Research issues: the food environment and obesity

Policy, Systems, and Environmental Strategies to Support Healthy Eating Behaviors in Early Childhood: A Scoping Review of Existing Evaluation Tools

BACKGROUND

Policy, systems, and environmental (PSE) change strategies aimed at supporting healthy eating behaviors work to enhance optimal nutrition by making healthy foods more available and accessible in the community. PSE change strategies can complement and strengthen knowledge, skills, and behaviors obtained through individual-level nutrition education.

OBJECTIVE

This scoping review aimed to identify existing literature evaluating early childhood (ie, children younger than age 5 years) PSE change strategies supporting healthy eating behaviors and to describe the evaluation tools used to assess the identified PSE change strategies.

METHODS

Three databases (PubMed, Cumulated Index in Nursing and Allied Health Literature, and Web of Science) were used to systematically search for articles published between 2013 and 2023 written in English and conducted in the United States that evaluated PSE change strategies supporting healthy eating behaviors in young children (ie, children younger than age 5 years). Two study members conducted the review, discussing and reconciling discrepancies until a consensus was reached for interobserver reliability.

RESULTS

Findings from this review identified 48 studies evaluating early childhood PSE change strategies supporting healthy eating behaviors, with 36 studies using 25 PSE-focused evaluation tools to evaluate these strategies. Most tools (80%) assessed PSE change strategies supporting access and availability of healthy food and beverage options in early childhood education settings. Studies did not evaluate child-level outcomes (ie, attitudes, preferences, and behaviors) to showcase improvement of early childhood nutrition. Only 60% of the tools reported evidence of validity or reliability.

CONCLUSIONS

Most of the studies identified in this scoping review were aimed to evaluate healthy eating PSE change strategies focused on improving access to and availability of healthy foods and beverages in early childhood education settings. Future research is needed to develop and validate PSE-focused evaluation tools assessing child-level healthy eating practices and behaviors.

The impact of food addiction behaviours on the treatment of overweight students

The present study evaluated the association of food addiction (FA), the change of the BMI/age z-score and the consumption of ultra-processed foods in overweight students undergoing a 16-month, multicomponent intervention in the school environment. FA was investigated using the Yale Food Addiction Scale for Children, and the dietary assessment was estimated using the semi-quantitative FFQ in overweight 9-11-year-old students (BMI/age z-score ≥ 1) of both sexes at their baseline and after the intervention (n 120). Among the schoolchildren, 33·4 % had FA in at least one of the two assessments. The analysis of mixed-effects models to assess the effect of the intervention and the change of the BMI/age z-score between evaluations showed that the occurrence of FA influenced the maintenance of weight (time#FA, β = 0·30, 95 % CI 0·05, 0·54, P = 0·016). Weight loss was observed only in individuals who did not present FA (BMI/age z-score = -0·3). When evaluating the effect of the intervention and the dietary variables, we verified a reduction in the consumption of sugary milk-based drinks -71·13 kJ (-17 kcal), P = 0·04 only in non-FA students at the end of the study. FA has been identified as an underlying factor with therapeutic relevance, and an enhanced understanding of FA can open new paths for the prevention and management of obesity.

Control-theory models of body-weight regulation and body-weight-regulatory appetite

Human body weight (BW), or some variable related to it, is physiologically regulated. That is, negative feedback from changes in BW elicits compensatory influences on appetite, which may be called BW-regulatory appetite, and a component of energy expenditure (EE) called adaptive thermogenesis (AdEE). BW-regulatory appetite is of general significance because it appears to be related to a variety of aspects of human appetite beyond just energy intake. BW regulation, BW-regulatory appetite and AdEE are frequently discussed using concepts derived from control theory, which is the mathematical description of dynamic systems involving negative feedback. The aim of this review is to critically assess these discussions. Two general types of negative-feedback control have been invoked to describe BW regulation, set-point control and simple negative-feedback control, often called settling-point control in the BW literature. The distinguishing feature of set-point systems is the existence of an externally controlled target level of regulation, the set point. The performance of almost any negative-feedback regulatory system, however, can be modeled on the basis of feedback gain without including a set point. In both set-point and simple negative-feedback models of BW regulation, the precision of regulation is usually determined mainly by feedback gain, which refers to the transformations of feedback into compensatory changes in BW-regulatory appetite and AdEE. Stable BW most probably represents equilibria shaped by feedback gain and tonic open-loop challenges, especially obesogenic environments. Data indicate that simple negative-feedback control accurately models human BW regulation and that the set-point concept is superfluous unless its neuroendocrine representation is found in the brain. Additional research aimed at testing control-theory models in humans and non-human animals is warranted.

Exploring the consumption of ultra-processed foods and its association with food addiction in overweight children

The present study explored the consumption of ultra-processed foods and its association with food addiction in overweight children. The prevalence of food addiction was investigated using the Yale Food Addiction Scale for Children in overweight 9-11 year-old children (BMI/age ≥1 Z score) of both sexes from two schools (n = 139). Food intake was estimated by a food frequency questionnaire and the food items were classified into 4 categories: minimally processed, culinary ingredients, processed foods and ultra-processed foods (UPF), based on their degree of processing. Among the children, 95% showed at least one of the seven symptoms of food addiction and 24% presented with a diagnosis of food addiction. In analysis of covariance adjusted for age and sex, a tendency of higher consumption of added sugar (refined sugar, honey, corn syrup) and UPF was found among those diagnosed with food addiction. Multiple logistic regression adjusted for sugar, sodium and fat ingestion showed that consumption of cookies/biscuits (OR = 4.19, p = 0.015) and sausages (OR = 11.77, p = 0.029) were independently associated with food addiction. The identification of foods that may be associated with addictive behavior is very important for correctly treating and preventing childhood obesity, which continues to be one of the greatest health problems in the world.

Eating dependence and weight gain; no human evidence for a 'sugar-addiction' model of overweight

BACKGROUND AND AIMS

There is an increasing societal concern that consumption of specific foods such as sugar might become 'addictive' and, hence, promote weight gain. Claims about the addictiveness of sugar however are based largely on findings from few animal studies, whereas there is a lack of direct human evidence for symptoms of sugar-related substance dependence. The current study examined in a large sample of human participants whether foods mainly containing sugar in particular might cause 'addiction-like' problems that meet clinical DSM criteria for substance dependence, and, also whether in turn this relates to body weight and negative affectivity (depressed mood).

METHODS

In a cross-sectional study, n = 1495 university students from a variety of faculties were assessed for DSM-related signs of food addiction for particular food categories (YFAS), and, also BMI and negative affectivity.

RESULTS

Results revealed that from the total sample, 95% experienced at least one symptom of food dependence and 12.6% met the YFAS classification for 'food addiction' as related to DSM-IV criteria. The majority of respondents experienced these problems for combined high-fat savoury (30%) and high-fat sweet (25%) foods, whereas only a minority experienced such problems for low-fat/savoury (2%) and mainly sugar-containing foods (5%). Overweight correlated only with addictive-like problems for high-fat savoury and high-fat sweet foods (P < 0.0001), while this was not found for foods mainly containing sugar.

CONCLUSION

The current findings indicate that sugary foods contribute minimally to 'food dependence' and increased risk of weight gain. Instead, they are consistent with the current scientific notion that food energy density, and the unique individual experience of eating, plays an important role in determining the reward value of food and promoting excessive energy intake.