating the replicability of findings that emerge from whole brain analyses or regions of interest analyses with the full sample.

A systematic review and meta-analysis of effects of early life non-cognitive skills on academic, psychosocial, cognitive and health outcomes

Success in school and the labour market relies on more than high intelligence. Associations between "non-cognitive" skills in childhood, such as attention, self-regulation, and perseverance, and later outcomes have been widely investigated. In a systematic review of this literature, we screened 9553 publications, reviewed 554 eligible publications, and interpreted results from 222 better quality publications. Better quality publications comprised randomised experimental and quasi-experimental studies (EQIs), and observational studies that made reasonable attempts to control confounding. For academic achievement outcomes there were 26 EQI publications but only 14 were available for meta-analysis with effects ranging from 0.16 to 0.37SD. However, within sub-domains effects were heterogeneous. The 95% prediction interval for literacy was consistent with negative, null and positive effects (-0.13 to 0.79). Similarly heterogeneous findings were observed for psychosocial, cognitive and language, and health outcomes. Funnel plots of EQIs and observational studies showed asymmetric distributions and potential for small study bias. There is some evidence that non-cognitive skills associate with improved outcomes. However, there is potential for small study and publication bias that may over-estimate true effects, and heterogeneity of effect estimates spanned negative, null and positive effects. The quality of evidence from EQIs under-pinning this field is lower than optimal and more than a third of observational studies made little or no attempt to control confounding. Interventions designed to develop children's non-cognitive skills could potentially improve outcomes. The inter-disciplinary researchers interested in these skills should take a more strategic and rigorous approach to determine which interventions are most effective.

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.

Childhood poverty dynamics and adulthood overweight/obesity: Unpacking the black box of childhood

Integrating several life course models, this study examines how childhood poverty dynamics shape the risk of adulthood overweight/obesity. Growth mixture models of yearly poverty data from age 0-16 from the U.S. Panel Study of Income Dynamics identify four childhood poverty trajectories: chronic poverty, early childhood poverty, downward mobility, and poverty-free. Chronic poverty and early childhood poverty groups have higher risk of adulthood overweight/obesity than the poverty-free group. Overweight/obesity risk is not significantly different between the chronic poverty group and the early childhood poverty group, suggesting that the effects of early childhood exposure persist despite subsequent upward mobility. Downward mobility in the absence of early childhood poverty does not significantly increase adulthood obesity risk, providing further evidence that early childhood is a critical period for developing risk of overweight and obesity. These findings shed new light on the timing model, social mobility model, cumulative model, and cumulative inequality theory.

Early maternal perceived stress and children's BMI: longitudinal impact and influencing factors

BACKGROUND

Maternal perceived stress has been discussed to contribute to the development of childhood overweight. Our aim was to investigate the longitudinal relationship of early maternal perceived stress and BMI z-scores in preschool children (≤ five years).

METHODS

A longitudinal analysis was conducted in 498 mother-child pairs of the German prospective birth cohort LINA with information on maternal perceived stress during pregnancy, one and two years after birth. BMI z-scores were based on annual measurements of children's weight/height and calculated based on WHO reference data. General estimation equations were applied to evaluate the impact of maternal stress on children's longitudinal BMI z-scores. Potential stressors contributing to the perceived stress of the mother were assessed by linear regression models. Using mediation analyses we evaluated the relationship between stressors, maternal perceived stress, and children's BMI z-score development.

RESULTS

Postnatal maternal stress during the first year after birth had a positive longitudinal relationship with children's BMI z-scores up to the age of five years. Gender-stratified analyses revealed that only girls showed this positive association while boy's BMI z-scores were unaffected by maternal stress. We identified three neighborhood strains and two socio-demographic factors, which contributed to the maternal perceived stress level. Stressors themselves did not directly affect girl's BMI z-scores but rather mediated their effect through the perceived stress level.

CONCLUSIONS

While different stressors contribute to maternal stress, the perceived stress level - rather than the stressors themselves - is strongly positively associated with BMI z-score development in girls.

Hungry brains: A meta-analytical review of brain activation imaging studies on food perception and appetite in obese individuals

The dysregulation of food intake in chronic obesity has been explained by different theories. To assess their explanatory power, we meta-analyzed 22 brain-activation imaging studies. We found that obese individuals exhibit hyper-responsivity of the brain regions involved in taste and reward for food-related stimuli. Consistent with a Reward Surfeit Hypothesis, obese individuals exhibit a ventral striatum hyper-responsivity in response to pure tastes, particularly when fasting. Furthermore, we found that obese subjects display more frequent ventral striatal activation for visual food cues when satiated: this continued processing within the reward system, together with the aforementioned evidence, is compatible with the Incentive Sensitization Theory. On the other hand, we did not find univocal evidence in favor of a Reward Deficit Hypothesis nor for a systematic deficit of inhibitory cognitive control. We conclude that the available brain activation data on the dysregulated food intake and food-related behavior in chronic obesity can be best framed within an Incentive Sensitization Theory. Implications of these findings for a brain-based therapy of obesity are briefly discussed.

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.