Psychometric properties of a new questionnaire to assess eating in the absence of hunger in children and adolescents

Children’s Eating Behaviour Questionnaire: association with BMI in children aged 3–10 years from Bosnia and Herzegovina

Objective:

To evaluate differences in children’s eating behaviour in relation to their weight status.

Design:

Prospective, cross-sectional study. Anthropometric measures were taken and age- and sex-adjusted BMI percentiles and Z-scores were calculated according to the Centers for Disease Control and Prevention recommendations to assess weight status. Parents completed a questionnaire which included demographic data and the Children’s Eating Behaviour Questionnaire (CEBQ) to assess eating behaviour.

Setting:

Tuzla Canton, Bosnia and Herzegovina (September 2016–September 2017).

Participants:

Male and female children aged 3–10 years and one of their parents.

Results:

The study sample comprised 2500 children; 6·8 % of them were underweight and 14·4 % were overweight, while there were 14·8 % obese children and 64·0 % had normal weight. The factor analysis of CEBQ revealed an eight-factor solution. Significant differences in CEBQ subscale scores were found within BMI categories for all CEBQ subscales except Food Fussiness. On the other hand, child BMI Z-scores showed a linear increase with the ‘food approach’ subscales of the CEBQ, except the Desire to Drink subscale which was excluded from analysis, and a decrease with ‘food avoidant’ subscales.

Conclusions:

The present study suggests that the CEBQ is valuable for identifying specific eating styles that are associated with weight status and can be seen as important and modifiable determinants implicated in the development and maintenance of overweight/obesity as well as underweight.

The association between alexithymia and eating behavior in children and adolescents

OBJECTIVE

Alexithymia, or the difficulty identifying or describing one's own emotions, may be a risk factor for dysregulated eating and excess weight gain. However, the relationships between alexithymia and eating behaviors in community samples of non-clinical youth have not been well-characterized. We hypothesized that alexithymia would be positively associated with disordered and disinhibited eating in a community-based sample of boys and girls without an eating disorder.

METHOD

Two hundred children (8-17 years old) across the weight spectrum completed an interview to assess loss of control (LOC) eating and eating-related psychopathology, a laboratory test meal designed to induce disinhibited eating, and questionnaires to assess alexithymia, eating in the absence of hunger, and emotional eating. Linear and logistic regressions were conducted to examine the relationship between alexithymia and eating variables, with age, sex, race, and fat mass as covariates. Test meal analyses also adjusted for lean mass. Given the overlap between alexithymia and depression, all models were repeated with depressive symptoms as an additional covariate.

RESULTS

Alexithymia was associated with an increased likelihood of reporting LOC eating (p < .05). Moreover, alexithymia was positively associated with disordered eating attitudes, emotional eating, and eating in the absence of hunger (ps < .05). Greater alexithymia was associated with more carbohydrate and less fat intake at the test meal (ps < .05). After adjusting for depressive symptoms, alexithymia remained associated with eating in the absence of hunger and carbohydrate and fat intake (ps < .05).

DISCUSSION

In healthy children, alexithymia is associated with some facets of eating behavior and food intake. If supported prospectively, these preliminary findings suggest alexithymia may be a modifiable risk factor to reduce disordered eating and excess weight gain in youth.

Associations of Weekday and Weekend Sleep with Children's Reported Eating in the Absence of Hunger

Insufficient average sleep duration has been inconsistently associated with poor diet and obesity risks in youth. Inconsistencies in findings across studies may be due to a general failure to examine associations in weekday versus weekend sleep. We hypothesized that greater variations in weekday and weekend sleep duration would be associated with more disinhibited eating behaviors, which, in turn, might be involved in the relationship between sleep and weight. We, therefore, examined, among healthy, non-treatment seeking youth, the associations of average weekly, weekend, and weekday sleep duration with eating in the absence of hunger (EAH), a disinhibited eating behavior associated with disordered eating and obesity. Sleep was assessed via actigraphy for 14 days. Participants completed a self-report measure of EAH. Adiposity was measured by dual-energy X-ray absorptiometry. Linear regressions were used to test the associations of sleep duration with EAH and the associations of sleep duration and EAH, with fat mass. Among 123 participants (8-17 years, 52.0% female, and 30.9% with overweight), there was no significant association between average weekly sleep and EAH. Further, there was no significant association among average weekly sleep duration or EAH and fat mass. However, average weekday sleep was negatively associated, and average weekend sleep was positively associated, with EAH (ps < 0.02). Weekend "catch-up" sleep (the difference between weekend and weekday sleep) was positively associated with EAH (p < 0.01). Findings indicate that shorter weekday sleep and greater weekend "catch-up" sleep are associated with EAH, which may place youth at risk for the development of excess weight gain over time.

Associations of prenatal exposure to impaired glucose tolerance with eating in the absence of hunger in early adolescence

OBJECTIVE

Exposure to impaired gestational glucose tolerance has been shown to have sex-specific associations with offspring obesity risk, perhaps by affecting the development of appetite regulation. We examined the extent to which prenatal exposure to impaired glucose tolerance was associated with eating in the absence of hunger (EAH) in early adolescent offspring, and in turn, whether EAH was cross-sectionally associated with body composition.

METHODS

We included data from 1097 adolescents participating in Project Viva, a pre-birth longitudinal cohort. We obtained the results of two-stage prenatal glycemic screening (50 g glucose challenge test, followed if abnormal by 100 g oral glucose tolerance test) at 26-28 weeks of gestation, and categorized mothers as having normal glucose tolerance, isolated hyperglycemia (IH, n = 92, 8.4%), impaired glucose tolerance (IGT, n = 36, 3.3%), or gestational diabetes mellitus (GDM, n = 52, 4.7%). At a median age of 13 years, offspring reported on two modified items of the Eating in the Absence of Hunger in Children and Adolescents questionnaire, we measured height and weight, and performed dual X-ray absorptiometry scans to assess fat and fat-free mass. We used multivariable linear regression analyses adjusted for sociodemographic and prenatal covariates, including maternal pre-pregnancy BMI.

RESULTS

On a ten-point scale, the mean (SD) EAH score was 4.4 points (SD = 1.5) in boys and 4.4 (SD = 1.4) in girls. In girls, prenatal exposure to both IH and IGT was associated with more EAH compared with normal glucose tolerance (e.g., for IH: 0.56 points, 95% CI: 0.17, 0.96), whereas in boys, prenatal exposure to IGT was associated with less EAH (-0.81 points, 95% CI: -1.41, -0.21). We did not observe an association between exposure to GDM and EAH, nor did we observe associations between EAH and body composition in early adolescence.

CONCLUSIONS

These findings suggest sex-specific associations of exposure to impaired gestational glucose tolerance with offspring EAH in early adolescence.

Problematic Eating Behaviors Are More Prevalent in African American Women Who Are Overweight or Obese Than African American Women Who Are Lean or Normal Weight

Problematic eating behaviors such as overeating and loss of control over consumption can lead to obesity. Problematic eating behaviors among women of differing body mass indexes were explored through focus group methodology, the Palatable Eating Motives Scale (PEMS), and a taste test in a sample of low-income African American women (n = 45). Women who were overweight or obese (W-O/O) reported more problematic eating behaviors including eating in the absence of hunger, frequent overeating, and increased food thoughts than women who were lean or normal weight (W-L/N). The W-O/O appear to possess more problematic eating behaviors than W-L/N.

Longitudinal associations between eating and drinking engagement during mealtime and eating in the absence of hunger in low income toddlers

To develop effective obesity-related interventions during early life, it is important to identify predictors of eating in the absence of hunger during toddlerhood. Hence, this study examined longitudinal associations between child eating and drinking engagement at 27 months of age and child eating in the absence of hunger (EAH) at 33 months of age (N = 91 children; 57.1% boys). At 27 months of age, we coded child eating and drinking engagement during a videotaped naturalistic lunch meal at home. We also obtained mothers' reports of their child's food responsiveness (FR), satiety responsiveness (SR), and desire to drink (DD) using the Child Eating Behavior Questionnaire (CEBQ). Children participated in a standard EAH protocol at 27 and 33 months of age where they were presented with palatable foods and the amount of food eaten was assessed (calculated as total kilocalories consumed). Correlational analyses showed that EAH at 27 months of age was positively related to EAH at 33 months of age and that neither mother-reported child FR or SR were associated with child eating engagement. Mother-reported child DD was associated with child drinking engagement. To predict EAH at 33 months, a regression analysis was conducted in which EAH at 27 months, mother-reported and observed child eating and drinking engagement at 27 months were entered as predictors, controlling for child demographics (i.e., age, sex, race/ethnicity and weight-for-length z-score (WLZ). Findings were that children who were observed to engage in more drinking at 27 months of age consumed more energy (measured as kcal) in the EAH at 33 months of age. Implications for understanding eating, and drinking, behaviors in toddlerhood are discussed.

Pre- and Postbariatric Subtypes and Their Predictive Value for Health-Related Outcomes Measured 3 Years After Surgery

BACKGROUND

Although bariatric surgery is the most effective treatment for severe obesity, a subgroup of patients shows insufficient postbariatric outcomes. Differences may at least in part result from heterogeneous patient profiles regarding reactive and regulative temperament, emotion dysregulation, and disinhibited eating. This study aims to subtype patients based on these aspects before and 2 years after bariatric surgery and tests the predictive value of identified subtypes for health-related outcomes 3 years after surgery.

METHODS

Within a prospective multicenter patient registry, N = 229 bariatric patients were examined before bariatric surgery, 2 and 3 years postoperatively via clinical interviews and self-report questionnaires. Pre- and postbariatric subtypes were differentiated by temperament, emotion dysregulation, and disinhibited eating using latent profile analyses (LPA). The predictive value of pre- and postbariatric subtypes for surgery outcomes measured 3 years postoperatively was tested via linear regression analyses.

RESULTS

LPA resulted in five prebariatric and three postbariatric subtypes which were significantly associated with different levels of general and eating disorder psychopathology. Post- versus prebariatric subtypes explained more variance regarding eating disorder psychopathology, depression, and quality of life assessed 3 years postoperatively, whereas neither pre- nor postbariatric subtypes predicted postbariatric weight loss. Patients with prebariatric deficits in self- and emotional control had an increased risk for showing these deficits postoperatively.

CONCLUSIONS

A re-evaluation of patients' psychological status after bariatric surgery is recommended to detect patients with potential risk for adverse psychological surgery outcomes in the long term.

Eating in the absence of hunger: Stability over time and associations with eating behaviours and body composition in children

BACKGROUND/OBJECTIVES

Eating in the absence of hunger (EAH) has been linked to obesity in adults and children. This study examined the stability of EAH in children between 4.5 and 6 years old, and associations with energy intake and portion selection, as well as cross-sectional and prospective associations with body composition.

METHODS

The participants were 158 boys and girls from the Growing Up in Singapore Towards healthy Outcomes cohort. At ages 4.5 and 6 years old children were provided lunch ad libitum, and immediately afterwards were exposed to palatable snacks to measure energy intake in the absence of hunger. At age 6 children completed an additional computer-based task to measure ideal portion size, where they selected pictures of the portions they would like to eat across eight foods. Measures of anthropometry (height/weight/skinfolds) were collected at both ages.

RESULTS

Children who consumed energy during the EAH task at age 4.5 years were 3 times more likely to also do so at age 6 years. Children with high EAH intakes at age 4.5 years had high EAH intakes at age 6, highlighting stability of this behaviour over time. Energy consumed at lunch was unrelated to energy consumed during the EAH task, but children who ate in the absence of hunger cumulatively consumed more energy over lunch and the EAH task. Children who showed EAH tended to select larger ideal portions of foods during the computer task. EAH was not associated with measures of body composition.

CONCLUSIONS

EAH is a stable behavioural risk factor for increased energy intake, but was not associated with body composition in this cohort. The majority of children ate in the absence of hunger, suggesting that interventions aimed at reducing responsiveness to external food cues could help to reduce energy intakes. Trial Registry Number: NCT01174875; https://clinicaltrials.gov/.

Identifying behavioral phenotypes for childhood obesity

Existing programs which aim to prevent and treat childhood obesity often do not take into account individual variation and the underlying mechanisms that impact child eating behavior. Individual differences in children's appetitive traits have been shown to appear as early as during infancy and become more pronounced as children grow older and become more exposed to the obesogenic food environment. Differences in genetic predispositions interacting with factors in children's early environment account in part for individual differences in appetitive traits. It is very likely that obesogenic eating phenotypes manifest themselves before the onset of childhood obesity. If so, identifying these phenotypes early is expected to move primary prevention strategies in a new direction and holds great potential to significantly enhance our ability to prevent childhood obesity. The aim of this narrative review is to discuss the role of behavioral phenotyping as an innovative approach for the development of more personalized obesity prevention and treatment interventions that are tailored to children's individual predispositions. We describe several examples of appetitive traits which have been linked to overeating and excess weight gain in children and thus may represent modifiable risk factors for future interventions. The review concludes with a comprehensive synthesis of opportunities for future human ingestive behavior research on identifying behavioral phenotypes for childhood obesity.

Noradrenaline transporter availability on [11C]MRB PET predicts weight loss success in highly obese adults

PURPOSE

Although the mechanisms by which the central noradrenaline (NA) system influences appetite and controls energy balance are quite well understood, its relationship to changes in body weight remains largely unknown. The main goal of this study was to further clarify whether the brain NA system is a stable trait or whether it can be altered by dietary intervention.

METHODS

We aimed to compare central NA transporter (NAT) availability in ten obese, otherwise healthy individuals with a body mass index (BMI) of 42.4 ± 3.7 kg/m² (age 34 ± 9 years, four women) and ten matched non-obese, healthy controls (BMI 23.9 ± 2.5 kg/m², age 33 ± 10 years, four women) who underwent PET with the NAT-selective radiotracer (S,S)-[¹¹C]O-methylreboxetine (MRB) before and 6 months after dietary intervention.

RESULTS

MRI-based individual volume-of-interest analyses revealed an increase in binding potential (BP_ND) in the insula and the hippocampus of obese individuals, which correlated well with changes in BMI (-3.3 ± 5.3%; p = 0.03) following completion of the dietary intervention. Furthermore, voxel-wise regression analyses showed that lower BP_ND in these regions, but also in the midbrain and the prefrontal cortex, at baseline was associated with higher achieved weight loss (e.g., hippocampal area R² = 0.80; p < 0.0001). No changes were observed in non-obese controls.

CONCLUSION

These first longitudinal interventional data on NAT availability in highly obese individuals indicate that the central NA system is modifiable. Our findings suggest that NAT availability before intervention could help predict the amount and success of weight loss in obese individuals and help adjust treatment options individually by allowing prediction of the benefit of a dietary intervention.

Association of the FTO fat mass and obesity-associated gene rs9939609 polymorphism with rewarding value of food and eating behavior in Chilean children

OBJECTIVES

The aim of this study was to assess the association between the single-nucleotide polymorphism rs9939609 in the FTO gene and homeostatic/non-homeostatic eating behavior patterns in Chilean children.

METHODS

A cross-sectional study was conducted in 258 children (44% female; 8-14 y of age). Anthropometric measurements (weight, height, Z-score of height, body mass index, and waist circumference) were performed. Eating behavior was assessed using the Eating in Absence of Hunger Questionnaire; the Child Eating Behavior Questionnaire; the Three Factor Eating Questionnaire, and the Food Reinforcement Value Questionnaire. Genotype of rs9939609 was determined by a Taqman assay. Association of rs9939609 with eating behavior was assessed using non-parametric tests.

RESULTS

Allelic frequencies of rs9939609 were estimated as 77% for the A allele and 23% for the T allele. We found that normal-weight girl A carriers had higher scores of Satiety Responsiveness and Slowness on the Eating subscale. Normal-weight boy A carriers showed significantly higher scores on the Negative Affect and lower scores of the Desire to Drink subscale. In overweight children, A carriers showed higher scores on the Food Responsiveness, Emotional Overeating, Enjoyment of Food, and Food Choice subscales and lower scores on the Satiety- Responsiveness and Slowness in Eating subscales. In obese children, we found higher scores on the Cognitive Restrained subscale and lower Food Choice.

CONCLUSION

The rs9939609 A allele of the FTO gene is associated with eating behavior traits and may predispose to obesity.

Identifying prebariatric subtypes based on temperament traits, emotion dysregulation, and disinhibited eating: A latent profile analysis

OBJECTIVE

The efficacy of bariatric surgery has been proven; however, a subset of patients fails to achieve expected long-term weight loss postoperatively. As differences in surgery outcome may be influenced by heterogeneous psychological profiles in prebariatric patients, previous subtyping models differentiated patients based on temperament traits. The objective of this study was to expand these models by additionally considering emotion dysregulation and disinhibited eating behaviors for subtyping, as these factors were associated with maladaptive eating behaviors and poor postbariatric weight loss outcome.

METHOD

Within a prospective multicenter registry, N = 370 prebariatric patients were examined using interview and self-report questionnaires. A latent profile analysis was performed to identify subtypes based on temperament traits, emotion dysregulation, and disinhibited eating behaviors.

RESULTS

Five prebariatric subtypes were identified with specific profiles regarding self-control, emotion dysregulation, and disinhibited eating behaviors. Subtypes were associated with different levels of eating disorder psychopathology, depression, and quality of life. The expanded model increased variance explanation compared to temperament-based models.

CONCLUSION

By adding emotion dysregulation and disinhibited eating behaviors to previous subtyping models, specific prebariatric subtypes emerged with distinct psychological deficit patterns. Future investigations should test the predictive value of these subtypes for postbariatric weight loss and health-related outcomes.

Exposure to maternal diabetes in utero and offspring eating behavior: The EPOCH study

The risk of becoming overweight among offspring exposed to gestational diabetes (GDM) in utero is two-fold higher than in the general population. The responsible mechanisms are likely multifactorial, with some evidence that GDM exposure alters brain satiety signaling, which may impact eating behavior. To better understand these effects, we investigated the relationship between GDM exposure, eating behavior, and total energy intake in 268 adolescents from the Exploring Perinatal Outcomes among Children cohort, who were exposed (n = 50) or not exposed (n = 217) to GDM in utero. Eating behavior was measured by the Eating in the Absence of Hunger in Children and Adolescents (EAH-C) questionnaire, which included subscale scores for Negative Affect, External Stimuli, and Fatigue/Boredom. Total energy intake (kcal/day) was derived from the Block Kid's Food Questionnaire. The associations between GDM exposure and the outcomes of total score and each EAH-C subscale were evaluated in separate multivariable models. In addition to the main predictor, GDM, the models included a GDM-by-sex interaction term and were adjusted for important covariates. The associations between EAH-C total and subscale scores and the outcome of total energy intake were also tested in separate multivariable models. Female offspring exposed to GDM in utero (vs unexposed males and females) were more likely to continue eating beyond satiation due to feelings of boredom and fatigue (β = 0.47, 95% CI: 0.11, 0.83), and in general (EAH-C total score; β = 4.20, 95% CI: 0.56, 7.86) compared to unexposed males. All EAH-C subscale and total scores were significantly, positively associated with higher energy intake (p < 0.05 for all, respectively). Our findings highlight the need for further investigation into the possible early life programming of eating behaviors by GDM exposure in utero.

Relationship between food insecurity, child weight status, and parent-reported child eating and snacking behaviors

PURPOSE

Prior studies showed that food insecurity may increase the odds of obesity in children and adults. We still know very little about the familial aggregation of obesity in food-insecure households or the mechanisms by which food insecurity confers an increased risk of obesity to children. The purpose of this study was to compare children and mothers from food-insecure and food-secure households in their weight status, child eating patterns/behaviors, and maternal feeding practices.

DESIGN AND METHODS

Fifty mothers of 8-10-year-old children were asked to complete questionnaires, including the U.S. Household Food Security survey, and had their own and their children's heights and weights measured.

RESULTS

The odds of a child being obese were five times higher for children from food-insecure households compared with children from food-secure households (95% confidence interval 1.15-20.8). In univariate analyses, children from food-insecure households showed significantly greater external eating, both past satiation and in the absence of hunger (p < .03), and mothers from food-insecure households expressed significantly greater concern about their children's weight and used restrictive feeding practices to a greater extent (p < .03) when compared with families from food-secure households. A greater proportion of children from food-secure households consumed three to four snacks per day (45.9 vs. 15.4%), while a higher proportion of children from food-insecure households consumed five or more snacks per day (15.4 vs. 0%; p = .02).

PRACTICE IMPLICATIONS

These findings provide further support for an association between food insecurity and childhood obesity and suggest that differences in external eating, child snacking patterns, and select maternal feeding practices may be implicated in food-insecure children's overconsumption of calories. When caring for food-insecure children, healthcare providers should screen for problematic eating patterns and feeding practices.

Eating in the absence of hunger during childhood predicts self-reported binge eating in adolescence

OBJECTIVE

The objectives of the current study were to examine whether eating in the absence of hunger (EAH) at age 7 predicted reports of self-reported binge eating at age 15 and to identify factors among girls with high-EAH that moderated risk of later binge eating.

METHOD

Subjects included 158 girls assessed at age 7 and age 15. Logistic regression was used to predict binge eating at age 15 from calories consumed during EAH at age 7. A series of logistic regressions were used to examine the odds of reporting binge eating given levels of risk factors (e.g., anxiety) among those with high-EAH in childhood.

RESULTS

Girls' EAH intake predicted reports of binge eating at age 15; after adjusting for age 7 BMI, for each additional 100kcal consumed, girls were 1.7 times more likely to report binge eating in adolescence. Among those with high-EAH, BMI, anxiety, depression, dietary restraint, emotional disinhibition, and body dissatisfaction all predicted binge eating.

DISCUSSION

EAH during childhood predicted reports of binge eating during adolescence; girls with elevated BMI, negative affect, and maladaptive eating- and weight-related cognitions were at increased risk. High-EAH in childhood may be useful for indicating those at risk for developing binge eating.

Association of the dopamine D2 receptor rs1800497 polymorphism and eating behavior in Chilean children

OBJECTIVES

Studies have established a strong genetic component in eating behavior. The TaqI A1 polymorphism (rs1800497) has previously been associated with obesity and eating behavior. Additionally, this polymorphism has been associated with diminished dopamine D2 receptor (DRD2) density, higher body mass, and food reinforcement. The aim of this study was to evaluate the association between the DRD2 rs1800497 polymorphism and eating behavior in Chilean children.

METHODS

This was a cross-sectional study in which we selected 258 children (44% girls, 56% boys; ages 8-14 y) with a wide variation in body mass index. Anthropometric measurements were performed by standard procedures. Eating behavior was assessed using the Eating in Absence of Hunger Questionnaire (EAHQ), Child Eating Behavior Questionnaire, and the Food Reinforcement Value Questionnaire. Genotype of the rs1800497 was determined by polymerase chain reaction-restriction fragment length polymorphism. Association of the TaqI A1 variant (T allele) with eating behavior was assessed using nonparametric tests.

RESULTS

Compared with normal-weight children, the obese group demonstrated higher scores on the External Eating and Fatigue/Boredom subscales of the EAHQ. Higher scores were assessed in Food Responsiveness, Emotional Overeating, Enjoyment to Food and Desire to Drink subscales (P < 0.001) and lower scores of the Satiety Responsiveness and Slowness in Eating (P < 0.05). In the sex-specific analysis, the TaqI A1 allele was associated with higher scores on Satiety Responsiveness and Emotional Undereating subscales in obese girls, and higher scores of Enjoyment of Food subscale in boys.

CONCLUSION

The TaqI A1 polymorphism may be a risk factor for eating behavior traits that may predispose children to greater energy intake and obesity.

Association of the melanocortin 4 receptor gene rs17782313 polymorphism with rewarding value of food and eating behavior in Chilean children

Studies conducted in monozygotic and dizygotic twins have established a strong genetic component in eating behavior. Rare mutations and common variants of the melanocortin 4 receptor (MC4R) gene have been linked to obesity and eating behavior scores. However, few studies have assessed common variants in MC4R gene with the rewarding value of food in children. The objective of the study was to evaluate the association between the MC4R rs17782313 polymorphism with homeostatic and non-homeostatic eating behavior patterns in Chileans children. This is a cross-sectional study in 258 Chilean children (44 % female, 8-14 years old) showing a wide variation in BMI. Anthropometric measurements (weight, height, Z-score of BMI and waist circumference) were performed by standard procedures. Eating behavior was assessed using the Eating in Absence of Hunger Questionnaire (EAHQ), the Child Eating Behavior Questionnaire (CEBQ), the Three-Factor Eating Questionnaire (TFEQ), and the Food Reinforcement Value Questionnaire (FRVQ). Genotype of the rs17782313 nearby MC4R was determined by a Taqman assay. Association of the rs17782313 C allele with eating behavior was assessed using non-parametric tests. We found that children carrying the CC genotype have higher scores of food responsiveness (p value = 0.02). In obese girls, carriers of the C allele showed lower scores of satiety responsiveness (p value = 0.02) and higher scores of uncontrolled eating (p value = 0.01). Obese boys carrying the C allele showed lower rewarding value of food in relation to non-carriers. The rs17782313 C allele is associated with eating behavior traits that may predispose obese children to increased energy intake and obesity.

Development and preliminary effectiveness of an innovative treatment for binge eating in racially diverse adolescent girls

INTRODUCTION

Binge and loss of control (LOC) eating are significant concerns among many adolescents and are associated with poor physical, social, and psychological functioning. Black girls appear to be particularly vulnerable to binge and LOC eating. Yet, empirically validated, culturally sensitive treatments for these disordered eating behaviors are not well established. This investigation examined satisfaction, feasibility, and preliminary outcomes of a binge eating intervention for ethnically diverse adolescent girls.

METHODS

Participants were 45 girls (age 13-17years; 44.4% white, 42.2% black) randomized into a dialectical behavior therapy (DBT)-based intervention (Linking Individuals Being Emotionally Real, LIBER8) or a weight management group (2BFit). Following each meeting, participants completed satisfaction measures, and therapists assessed intervention feasibility. Participants also completed assessments of eating behavior and related psychological constructs at baseline, immediately following the intervention, and at 3-month follow-up.

RESULTS

Descriptive statistics indicated that LIBER8 was feasible, and participants were highly satisfied with this intervention. Significant reductions in eating disorder cognitions, dietary restraint, and eating in response to negative affect were observed for participants in both groups, with no differences between LIBER8 and 2BFit.

DISCUSSION

The acceptability and feasibility of LIBER8 and associated reductions in emotional eating show promise in ameliorating binge eating and provide insight into multiple options for treating this challenging eating concern.

What drives the association between weight-conscious peer groups and disordered eating? Disentangling genetic and environmental selection from pure socialization effects

Previous studies suggest strong associations between exposure to weight-conscious peer groups and increased levels of disordered eating. This association has been attributed to socialization effects (i.e., membership leads to disordered eating); however, selection effects (i.e., selecting into peer groups based on genetic and/or environmental predispositions toward disordered eating) could contribute to or even account for these associations. The current study was the first to use a co-twin control design to disentangle these types of selection factors from socialization effects. Participants included 610 female twins (ages 8-14) drawn from the Michigan State University Twin Registry. To comprehensively examine a range of eating pathology, several disordered eating attitudes and behaviors (e.g., body dissatisfaction, binge eating) were examined via self-report questionnaires. Questionnaires also were used to assess peer group emphasis on body weight and shape. Replicating previous results, significant individual-level associations were found between membership in weight-conscious peer groups and disordered eating. However, co-twin control analyses indicated that these associations were largely due to genetic and/or shared environmental selection factors rather than pure socialization effects. Importantly, results remained unchanged when controlling for pubertal status, suggesting that effects do not vary across developmental stage. Overall, these findings question whether associations between weight-conscious peer groups and disordered eating are due entirely to socialization processes. Future studies are needed to identify the specific genetic and/or shared environmental factors that may drive selection into weight-conscious peer groups.

Weight bias internalization, emotion dysregulation, and non-normative eating behaviors in prebariatric patients

OBJECTIVE

Weight bias internalization (WBI) is associated with eating disorder psychopathology and non-normative eating behaviors among individuals with overweight and obesity, but has rarely been investigated in prebariatric patients. Based on findings demonstrating a relationship between emotion dysregulation and eating behavior, this study sought to investigate the association between WBI and eating disorder psychopathology as well as non-normative eating behaviors (i.e., food addiction, emotional eating, and eating in the absence of hunger), mediated by emotion dysregulation.

METHOD

Within a consecutive multicenter study, 240 prebariatric patients were assessed using self-report questionnaires. The mediating role of emotion dysregulation was examined using structural equation modeling.

RESULTS

The analyses yielded no mediational effect of emotion dysregulation on the association between WBI and eating disorder psychopathology. However, emotion dysregulation fully mediated the associations between WBI and emotional eating as well as eating in the absence of hunger. Further, emotion dysregulation partially mediated the relationship between WBI and food addiction symptoms.

DISCUSSION

Prebariatric patients with high levels of WBI are at risk for non-normative eating behaviors, especially if they experience emotion regulation difficulties. These findings highlight the importance of interventions targeting WBI and improving emotion regulation skills for the normalization of eating behavior in prebariatric patients.

Mindfulness and eating behavior in adolescent girls at risk for type 2 diabetes

OBJECTIVE

The purpose of this investigation was to examine the relationship of dispositional mindfulness to binge eating and associated eating attitudes and behaviors among adolescent girls at risk for type 2 diabetes (T2D).

METHODS

Participants were 114 overweight or obese adolescents enrolled in a study of girls with a family history of T2D and mild depressive symptoms. Adolescent self-reports of mindfulness, eating in the absence of hunger, and depressive symptoms were collected. An interview was administered to determine presence of binge eating episodes and a behavioral task was used to assess the reinforcing value of food relative to other nonsnack food rewards. Body composition was assessed using dual-energy X-ray absorptiometry.

RESULTS

In analyses accounting for race, percent body fat, lean mass, height, age, and depressive symptoms, dispositional mindfulness was associated with a lower odds of binge eating (p = .002). Controlling for the same potential confounds, mindfulness was also inversely associated with eating concern, eating in the absence of hunger in response to fatigue/boredom, and higher food reinforcement relative to physical activity (all p < .05).

DISCUSSION

In girls with a family history of T2D, independent of body composition and depressive symptoms, intraindividual differences in mindfulness are related to binge eating and associated attitudes and behaviors that may confer risk for obesity and metabolic problems. Further research is needed to determine the extent to which mindfulness plays a role in the etiology and/or maintenance of disinhibited eating in adolescents at risk for T2D.

A prospective study of adolescent eating in the absence of hunger and body mass and fat mass outcomes

OBJECTIVE

Eating in the absence of hunger (EAH) refers to the consumption of palatable foods in a sated state. It has been proposed that EAH promotes excess weight gain in youth; yet there are limited prospective data to support this hypothesis. We examined whether EAH at baseline predicted increases in body mass (BMI and BMIz) and fat mass (kg) 1 year later among adolescent boys and girls.

METHODS

EAH was assessed as adolescents' consumption of palatable snack foods following eating to satiety from an ad libitum lunch buffet. Parents also completed a questionnaire about their children's EAH. Body composition was assessed using air displacement plethysmography.

RESULTS

Of 196 adolescents assessed for EAH at baseline, 163 (83%) were re-evaluated 1 year later. Accounting for covariates, which included respective baseline values for each dependent variable, race, height, age, sex, and pubertal stage, there were no significant associations between baseline observed or parent-reported EAH and change in adolescent BMI, BMIz, or fat mass. Results did not differ by sex, child weight status, or maternal weight status.

CONCLUSIONS

No evidence was found to support the hypothesis that EAH is a unique endophenotype for adolescent weight or fat gain.

Temperament Dispositions, Problematic Eating Behaviours and Overweight in Adolescents

Obesity, a common health condition in adolescence leading to severe medical complications, is assumed to be influenced by temperament factors. This paper investigates associations between reactive and regulative temperament, problematic eating behaviours and excess weight. Several self-report instruments were completed by 130 adolescents (mean age 14.13 ± 0.61 years), including 27 overweight and obese individuals (20.8%). Bootstrap analysis revealed a mediating effect of restrained eating on the relation between reactive temperament and body mass index percentile, which differed according to gender: Restrained eating, which predicted weight gain, was more present in girls having a higher sensitivity to reward and in boys showing a higher sensitivity to punishment. No effect of regulative temperament was found. These results have important implications for weight management programmes, as they suggest that reducing restrained eating by working on temperament may help to control weight.

Systematic review: mealtime behavior measures used in pediatric chronic illness populations

OBJECTIVE

This systematic review evaluates the utility and psychometric properties of pediatric mealtime assessments (direct observation and parent-report measures) using evidence-based criteria developed by the Division 54 Evidence-Based Assessment Task Force.

METHOD

Measures of mealtime behavior used in at least one chronic illness pediatric population were eligible for inclusion. A total of 23 assessment measures were reviewed (16 parent-/self-report; 7 direct observation).

RESULTS

3 parent-report and 4 direct observation measures were classified as well-established, 3 met criteria for approaching well-established, and 13 were categorized as promising. Measures have been primarily used in children with feeding disorders, cystic fibrosis, and autism spectrum disorders.

CONCLUSIONS

Overall, the literature of pediatric mealtime assessment tools shows a strong evidence base for many direct observation methods and subjective parent-report measures. Exploratory and confirmatory factor analyses are available for some measures; recommendations for future validation research and measure development across pediatric populations are discussed.

Eating in the absence of hunger in college students

Nearly one-third of college students are overweight or obese. Disinhibited eating, a phenomenon defined as the lack of self-restraint over food consumption prompted by emotional or external factors, is prevalent among college students and may be a target for intervention in this population. Eating in the absence of hunger (EAH) is a form of disinhibited eating that has been studied extensively in children and adolescents, but there is little investigation of EAH among college students. In this research, a validated measure for assessing continual and beginning EAH in children and adolescents was modified and assessed in a free-living college population (n = 457; 84% F; 24.5 ± 7.6 years; 23.4 ± 4.8 kg/m(2)). Nine subscales grouped into three latent factors (emotion, external, and physical) accounted for 68% of the variance in continual EAH, and a separate set of nine subscales grouped into the same latent factors accounted for 71% of the variance in beginning EAH (Cronbach's alpha: 0.82 for continual EAH and 0.81 for beginning EAH). Female sex and sedentary behavior were significantly related to continual EAH, relationships driven by scores for the emotion factor, and to beginning EAH, relationships driven by scores for the physical factor. BMI was weakly related to the emotion factor (p = 0.06) for continuing EAH only. The observation that a sedentary lifestyle was associated to EAH (both continuing and beginning EAH) in a college population is a novel finding and reveals a possible strategy to moderate EAH.

Systematic review to identify and appraise outcome measures used to evaluate childhood obesity treatment interventions (CoOR): evidence of purpose, application, validity, reliability and sensitivity

BACKGROUND

Lack of uniformity in outcome measures used in evaluations of childhood obesity treatment interventions can impede the ability to assess effectiveness and limits comparisons across trials.

OBJECTIVE

To identify and appraise outcome measures to produce a framework of recommended measures for use in evaluations of childhood obesity treatment interventions.

DATA SOURCES

Eleven electronic databases were searched between August and December 2011, including MEDLINE; MEDLINE In-Process and Other Non-Indexed Citations; EMBASE; PsycINFO; Health Management Information Consortium (HMIC); Allied and Complementary Medicine Database (AMED); Global Health, Maternity and Infant Care (all Ovid); Cumulative Index to Nursing and Allied Health Literature (CINAHL) (EBSCOhost); Science Citation Index (SCI) [Web of Science (WoS)]; and The Cochrane Library (Wiley) - from the date of inception, with no language restrictions. This was supported by review of relevant grey literature and trial databases.

REVIEW METHODS

Two searches were conducted to identify (1) outcome measures and corresponding citations used in published childhood obesity treatment evaluations and (2) manuscripts describing the development and/or evaluation of the outcome measures used in the childhood intervention obesity evaluations. Search 1 search strategy (review of trials) was modelled on elements of a review by Luttikhuis et al. (Oude Luttikhuis H, Baur L, Jansen H, Shrewsbury VA, O'Malley C, Stolk RP, et al. Interventions for treating obesity in children. Cochrane Database Syst Rev 2009;1:CD001872). Search 2 strategy (methodology papers) was built on Terwee et al.'s search filter (Terwee CB, Jansma EP, Riphagen II, de Vet HCW. Development of a methodological PubMed search filter for finding studies on measurement properties of measurement instruments. Qual Life Res 2009;18:1115-23). Eligible papers were appraised for quality initially by the internal project team. This was followed by an external appraisal by expert collaborators in order to agree which outcome measures should be recommended for the Childhood obesity Outcomes Review (CoOR) outcome measures framework.

RESULTS

Three hundred and seventy-nine manuscripts describing 180 outcome measures met eligibility criteria. Appraisal of these resulted in the recommendation of 36 measures for the CoOR outcome measures framework. Recommended primary outcome measures were body mass index (BMI) and dual-energy X-ray absorptiometry (DXA). Experts did not advocate any self-reported measures where objective measurement was possible (e.g. physical activity). Physiological outcomes hold potential to be primary outcomes, as they are indicators of cardiovascular health, but without evidence of what constitutes a minimally importance difference they have remained as secondary outcomes (although the corresponding lack of evidence for BMI and DXA is acknowledged). No preference-based quality-of-life measures were identified that would enable economic evaluation via calculation of quality-adjusted life-years. Few measures reported evaluating responsiveness.

LIMITATIONS

Proposed recommended measures are fit for use as outcome measures within studies that evaluate childhood obesity treatment evaluations specifically. These may or may not be suitable for other study designs, and some excluded measures may be more suitable in other study designs.

CONCLUSIONS

The CoOR outcome measures framework provides clear guidance of recommended primary and secondary outcome measures. This will enhance comparability between treatment evaluations and ensure that appropriate measures are being used. Where possible, future work should focus on modification and evaluation of existing measures rather than development of tools de nova. In addition, it is recommended that a similar outcome measures framework is produced to support evaluation of adult obesity programmes.

FUNDING

The National Institute for Health Research Health Technology Assessment programme.

The Kids-Palatable Eating Motives Scale: relation to BMI and binge eating traits

INTRODUCTION

Despite high rates of obesity in adolescents, little is known about their individual motives for eating caloric foods for reasons unrelated to hunger. The goal of this study was to provide a preliminary validation of the "Kids Palatable Eating Motives Scale" (K-PEMS), a self-report survey designed to identify individual motives for eating tasty foods in adolescents. The study also sought to determine if any specific motive(s) can account for variance in BMI and binge-eating disorder (BED) traits which can exacerbate obesity.

METHODS

BMIz and responses to the K-PEMS and the Children's Binge Eating Disorder Scale (C-BEDS) were obtained from inner-city low-income African American adolescents. Linear and logistic regressions were used to identify K-PEMS motives that were associated with greater BMIz and binge-eating traits.

RESULTS

The K-PEMS identified eating tasty foods for Social, Conformity, Reward Enhancement, and Coping motives. Higher frequency of eating tasty foods for Social and Conformity motives and lower frequency of eating these foods for Reward Enhancement accounted for 39% of the variance in BMIz among the overweight and obese adolescents. In contrast, eating for Coping motives was related to a 3-fold increase in the amended provisional criteria for BED in children which occurred in 7% of this young minority sample.

DISCUSSION

The K-PEMS can be used to identify adolescents' primary motives for eating tasty foods. These motives may provide early identification of obesity and binge-eating risk but more importantly, can be tailor-targeted to affect specific behavioral and/or cognitive changes to prevent these conditions in adulthood.

Emotional Openness, problematic eating behaviours, and overweight in adolescents

Overweight, a common health condition in adolescence, has been linked with difficulties in emotional processing. This study investigates associations between emotional processing, conceptualised through the model of Emotional Openness (EO), problematic eating behaviours, including Eating in the Absence of Hunger and disinhibited eating, and overweight in adolescents. Several self-report instruments were completed by 160 youngsters (mean age: 14.36±0.61years) from the community, including 39 overweight and obese adolescents (24.5%). In girls, bootstrap analyses supported a mediating effect of restrained eating on the relation between three EO dimensions and body mass index percentile, in particular the communication of emotions, the cognitive-conceptual representation of emotions, and the perception of bodily indicator of emotions. No mediating effect was found in boys. These results have important implications for psychological weight management interventions, as they underline the relevance of work on emotional processing in order to reduce problematic eating behaviours.

[Children's eating behaviour: comparison between normal and overweight children from a school in Pelotas, Rio Grande do Sul, Brazil]

OBJECTIVE:

To evaluate differences in children's eating behavior in relation to their nutritional status, gender and age.

METHODS:

Male and female children aged six to ten years were included. They were recruited from a private school in the city of Pelotas, Rio Grande do Sul, southern Brazil, in 2012. Children´s Eating Behaviour Questionnaire (CEBQ) subscales were used to assess eating behaviors: Food Responsiveness (FR), Enjoyment of Food (EF), Desire to Drink (DD), Emotional Overeating (EOE), Emotional Undereating (EUE), Satiety Responsiveness (SR), Food Fussiness (FF) and Slowness in Eating (SE). Age-adjusted body mass index (BMI) z-scores were calculated according to the WHO recommendations to assess nutritional status.

RESULTS:

The study sample comprised 335 children aged 87.9±10.4 months and 49.3% had normal weight (n=163), 26% were overweight (n=86), 15% were obese (n=50) and 9.7% were severely obese (n=32). Children with excess weight showed higher scores at the CEBQ subscales associated with "food approach" (FR, EF, DD, EOE, p<0.001) and lower scores on two "food avoidance" subscales (SR and SE, p<0.001 and p=0.003, respectively) compared to normal weight children. Differences in the eating behavior related to gender and age were not found.

CONCLUSIONS:

"Food approach" subscales were positively associated to excess weight in children, but no associations with gender and age were found.

Design and implementation of a study evaluating extinction processes to food cues in obese children: the Intervention for Regulations of Cues Trial (iROC)

Obesity and its health sequelae affect a significant portion of children in the United States. Yet, the current gold-standard family-based behavioral weight-loss treatments are only effective for one-third of children long-term. Therefore, we developed iROC (Intervention for Regulation of Cues) to specifically target a method to decrease overeating in overweight children, based on learning theory, to inform and enhance interventions targeting diet and obesity in youth. This study will rigorously test extinction processes as a method of decreasing physiological and psychological responses to food cues in overweight and obese children. Through exposing children to their highly craved foods, and 'training the brain and body' to decrease overeating, we are hoping to produce longer-lasting weight loss or weight-gain prevention over time.

Association of obesity and eating in the absence of hunger among college students in a Mexican-USA border city

Few studies have examined disinhibited eating behaviors in Mexico. However eating in the absence of hunger (EAH), defined as eating in response to the presence of palatable foods in the absence of physiological hunger, is one of the more frequently examined behaviors. The purpose of this study was to assess the association between obesity and EAH among college students in a large Mexican-USA border city. Two-hundred and one sophomore college students completed the EAH questionnaire (EAH-C). Weight and height were measured. To assess reproducibility a test-retest was conducted in a subset sample (n = 20). Test-retest correlations ranged from ρ = 0.44 to 0.86, p < 0.01. Data obtained from the EAH-C were subjected to a principal components analysis with a varimax rotation. The mean age of participants was 21.0 ± 2.0 years, 52 % were female. The prevalence of overweight and obesity was 29 and 14 % respectively. The internal validity was assessed by Cronbach's alph. Internal consistency for all subscales was: external eating (α = 0.83), negative affect (α = 0.92) and fatigue/boredom (α = 0.86). Principal component analysis generated four subscales for the EAH-C: external eating, negative affect, fatigue and boredom. Comparing normal weight students versus obese students, normal weight students (57.1%) had higher scores on boredom subscale than obese students (p < 0.008). Female students had higher scores in the negative affect subscale than the males (p < 0.001). We conclude that the EAH-C had internal consistent subscales with good convergent validity. In this study population we found no association between EAH and obesity.

The relationship between controlling feeding practices and boys' and girls' eating in the absence of hunger

Parental controlling feeding practices have been directly associated with maladaptive child eating behaviors, such as eating in the absence of hunger (EAH). The aims of this study were to examine EAH in very young children (3-4years old) and to investigate the association between maternal controlling feeding practices and energy intake from a standardized selection of snacks consumed 'in the absence of hunger'. Thirty-seven mother-child dyads enrolled in the NOURISH RCT participated in a modified EAH protocol conducted in the child's home. All children displayed EAH, despite 80% reporting to be full or very full following completion of lunch 15min earlier. The relationships between maternal and child covariates and controlling feeding practices and EAH were examined using non-parametric tests, and were stratified by child gender. For boys only, pressure to eat was positively associated with EAH. Neither restriction nor monitoring practices were associated with EAH in either boys or girls. Overall, the present findings suggest that gender differences in the relationship between maternal feeding practices and children's eating behaviors emerge early and should be considered in future research and intervention design.

Eating in the absence of hunger but not loss of control behaviors are associated with 16p11.2 deletions

OBJECTIVE

The ∼600-kb BP4-BP5 16p11.2 deletion has been consistently associated with obesity. We studied two heritable disinhibited eating behaviors, eating in the absence of hunger (EAH) and loss of control (LOC), to better characterize the relationship between the deletion and obesity.

METHODS

Our study population included ninety-three 16p11.2 CNV carriers (64 with deletions and 29 with duplications) and their families. We performed analyses using linear mixed models and focused on deletion carriers.

RESULTS

We confirmed previous associations between the 16p11.2 deletion and obesity (P < 0.0001) and between all EAH subscales and obesity (P < 0.05), after adjusting for confounders. We found significant associations between the deletion and EAH due to external cues (P = 0.004) and EAH due to boredom (P = 0.003), but not EAH due to fatigue/anxiety or negative affect. Conditioning BMI on the 16p11.2 deletion and each EAH behavior did not abolish the association between the deletion and obesity. LOC was underrepresented and not associated with the deletion.

CONCLUSIONS

We report evidence that the 16p11.2 deletion may influence specific obesity-associated disinhibited eating behaviors: EAH due to external trigger and EAH due to boredom. Prospective studies are needed to confirm the temporal order of EAH behaviors and obesity related to the deletion.

Framework of outcome measures recommended for use in the evaluation of childhood obesity treatment interventions: the CoOR framework

INTRODUCTION

Consensus is lacking in determining appropriate outcome measures for assessment of childhood obesity treatments. Inconsistency in the use and reporting of such measures impedes comparisons between treatments and limits consideration of effectiveness. This study aimed to produce a framework of recommended outcome measures: the Childhood obesity treatment evaluation Outcomes Review (CoOR) framework.

METHODS

A systematic review including two searches was conducted to identify (1) existing trial outcome measures and (2) manuscripts describing development/evaluation of outcome measures. Outcomes included anthropometry, diet, eating behaviours, physical activity, sedentary time/behaviour, fitness, physiology, environment, psychological well-being and health-related quality of life. Eligible measures were appraised by the internal team using a system developed from international guidelines, followed by appraisal from national external expert collaborators.

RESULTS

A total of 25,486 papers were identified through both searches. Eligible search 1 trial papers cited 417 additional papers linked to outcome measures, of which 56 were eligible. A further 297 outcome development/evaluation papers met eligibility criteria from search 2. Combined, these described 191 outcome measures. After internal and external appraisal, 52 measures across 10 outcomes were recommended for inclusion in the CoOR framework.

CONCLUSION

Application of the CoOR framework will ensure greater consistency in choosing robust outcome measures that are appropriate to population characteristics.

Nonnormative eating behavior and psychopathology in prebariatric patients with binge-eating disorder and night eating syndrome

BACKGROUND

Binge-eating disorder (BED) as a distinct eating disorder category and night eating syndrome (NES) as a form of Other Specified Feeding or Eating Disorders were recently included in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This study sought to investigate the prevalence of BED and NES and associations with various forms of nonnormative eating behavior and psychopathology in prebariatric patients. Within a consecutive multicenter registry study, patients in 6 bariatric surgery centers in Germany were recruited.

METHODS

Overall, 233 prebariatric patients were assessed using the Eating Disorder Examination and self-report questionnaires. Assessment was unrelated to clinical procedures.

RESULTS

Diagnostic criteria for full-syndrome BED and NES were currently met by 4.3% and 8.2% of prebariatric patients, respectively. In addition, 8.6% and 6.9% of patients met subsyndromal BED and NES criteria, respectively. Co-morbid BED and NES diagnoses were present in 3.9% of patients. In comparison to patients without any eating disorder symptoms, patients with BED and NES reported greater emotional eating, eating in the absence of hunger, and more symptoms of food addiction. Moreover, differences between patients with BED and NES emerged with more objective binge-eating episodes and higher levels of eating concern, weight concern, and global eating disorder psychopathology in patients with BED.

CONCLUSION

BED and NES were shown to be prevalent among prebariatric patients, with some degree of overlap between diagnoses. Associations with nonnormative eating behavior and psychopathology point to their clinical significance and discriminant validity.

Understanding eating in the absence of hunger among young children: a systematic review of existing studies

BACKGROUND

Eating in the Absence of Hunger (EAH), or consuming highly palatable foods when satiated, is one behavioral pathway that may lead to childhood obesity. EAH is an objective, laboratory-based measure. A more comprehensive understanding of potential determinants of EAH could inform childhood obesity programs outside of a laboratory setting.

OBJECTIVE

Systematic review of EAH experiments to identify individual, familial, and societal-level correlates of EAH among children 12 years of age or younger.

DESIGN

1487 studies were retrieved from five electronic databases (Medline [PubMed], Web of Science, Cochrane Library, CINAHL, PsycINFO). Eligible studies were those that measured EAH as initially operationalized in a laboratory setting enrolling children ≤12 years or reporting age-specific results for children ≤12 years. Only articles written in English were included.

RESULTS

12 cross-sectional, six prospective, and one behavioral-intervention studies were included in the review. EAH was observable among boys and girls; absolute levels of EAH increased with age; and maternal feeding styles were associated with EAH among girls. The most consistent evidence supported increased levels of EAH among overweight and obese versus normal weight children, both cross-sectionally and prospectively. Two studies supported a genetic component to EAH.

CONCLUSIONS

Studies enrolling independent samples support a positive association between weight status and EAH among children; studies addressing causality are needed. Other various individual, genetic, and familiar characteristics were associated with EAH, yet studies among more heterogeneous sample populations are needed to confirm findings. Studies addressing societal-level factors related to EAH were absent.

An intervention based on Schachter's externality theory for overweight children: the regulation of cues pilot

OBJECTIVE

This study evaluated the feasibility, acceptability, and initial efficacy of an intervention based on Schachter's externality theory; the Regulation of Cues (ROC) program.

METHODS

44 overweight and obese 8-12-year-old children and their parents were randomly assigned to a 4-month ROC program or the control group. Outcomes were assessed at baseline, posttreatment, and 4 months posttreatment and included acceptability and feasibility, body weight, and eating behaviors.

RESULTS

The ROC program had moderate to high acceptability ratings. Significant improvements were found for the ROC group compared with the control group on child food responsiveness at posttreatment and eating in the absence of hunger at 4 months posttreatment. Improvements were seen for the ROC group compared with the control group on body weight measures and food responsiveness, although these only approached significance.

CONCLUSION

The ROC intervention may be useful with overweight and obese children. Larger, fully powered studies are needed to further evaluate the efficacy of this model.

Concurrent and convergent validity of the eating in the absence of hunger questionnaire and behavioral paradigm in overweight children

OBJECTIVE

This study aimed to assess the concurrent and convergent validity of the Eating in the Absence of Hunger (EAH) questionnaire parent report of child (EAH-PC) and child self-report (EAH-C) with the EAH behavioral paradigm (EAH%) and usual dietary intake.

METHOD

Data were obtained at baseline assessment for 117 treatment-seeking overweight and obese (BMI > 85th percentile) 8- to 12-year old children (53% female, 54% white) and their parents. Children participated in the EAH free access paradigm after a standardized ad libitum meal. Parents and children completed EAH questionnaires, and the children completed three 24 h recalls. EAH External Eating subscale and total scores were assessed.

RESULTS

EAH% was inversely associated with the EAH-PC total score (p < .04), however, it was not associated with the EAH-PC External Eating scale, EAH-C total score or EAH-C External Eating scale. Daily caloric intake was positively related to both the EAH-C total score (p < .02) and External Eating subscale (p < .007). Daily caloric intake was inversely related to EAH-PC total score (p < .05), but was not related to EAH-PC External Eating subscale or EAH%.

DISCUSSION

Concurrent validity was not supported for EAH questionnaires, but convergent validity was supported for EAH-C and child daily caloric intake. Further research is warranted to assess whether EAH questionnaires and paradigm are measuring different aspects of EAH in treatment-seeking children.

Overeating phenotypes in overweight and obese children

The purpose of this study was to identify overeating phenotypes and their correlates in overweight and obese children. One hundred and seventeen treatment-seeking overweight and obese 8-12year-old children and their parents completed the study. Children completed an eating in the absence of hunger (EAH) paradigm, the Eating Disorder Examination interview, and measurements of height and weight. Parents and children completed questionnaires that evaluated satiety responsiveness, food responsiveness, negative affect eating, external eating and eating in the absence of hunger. Latent profile analysis was used to identify heterogeneity in overeating phenotypes in the child participants. Latent classes were then compared on measures of demographics, obesity status and nutritional intake. Three latent classes of overweight and obese children were identified: High Satiety Responsive, High Food Responsive, and Moderate Satiety and Food Responsive. Results indicated that the High Food Responsive group had higher BMI and BMI-Z scores compared to the High Satiety Responsive group. No differences were found among classes in demographics or nutritional intake. This study identified three overeating phenotypes, supporting the heterogeneity of eating patterns associated with overweight and obesity in treatment-seeking children. These finding suggest that these phenotypes can potentially be used to identify high risk groups, inform prevention and intervention targets, and develop specific treatments for these behavioral phenotypes.

Alterations of the salience network in obesity: a resting-state fMRI study

Obesity is a major health problem in modern societies. It has been related to abnormal functional organization of brain networks believed to process homeostatic (internal) and/or salience (external) information. This study used resting-state functional magnetic resonance imaging analysis to delineate possible functional changes in brain networks related to obesity. A group of 18 healthy adult participants with obesity were compared with a group of 16 lean participants while performing a resting-state task, with the data being evaluated by independent component analysis. Participants also completed a neuropsychological assessment. Results showed that the functional connectivity strength of the putamen nucleus in the salience network was increased in the obese group. We speculate that this abnormal activation may contribute to overeating through an imbalance between autonomic processing and reward processing of food stimuli. A correlation was also observed in obesity between activation of the putamen nucleus in the salience network and mental slowness, which is consistent with the notion that basal ganglia circuits modulate rapid processing of information.

Genetics of food intake self-regulation in childhood: literature review and research opportunities

Pediatric obesity results from a daily energy imbalance between intake and expenditure, an imbalance potentially as slight as ~30-50 kcal/day (e.g., a few extra sips of cola or bites of a cookie). That an 'energy gap' so small may be so powerful suggests the importance of understanding mechanisms of food intake self-regulation (FISR). This review focuses on 4 behavioral indices of FISR in childhood: (1) eating in the absence of hunger; (2) eating rate; (3) caloric compensation and satiety responsiveness, and (4) food responsiveness. Evidence from pediatric samples around the world indicates that these traits are associated with body mass index, are heritable, and are linked to polymorphisms in the FTO gene. We review these data, also discussing their relevance to practical issues of parental feeding styles, portion sizes, and health literacy and numeracy. Research gaps and opportunities for future investigation are discussed. Multidisciplinary approaches and study designs that can address gene-environment interactions are needed to advance the science of FISR and stimulate new avenues for childhood obesity prevention.

Latent profile analysis to determine the typology of disinhibited eating behaviors in children and adolescents

OBJECTIVE

We used latent profile analysis (LPA) to classify children and adolescents into subtypes based on the overlap of disinhibited eating behaviors-eating in the absence of hunger, emotional eating, and subjective and objective binge eating.

METHOD

Participants were 411 youths (8-18 years) from the community who reported on their disinhibited eating patterns. A subset (n = 223) ate ad libitum from two test meals.

RESULTS

LPA produced five subtypes that were most prominently distinguished by objective binge eating (OBE; n = 53), subjective binge eating (SBE; n = 59), emotional eating (EE; n = 62), a mix of emotional eating and eating in the absence of hunger (EE-EAH; n = 172), and no disinhibited eating (No-DE; n = 64). Accounting for age, sex, race, and body mass index z score (BMI-z), the four disinhibited eating groups had more problem behaviors than the no disinhibited eating group (p = .001). OBE and SBE subtypes had greater BMI-z, percent fat mass, disordered eating attitudes, and trait anxiety than EE, EE-EAH, and No-DE subtypes (ps < .01). However, the OBE subtype reported the highest eating concern (p < .001), and the OBE, SBE, and EE subtypes reported higher depressive symptoms than the EE-EAH and No-DE subtypes. Across both test meals, OBE and SBE subtypes consumed a lesser percentage of protein and a higher percentage of carbohydrate than the other subtypes (ps < .02), adjusting for age, sex, race, height, lean mass, percent fat mass, and total intake. EE subtypes also consumed a greater percentage of carbohydrate and a lower percentage of fat than the EE-EAH and No-DE subtypes (ps < .03). The SBE subtype consumed the least total calories (p = .01).

DISCUSSION

We conclude that behavioral subtypes of disinhibited eating may be distinguished by psychological characteristics and objective eating behavior. Prospective data are required to determine whether subtypes predict the onset of eating disorders and obesity.

Links of adolescent- and parent-reported eating in the absence of hunger with observed eating in the absence of hunger

OBJECTIVE

Eating in the absence of hunger (EAH) typically was assessed by measuring snack intake after consumption of a meal. There were no validated self-report measures of EAH. The relationship of adolescent self-report and parent-reported EAH to adolescents' measured intake in the absence of hunger was examined.

DESIGN AND METHODS

Ninety adolescents completed the Eating in the Absence of Hunger Questionnaire for Children and Adolescents (EAH-C) to describe eating when not hungry. Parents described children's EAH on a parallel version designed for parents (EAH-P). In a randomized crossover study, adolescent EAH in response to external cues was measured as snack intake after a lunch meal standardized to provide 50% of daily energy requirements and after a large array (>10,000 kcal).

RESULTS

Parents' reports of children's EAH in response to external cues were associated with greater EAH after both meals, adjusting for body composition, sex, age, race, puberty, and meal intake. Adolescent-reported EAH was unrelated or showed an inverse association with observed EAH.

CONCLUSIONS

Parent-reported EAH showed a positive association with adolescents' observed EAH and may be a useful research and clinical tool for assessing EAH in response to external cues in conditions when laboratory assessments are not feasible.