Eating in the absence of hunger: a genetic marker for childhood obesity in prepubertal boys?

Eating in the Absence of Hunger in Hispanic Preschoolers: Relationships with Child Sex, Food Preference, and Weight Status

Background/Objectives: This study examines the relationship of eating in the absence of hunger (EAH) with child sex, food preference, and body mass index (BMI) percentiles in primarily Hispanic preschoolers, an understudied population. Methods: This was a secondary analysis of data from 211 children (79% Hispanic) aged 3 to 5 years from low-income families who completed a cluster randomized controlled trial from September 2017 to June 2020. Weight and height were used to calculate BMI percentiles. Sweet (animal crackers) and salty (pretzels) snacks were used to conduct a validated classroom-based EAH assessment. A generalized estimating equation (GEE) approach investigated associations between the grams of snacks consumed and BMI percentiles. A set of nested multivariable GEEs were estimated, while adjusting for potentially important covariates. Results: Boys significantly consumed more snacks than girls (13.34 ± 9.71 g vs. 8.13 ± 7.36 g; p < 0.001). Children who indicated greater preference for sweet snacks consumed more sweet snacks (r = 0.19; b = 2.05, p < 0.001) and total grams of total snacks (r = 0.18; b = 2.42, p = 0.004) but not salty snacks (pretzels). Consuming more sweet snacks was significantly associated with higher BMI percentiles (b = 0.55; p = 0.024). Conclusions: The findings suggest that a preference for sweet snacks is associated with EAH, and eating sweet snacks in the absence of hunger is related to higher BMI percentiles. Obesity prevention programs may focus on addressing eating sweet snacks in the absence of hunger starting in early childhood.

Unraveling Childhood Obesity: A Grounded Theory Approach to Psychological, Social, Parental, and Biological Factors

Childhood obesity is a major medical and public health issue of global interest, which is influenced by a diverse array of factors and carries significant medical and psychosocial implications. Despite the extensive studies that have been conducted to explore the specific issue, the impact of several factors that influence, generate, worsen, and make chronic the phenomenon needs further exploration. This study aimed to construct a grounded theory that includes and connects the psychological, social, parental, and biological factors affecting childhood obesity. Key psychological factors include mental health issues such as depression and emotional eating, while social factors encompass socioeconomic status and cultural influences. Parental factors involve parenting styles and feeding practices, and biological factors relate to genetic predispositions and prenatal conditions. These factors interact in complex ways, highlighting the multifactorial nature of childhood obesity. The study employed a qualitative grounded theory approach, using research articles to achieve a thorough understanding. Qualitative analysis of the articles was conducted using Atlas.ti 24.0 software. Twenty-five research articles were required to reach theoretical saturation. The analysis resulted in 336 codes that were grouped into seven broad categories and twenty-four different subcategories. Through the construction of the theoretical framework, it was recognized that obesity in minors is a complex and multifactorial issue and that the network of causes and influencing factors covers a broad spectrum ranging from the individual to the family, and subsequently to society at large, which interact with each other.

Psychometric properties of the Turkish version of the eating in the absence of hunger in children and adolescents (EAH-C)

BACKGROUND AND PURPOSE

Eating in the absence of hunger is a risk factor for excessive energy intake and predisposes children to overweight/obesity. The purpose of this study was to test the validity and reliability of the "Eating in the Absence of Hunger Questionnaire for Children and Adolescents (EAH-C)" in Türkiye.

METHODS

This study was conducted in a total of six schools, with children 8-18 years old between September and December 2022. Factor analysis, item-total score analysis and Cronbach's alpha coefficient were used for the validity and reliability.

RESULTS

The calculated KMO statistic was >0.60, and the Bartlett's test statistic was <0.05. The three subscales accounted for 65.22% of the total variance. Factor loads ranged from 0.41 to 0.84. The value obtained by dividing χ2 by the number of degrees of freedom was <5; the RMSEA was <0.10; the RMR was <0.08; and the TLI, GFI, AGFI, and CFI were >0.90. Cronbach's alpha coefficient was 0.91 for the total scale.

CONCLUSIONS

Our study has confirmed that the Turkish-language version of the EAH-C is a valid and reliable tool.

PRACTICE IMPLICATIONS

In the effort of prevention of childhood obesity, identifying eating behaviors in the absence of hunger in children and adolescents will benefit policymakers to develop intervention and prevention programs, in addition to providing guidance to pediatric nurses, all healthcare professionals, researchers, children, and parents.

PACE: a Novel Eating Behavior Phenotype to Assess Risk for Obesity in Middle Childhood

BACKGROUND

Behavioral phenotypes that predict future weight gain are needed to identify children susceptible to obesity.

OBJECTIVES

This prospective study developed an eating behavior risk score to predict change in adiposity over 1 y in children.

METHODS

Data from 6 baseline visits (Time 1, T1) and a 1-y follow-up visit (Time 2, T2) were collected from 76, 7- to 8-y-old healthy children recruited from Central Pennsylvania. At T1, children had body mass index (BMI) percentiles <90 and were classified with either high (n = 33; maternal BMI ≥30 kg/m2) or low (n = 43; maternal BMI ≤25 kg/m2) familial risk for obesity. Appetitive traits and eating behaviors were assessed at T1. Adiposity was measured at T1 and T2 using dual-energy x-ray absorptiometry, with a main outcome of fat mass index (FMI; total body fat mass divided by height in meters squared). Hierarchical linear regressions determined which eating measures improved prediction of T2 FMI after adjustment for covariates in the baseline model (T1 FMI, sex, income, familial risk, and Tanner stage).

RESULTS

Four eating measures-Portion susceptibility, Appetitive traits, loss of control eating, and eating rate-were combined into a standardized summary score called PACE. PACE improved the baseline model to predict 80% variance in T2 FMI. PACE was positively associated with the increase in FMI in children from T1 to T2, independent of familial risk (r = 0.58, P < 0.001). Although PACE was higher in girls than boys (P < 0.05), it did not differ by familial risk, income, or education.

CONCLUSIONS

PACE represents a cumulative eating behavior risk score that predicts adiposity gain over 1 y in middle childhood. If PACE similarly predicts adiposity gain in a cohort with greater racial and socioeconomic diversity, it will inform the development of interventions to prevent obesity. This trial was registered at clinicaltrials.gov as NCT03341247.

Aberrant functional connectivity between reward and inhibitory control networks in pre-adolescent binge eating disorder

BACKGROUND

Behavioral features of binge eating disorder (BED) suggest abnormalities in reward and inhibitory control. Studies of adult populations suggest functional abnormalities in reward and inhibitory control networks. Despite behavioral markers often developing in children, the neurobiology of pediatric BED remains unstudied.

METHODS

58 pre-adolescent children (aged 9-10-years) with BED (mBMI = 25.05; s.d. = 5.40) and 66 age, BMI and developmentally matched control children (mBMI = 25.78; s.d. = 0.33) were extracted from the 3.0 baseline (Year 0) release of the Adolescent Brain Cognitive Development (ABCD) Study. We investigated group differences in resting-state functional MRI functional connectivity (FC) within and between reward and inhibitory control networks. A seed-based approach was employed to assess nodes in the reward [orbitofrontal cortex (OFC), nucleus accumbens, amygdala] and inhibitory control [dorsolateral prefrontal cortex, anterior cingulate cortex (ACC)] networks via hypothesis-driven seed-to-seed analyses, and secondary seed-to-voxel analyses.

RESULTS

Findings revealed reduced FC between the dlPFC and amygdala, and between the ACC and OFC in pre-adolescent children with BED, relative to controls. These findings indicating aberrant connectivity between nodes of inhibitory control and reward networks were corroborated by the whole-brain FC analyses.

CONCLUSIONS

Early-onset BED may be characterized by diffuse abnormalities in the functional synergy between reward and cognitive control networks, without perturbations within reward and inhibitory control networks, respectively. The decreased capacity to regulate a reward-driven pursuit of hedonic foods, which is characteristic of BED, may in part, rest on this dysconnectivity between reward and inhibitory control networks.

Discordance between assessments of food cue responsiveness: Implications for assessment in youth with overweight/obesity

Food cue responsiveness (FCR), broadly defined as behavioral, cognitive, emotional and/or physiological responses to external appetitive cues outside of physiological need, contributes to overeating and obesity among youth and adults. A variety of measures purportedly assess this construct, ranging from youth- or parent-report surveys to objective eating tasks. However, little research has assessed their convergence. It is especially important to evaluate this in children with overweight/obesity (OW/OB), as reliable and valid assessments of FCR are essential to better understand the role of this critical mechanism in behavioral interventions. The present study examined the relationship between five measures of FCR in a sample of 111 children with OW/OB (mean age = 10.6, mean BMI percentile = 96.4; 70% female; 68% white; 23% Latinx). Assessments included: objectively measured eating in the absence of hunger (EAH), parasympathetic activity when exposed to food, parent reported food responsiveness subscale from the Child Eating Behavior Questionnaire (CEBQ-FR), child self-reported Power of Food total score (C-PFS), and child self-reported Food Cravings Questionnaire total score (FCQ-T). Statistically significant spearman correlations were found between EAH and CEBQ-FR (ρ = 0.19, p < 0.05) and parasympathetic reactivity to food cues with both C-PFS (ρ = -0.32, p = 0.002) and FCQ-T (ρ = -0.34, p < 0.001). No other associations were statistically significant. These relationships remained significant in subsequent linear regression models controlling for child age and gender. The lack of concordance between measures assessing highly conceptually related constructs is of concern. Future studies should seek to elucidate a clear operationalization of FCR, examine the associations between FCR assessments in children and adolescents with a range of weight statuses, and evaluate how to best revise these measures to accurately reflect the latent construct being assessed.

Child Weight Status: The Role of Feeding Styles and Highly Motivated Eating in Children

Although parental feeding plays an important role in child eating and weight status, high food motivation among children may also be a factor shaping how feeding impacts child weight. This study explored whether individual differences in preschool children's food motivation interacted with mothers' feeding styles in predicting subsequent child weight status. Participants included 129 Hispanic Head Start mother/child dyads. Data were collected at ages 4-5 years (Time 1) and 7-9 (Time 3). Staff measured heights/weights and observed children in an eating in the absence of hunger task. Mothers reported on feeding styles/practices and children's eating behaviors. A principal components analysis derived a measure of highly motivated eating in children. Multiple regressions predicted Time 3 child BMI z-scores. Time 3 BMI z-scores were positively predicted by authoritative and indulgent feeding styles and negatively predicted by monitoring. Since feeding style interacted with highly motivated eating, separate regressions were run for high and low food motivation in children. Unexpectedly, results showed that authoritative feeding positively predicted Time 3 child BMI z-scores only for children showing low levels of food motivation. Characterizing differential parental feeding and child eating phenotypes may assist in tailoring childhood obesity prevention programs for the target populations.

Factors Associated with Eating in the Absence of Hunger among Children and Adolescents: A Systematic Review

Eating in the absence of hunger (EAH) has been extensively studied over the past two decades and has been associated with excess body weight and the development of obesity. However, determinants of EAH remain uncertain. This systematic review aims to identify individual, familial, and environmental factors associated with EAH among children and adolescents. We included studies with a measure of EAH in participants aged 3-17 years old and including ≥1 factor associated with EAH. Our search identified 1494 articles. Of these, we included 81 studies: 53 cross-sectional, 19 longitudinal and nine intervention studies. In childhood (≤12 years old), EAH increases with age, it is greater in boys compared to girls, and it is positively associated with adiposity. Moreover, EAH development seems to be influenced by genetics. In adolescence, the number of studies is limited; yet, studies show that EAH slightly increases or remains stable with age, is not clearly different between sexes, and findings for overweight or obesity are less consistent across studies in adolescence. For familial factors, parental restrictive feeding practices are positively associated with EAH during childhood, mostly for girls. Studies assessing environmental factors are lacking and robust longitudinal studies spanning from early childhood to adolescence are needed.

Characteristics of eating behavior profiles among preschoolers with low-income backgrounds: a person-centered analysis

BACKGROUND

Individual differences in eating behaviors among young children are well-established, but the extent to which behaviors aggregate within individuals to form distinct eating behavior profiles remains unknown. Our objectives were to identify eating behavior profiles among preschool-aged children and evaluate associations with temperament and weight.

METHODS

A secondary, cross-sectional analysis of baseline data from 2 cohort studies was conducted involving 1004 children aged 3-4 years and their parents with low-income backgrounds. Children's eating behaviors and temperament were assessed by parental report. Body mass index z-scores and weight status were calculated using measured heights and weights. Latent profile analysis (LPA) was used to generate profiles and bivariate analyses were used to evaluate associations with temperament and weight status.

RESULTS

LPA revealed the presence of 3 eating behavior profiles among children. Children with High Food Approach profiles (21.2%) had lower temperamental inhibitory control and the highest percent of children with obesity relative to the other profiles. Children with High Food Avoidant profiles (35.6%) had lower temperamental impulsivity and lower BMI z-scores relative to the other profiles, whereas children with Moderate Eating profiles (intermediary levels of all behaviors; 43.2%) had higher temperamental inhibitory control and lower anger/frustration, than other profiles.

CONCLUSIONS

Young children's eating behaviors appear to aggregate within individuals to form empirically distinct profiles reflecting food approach, food avoidance, and moderate approaches to eating that are differentiated by aspects of temperament and weight. Future work should seek to understand the extent to which health promotion and obesity prevention approaches should be tailored to take into account children's fundamental dispositions towards eating.

Regional gray matter abnormalities in pre-adolescent binge eating disorder: A voxel-based morphometry study

BACKGROUND

Binge eating disorder (BED) is a pernicious psychiatric disorder which is linked with an array of multisystemic organ morbidity, broad psychiatric morbidity, and obesity. Despite behavioral markers often developing in early childhood, the neurobiological markers of early-onset BED remain understudied, and developmental pathophysiology remains poorly understood.

METHODS

71 preadolescent children (aged 9-10-years) with BED and 74 age, BMI and developmentally matched control children were extracted from the 3.0 baseline (Year 0) release of the Adolescent Brain Cognitive Development (ABCD) Study. We investigated group differences in gray matter density (GMD) via voxel-based morphometry (VBM). We additionally performed region of interest analyses, assessing the association between GMD in nodes of the reward (orbitofrontal cortex; OFC) and inhibitory control (dorsolateral prefrontal cortex; dlPFC) networks, and parent-reported behavioral inhibition and approach tendencies.

RESULTS

Diffuse elevations in cortical GMD were noted in those with BED, which spanned prefrontal, parietal, and temporal regions. No areas of reduced GMD were noted in those with BED. No alterations in subcortical GMD were noted. Brain-behavioral associations suggest a distinct and negative relationship between GMD in the OFC and dlPFC, respectively, and self-reported markers of hedonic behavioral approach tendencies.

CONCLUSIONS

Early-onset BED may be characterized by diffuse morphological abnormalities in gray matter density, suggesting alterations in cortical architecture which may reflect decreased synaptic pruning and arborization, or decreased myelinated fibers and therefore inter-regional afferents.

Validation of a Classroom Version of the Eating in the Absence of Hunger Paradigm in Preschoolers

Eating in the absence of hunger (EAH), a measure of children's propensity to eat beyond satiety in the presence of highly palatable food, has been associated with childhood obesity and later binge eating behavior. The EAH task is typically conducted in a research laboratory setting, which is resource intensive and lacks ecological validity. Assessing EAH in a group classroom setting is feasible and may be a more efficient alternative, but the validity of the classroom assessment against the traditional individually-administered paradigm has not been tested. The objective of this study was to compare EAH measured in a classroom setting to the one-on-one version of the paradigm in a sample of Head Start preschoolers. Children (n = 35) from three classrooms completed both classroom and individual EAH tasks in a random, counterbalanced order. In the group condition, children sat with peers at their classroom lunch tables; in the individual condition, children met individually with a researcher in a separate area near their classroom. In both conditions, following a meal, children were provided free access to generous portions of six snack foods (~750 kcal) and a selection of toys for 7 min. Snacks were pre- and post-weighed to calculate intake. Parents completed a survey of their child's eating behaviors, and child height and weight were measured. Paired t-tests and intraclass correlation coefficients were used to compare energy intake between conditions, and correlations between EAH intake and child BMI, eating behaviors, and parent feeding practices were examined to evaluate concurrent validity. Average intake was 63.0 ± 50.4 kcal in the classroom setting and 53.7 ± 44.6 in the individual setting, with no significant difference between settings. The intraclass correlation coefficient was 0.57, indicating moderate agreement between conditions. Overall, the EAH protocol appears to perform similarly in classroom and individual settings, suggesting the classroom protocol is a valid alternative. Future studies should further examine the role of age, sex, and weight status on eating behavior measurement paradigms.

The complicated relationship among parent and child disinhibited eating behaviors

Disinhibited eating behaviors (e.g., loss of control eating (LOC) and eating in the absence of hunger (EAH)) contribute to overeating and obesity. This study aimed to evaluate whether these traits are related in parent-child dyads and how the reporter of child eating behavior (parent or child) impacts this relationship. Two-hundred and ninety treatment-seeking children, ages 8-13, with overweight or obesity (BMI percentile for age and sex 85-99.9%) and their parents were included. LOC and EAH were assessed by child report for self, parent report for self, and parent report for child. Parent and child disinhibited eating behaviors were related only when parents reported on both their own and their child's eating behaviors (p-values < 0.04). Child report of LOC and EAH for self was not associated with parent report of LOC and EAH for self (p-values > 0.05). There was a significant interaction between parent's EAH and BMI as it related to parent report of child EAH (B = 0.02; SE = 0.005; p = 0.004) such that parents with lower BMI reported their own EAH to be lower than parents with higher BMI, but parent report of child EAH was similar regardless of the parent's BMI. Disinhibited eating behaviors were related only when a single parent reported on both their own and their child's behavior, suggesting a potential reporting bias. Given that the relation between parent and child disinhibited eating behaviors varies based on who is reporting the child's behavior, it may be important to consider both parent and child report when designing research studies or in clinical settings while also recognizing potential reporting biases.

Validación psicométrica del Cuestionario de Emociones en la Motivación de la Ingesta

La medición apropiada de la influencia de las emociones en la ingesta de alimentos resulta relevante para encaminar las estrategias de salud en materia de prevención de obesidad y  Trastornos de Conducta Alimentaria. El objetivo del presente estudio fue validar un instrumento para medir la influencia de las emociones en la motivación de la ingesta, desde la construcción hasta su validación. En la construcción participaron 6 jueces expertos en psicología y en la validación participaron 416 adultos mexicanos (56 % mujeres, 44 % hombres, edad M = 39.43 años, DE = 12.56). Se obtuvo una confiabilidad a través del coeficiente alpha de Cronbach de 0.906. La validez de constructo fue a través del análisis factorial de componentes principales con rotación varimax, del cual se obtuvieron 4 factores que explican 50.36% de la varianza, con un KMO de 0.888 un valor χ2 de la prueba de Bartlett de 4418.36 p < 0.001. Una limitación del estudio fue la regionalización de la muestra, por lo que se sugiere replicar el estudio con otras poblaciones. La escala mostró buenas propiedades psicométricas para medir la influencia de las emociones en la motivación de la ingesta.

Eating in the absence of hunger in 18-month-old children in a home setting

BACKGROUND

Eating in the absence of hunger (EAH), the susceptibility to eat despite satiety, may increase overweight. While EAH has been established in school-aged children, less is known about it during toddlerhood.

OBJECTIVES

This study assessed to what extent 18-month-old children eat in the absence of hunger, the stability of this behaviour at 24 months and the association of child eating behaviours with EAH.

METHODS

Children were presented with four palatable finger foods (total 275 kcal) after dinner. Univariate GLM's assessed the association between EAH, child satiety and eating behaviours and energy intake of dinner at 18 and 24 months (n = 206 and 103, respectively). Another GLM was run to assess the association between EAH at both time points.

RESULTS

Mean (±SD) energy intakes from dinner and finger foods were 240 kcal (±117) and 40 kcal (±37), respectively. No association was found between energy intake of dinner and finger foods. Enjoyment of food was significantly related to intake of finger foods (P = .005). EAH at 18 months predicted EAH at 24 months.

CONCLUSION

Eighteen-month-old children ate in the absence of hunger, irrespective of satiety. Thus, preceding energy intake was not compensated for. Other factors, for example, enjoyment of food seem to determine finger food intake.

The Role of Caregiver's Feeding Pattern in the Association between Parents' and Children's Healthy Eating Behavior: Study in Taichung, Taiwan

While parenting style has been linked with parent feeding behavior (FB), little is known about the role FB plays in the relationship between parents’ eating behavior (PEB) and children’s eating behavior (CEB). Based on social learning theory, we hypothesized that children learn to develop healthy CEB by obeying and imitating parents’ healthy eating and feeding behaviors, and that FB is the mediator between PEB and CEB. In total, 257 survey responses from parents of children up to 5 years old were included in the study. Results indicated that CEB did not differ by children’s age, gender, or birth order; for parents, older age and lower educational levels were associated with less healthy unhealthier FB and PEB. Healthy PEB and FB explained 46.8% and 21.7% of the variance in healthy CEB, respectively. The model confirmed that FB reduced the coefficient of healthy PEB from 0.563 to 0.468 and increased the variance explained from 35.0% to 38.5%. FB was a mediator for PEB and CEB. Discussion covers the complexity of ideal parenting styles and child feeding and their associated effects on CEB in varied environments, including different cultures. We concluded that PEB was the main predictor of CEB, and healthy feeding acted as a mediator.

Does eating in the absence of hunger extend to healthy snacks in children?

OBJECTIVES

To assess if eating in the absence of hunger (EAH) extends to healthier snacks and examine the relationship between the home food environment and EAH in children with normal weight (NW) or overweight/obesity (OB) who are at low risk (LR) or high risk (HR) for obesity based on maternal obesity.

METHODS

EAH was assessed after lunch and dinner when children received either low energy dense fruit snacks or high energy dense sweet/savoury snacks. The availability of obesogenic foods in the home was assessed by the Home Food Inventory.

RESULTS

Data showed significant main effects of risk group (P=.0003) and snack type (P < .001). EAH was significantly greater in HR-OB (284±8 kcal) than LR-NW (249±9 kcal) or HR-NW (251±8 kcal) children. Serving fruit rather than sweet/savoury snacks reduced energy intake, on average, by 60% (223 kcal) across risk groups. For each unit increase in the obesogenic home food environment, EAH of sweet/savoury snacks decreased by 1.83 calories.

CONCLUSIONS

Offering low energy dense snacks after a meal can moderate EAH and increase children's intake of healthy foods. Increased access to obesogenic foods in the home may reduce the salience of high energy dense snacks when they become available in other settings.

Observed restrictive feeding practices among low-income mothers of pre-adolescents

OBJECTIVES

To describe verbal and non-verbal restrictive feeding practices used by low-income mothers with their pre-adolescent children during a laboratory-based protocol, and examine associations between mother/child anthropometrics, child appetitive traits and mothers' restrictive practices.

METHODS

Mothers and children (dyad n = 108, mean child age = 11.0 years [SD = 1.2]) were provided a standardized meal and then buffet of desserts. Sessions were video-recorded, and trained coders reliably identified positive and negative restrictive statements, non-verbal restrictive behaviours and redirection to healthier foods. Mother/child anthropometrics were measured by trained study staff and child appetitive traits reported by mothers using subscales of the Children's Eating Behaviours Questionnaire. Negative binomial regression was used to examine associations between mother/child characteristics and restrictive practices.

RESULTS

Nearly all mothers (89.8%) engaged in restrictive feeding during the dessert buffet. Positive restrictive statements were the most common form of restriction (mean statements/10 minutes = 3.2 [SD = 3.1]). No associations were observed between children's body mass index (BMI) or appetitive traits and mothers' restrictive feeding practices. Associations of small effect size were observed between mothers' BMI, use of positive restrictive statements (incidence rate ratio [IRR] = 0.98 [0.96-0.996]) and non-verbal restrictive behaviours (IRR = 0.96 [0.93-0.99]).

CONCLUSIONS

Laboratory-based feeding protocols can objectively assess nuances in restrictive feeding practices. Further research is needed to understand how specific approaches to restriction affect children's eating behaviours and weight.

Adolescent obesity: Confessions of the young mind

Background

Obesity represents a worldwide leading health problem. Although the proportion of adolescent obesity is continuously rising, yet little is known considering adolescent's opinions regarding this condition.

Aim

To investigate adolescent's perceptions in relation to various aspects of obesity in a prospective cohort study.

Subjects and methods

The study population included primary school adolescents, 11-12 years of age. Anthropometric measurements of participants included height and weight. Overweight and obese participants were classified using the International Obesity Task Force criteria. A structured questionnaire assessing physical activity, dietary habits, parental guidance regarding dietary intake and psychological aspects in relation to social functioning, body weight and image was completed by each adolescent.

Results

Three hundred and thirty-five adolescents (181 boys) formed the study group. Obese participants were found to have significantly fewer friends (p = .050) and preferred indoor sedentary activities (p = .041). No differences were observed within the groups when questioned about their eating habits in terms of appetite and hunger. The majority of participants reported frequent consumption of homemade snacks in school resulting in no significant difference within the groups. Finally, body weight satisfaction was recorded for only 5.66% of the obese children, 25.66% and 68.64% of overweight and normal-weight participants respectively.

Conclusions

Our findings support the notion that adolescents are perfectly capable of expressing their opinions. When planning interventional programs for the management of adolescent obesity their views should be strongly considered.

Infants with big appetites: The role of a nonfood environment on infant appetitive traits linked to obesity

BACKGROUND

Individual differences in appetitive traits present in the first few weeks of life. Research has shown that infants with a greater food reinforcement ratio (FRR) have higher obesity risk. To date, limited work has examined the relation between FRR and appetitive traits of infants, and how FRR relates to appetitive traits and obesity development.

OBJECTIVES

To examine the relation between appetitive traits and food and nonfood reinforcement of infants aged 9-18 mo, and to examine whether food and nonfood reinforcement mediate the relation between appetitive traits and weight-for-length z-score (zWFL).

METHOD

This secondary data analysis was conducted by combining 4 different cohorts of infants (n = 143) who have complete data on the food/nonfood reinforcement task, Baby Eating Behavior Questionnaire, and anthropometrics and demographics assessments. Three different nonfood reinforcers were used: video (DVD; n = 27), playing with bubbles (Bubbles; n = 67), and music accompanied by instruments (Music; n = 49) for the nonfood portion of the task. For the food portion of the task, the infant's favorite food was used.

RESULTS

General appetite positively correlated with FRR and zWFL, but negatively correlated with nonfood reinforcement; satiety responsiveness negatively correlated with food reinforcement, FRR, and zWFL. Mediational analysis showed that effects of general appetite on zWFL were mediated by FRR (indirect effect = 0.100, 95% CI: 0.041, 0.187) and nonfood reinforcement (indirect effect = 0.076, 95% CI: 0.025, 0.156). We also observed the mediating effect of FRR on the relation of satiety responsiveness and zWFL (indirect effect = -0.097, 95% CI: -0.204, -0.026).

CONCLUSIONS

Our work contributes to the mechanistic understanding of the ontogeny of obesity development early in life among individuals who are born with appetitive drive for overconsumption. During early infancy, the nonfood environment may protect against this drive and prevent obesity development.

A Bidirectional Analysis of Feeding Practices and Eating Behaviors in Parent/Child Dyads from Low-Income and Minority Households

OBJECTIVE

To prospectively examine the bidirectional relationship between parental feeding practices (eg, instrumental feeding, encouragement to eat) and child eating behaviors (eg, food responsiveness, emotional eating) in low-income, ethnically diverse preschool children over a 3-year period.

STUDY DESIGN

Parent/child (age 2-4 years at baseline) pairs (n = 222 non-Hispanics; n = 312 Hispanics) participated in NET-Works (Now Everybody Together for Amazing and Healthful Kids), a randomized controlled trial carried out in community and in-home settings in urban areas of Minnesota. Data were collected at baseline and 12, 24, and 36 months. The present study is a secondary data analysis using cross-lagged models to identify bidirectional associations between parental feeding practices and child eating behaviors.

RESULTS

Three models showed significant cross-lagged effects (P < .05): model 1, parental instrumental feeding influencing later child food responsiveness; model 2, parental emotional feeding influencing later child food responsiveness; and model 3, parental emotional feeding influencing later child eating satiety. Model 1 showed significant bidirectional temporal paths, whereas models 2 and 3 showed significant unidirectional temporal paths from parental feeding practices to child eating behaviors.

CONCLUSIONS

Parental instrumental and emotional feeding practices prospectively influence child food responsiveness and satiety. This study demonstrates causal temporality between parental feeding practices and child eating behaviors. Heath care providers may want to use findings regarding parent feeding practices as part of their anticipatory guidance during well-child visits with parents of preschoolers.

Caregiver Influences on Eating Behaviors in Young Children: A Scientific Statement From the American Heart Association

A substantial body of research suggests that efforts to prevent pediatric obesity may benefit from targeting not just what a child eats, but how they eat. Specifically, child obesity prevention should include a component that addresses reasons why children have differing abilities to start and stop eating in response to internal cues of hunger and satiety, a construct known as eating self‐regulation. This review summarizes current knowledge regarding how caregivers can be an important influence on children's eating self‐regulation during early childhood. First, we discuss the evidence supporting an association between caregiver feeding and child eating self‐regulation. Second, we discuss what implications the current evidence has for actions caregivers may be able to take to support children's eating self‐regulation. Finally, we consider the broader social, economic, and cultural context around the feeding environment relationship and how this intersects with the implementation of any actions. As far as we are aware, this is the first American Heart Association (AHA) scientific statement to focus on a psychobehavioral approach to reducing obesity risk in young children. It is anticipated that the timely information provided in this review can be used not only by caregivers within the immediate and extended family but also by a broad range of community‐based care providers.

Short-Term Effects of an Obesity Prevention Program Among Low-Income Hispanic Families With Preschoolers

OBJECTIVE

To assess the short-term effects of an obesity prevention program promoting eating self-regulation and healthy food preferences in low-income Hispanic children.

DESIGN

Randomized controlled trial with pretest, posttest, and 6- and 12-month assessments.

SETTING AND PARTICIPANTS

Head Start and similar early learning institutions in Houston, TX, and Pasco, WA. A total of 255 families with preschoolers randomized into prevention (n = 136) and control (n = 119) groups.

INTERVENTION

Multicomponent family-based prevention program. Fourteen waves lasted 7 weeks each with 8-10 mother-child dyads in each group.

MAIN OUTCOME MEASURES

Parent assessments included feeding practices, styles, and knowledge. Child assessments included child eating self-regulation, willingness to try new foods, and parent report of child fruit and vegetable preferences. Parent and child heights and weights were measured.

ANALYSIS

Multilevel analyses were employed to consider the nested nature of the data: time points within families within waves.

RESULTS

The program had predicted effects on parental feeding practices, styles, and knowledge in the pre- to post-comparisons. Effects on child eating behavior were minimal; only the number of different vegetables tried showed significant pre-post differences.

CONCLUSIONS AND IMPLICATIONS

Short-term effects of this prevention program highlight the importance of family-focused feeding approaches to combating child overweight and obesity.

Pediatric Eating Behaviors as the Intersection of Biology and Parenting: Lessons from the Birds and the Bees

PURPOSE OF REVIEW

Current feeding advice to prevent pediatric obesity focuses on caregiver feeding behaviors. This review integrates newer data showing that child appetitive traits also have a genetic component.

RECENT FINDINGS

Caregiver feeding behaviors robustly correlate with child eating behaviors; however, there is also a strong heritable component. The satiety cascade delineates the biological drive underlying hunger, satiation, and satiety. Innate individual differences exist for the components of the satiety cascade, which may explain the heritability of child eating behaviors. However, given the correlation of caregiver feeding behaviors with child eating behaviors, any etiological model should include both genetic/biological components and environmental. Integrating the biological etiology of child eating behaviors into the current environmental model has implications for tailoring feeding advice which needs to move from a "one size fits all" approach to one that is tailored to individual differences in children's biological drives to appetite.

Eating in the absence of hunger in young children is related to brain reward network hyperactivity and reduced functional connectivity in executive control networks

BACKGROUND

Recent work has implicated disinhibited eating behaviours (DEB) as a potential pathway toward obesity development in children. However, the underlying neurobiology of disinhibited eating behaviours in young, healthy weight children, prior to obesity development, remains unknown.

OBJECTIVES

This study tested the relationship between DEB and intrinsic neuronal activity and connectivity in young children without obesity.

METHODS

Brain networks implicated in overeating including reward, salience and executive control networks, and the default mode network were investigated. DEB was measured by the eating in the absence of hunger (EAH) paradigm with postlunch kilocalories consumed from highly palatable foods (EAH kcal) used as the predictor. Intrinsic neuronal activity within and connectivity between specified networks were measured via resting-state functional magnetic resonance imaging. Eighteen typically developing children (mean age = 5.8 years) were included.

RESULTS

EAH kcal was positively associated with activity of the nucleus accumbens, a major reward network hub (P < 0.05, corrected). EAH kcal was negatively associated with intrinsic prefrontal cortex connectivity to the striatum (P < 0.01, corrected).

CONCLUSIONS

These results suggest that neural aspects of DEB are detectable in young children without obesity, providing a potential tool to better understand the development of obesity in this population.

A Biopsychosocial Model of Sex Differences in Children's Eating Behaviors

The prevalence of obesity and eating disorders varies by sex, but the extent to which sex influences eating behaviors, especially in childhood, has received less attention. The purpose of this paper is to critically discuss the literature on sex differences in eating behavior in children and present new findings supporting the role of sex in child appetitive traits and neural responses to food cues. In children, the literature shows sex differences in food acceptance, food intake, appetitive traits, eating-related compensation, and eating speed. New analyses demonstrate that sex interacts with child weight status to differentially influence appetitive traits. Further, results from neuroimaging suggest that obesity in female children is positively related to neural reactivity to higher-energy-dense food cues in regions involved with contextual processing and object recognition, while the opposite was found in males. In addition to differences in how the brain processes information about food, other factors that may contribute to sex differences include parental feeding practices, societal emphasis on dieting, and peer influences. Future studies are needed to confirm these findings, as they may have implications for the development of effective intervention programs to improve dietary behaviors and prevent obesity.

Design and methodology of a cluster-randomized trial in early care and education centers to meet physical activity guidelines: Sustainability via Active Garden Education (SAGE)

Strategies are needed to help early care and education centers (ECEC) comply with policies to meet daily physical activity and fruit and vegetable guidelines for young children. This manuscript describes the design and methodology of Sustainability via Active Garden Education (SAGE), a 12-session cluster-randomized controlled crossover design trial using community-based participatory research (CBPR) to test a garden-based ECEC physical activity and fruit and vegetables promotion intervention for young children aged 3-5 years in 20 sites. The SAGE curriculum uses the plant lifecycle as a metaphor for human development. Children learn how to plant, water, weed, harvest, and do simple food preparation involving washing, cleaning, and sampling fruit and vegetables along with active learning songs, games, science experiments, mindful eating exercises, and interactive discussions to reinforce various healthy lifestyle topics. Parents will receive newsletters and text messages linked to the curriculum, describing local resources and events, and to remind them about activities and assessments. Children will be measured on physical activity, height, and weight and observed during meal and snack times to document dietary habits. Parents will complete measures about dietary habits outside of the ECEC, parenting practices, home physical activity resources, and home fruit and vegetable availability. SAGE fills an important void in the policy literature by employing a participatory strategy to produce a carefully crafted and engaging curriculum with the goal of meeting health policy guidelines and educational accreditation standards. If successful, SAGE may inform and inspire widespread dissemination and implementation to reduce health disparities and improve health equity.

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.

Gene-Environment Interplay in Child Eating Behaviors: What the Role of "Nature" Means for the Effects of "Nurture"

PURPOSE OF REVIEW

This narrative review describes the evidence for both genetic and environmental influences on child appetitive traits and suggests ways of thinking about how these interact and correlate to influence how a child eats.

RECENT FINDINGS

Emerging evidence from social network analysis, and from longitudinal studies questioning the direction of association between parent feeding behaviors and child obesity risk, suggest that children's genes may shape the environmental risk for obesity that they are exposed to. There is strong evidence that child appetitive traits are both heritable and shaped by the environment. Instead of thinking about how genetic and environmental factors operate independently on each appetitive trait, research needs to expand the current paradigm to examine how genes and environments interact and shape each other.

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.

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/.

Adolescents at high risk of obesity show greater striatal response to increased sugar content in milkshakes

Background

Children of overweight or obese parents are at a high risk of developing obesity.

Objective

This study sought to examine the underlying neural factors related to parental obesity risk and the relative impact of sugar and fat when consuming a palatable food, as well as the impact of obesity risk status on brain response to appetizing food images.

Design

With the use of functional MRI, the responses of 108 healthy-weight adolescents [mean ± SD body mass index (kg/m2): 20.9 ± 1.9; n = 53 who were at high risk by virtue of parental obesity status, n = 55 who were low risk] to food stimuli were examined. Stimuli included 4 milkshakes, which systematically varied in sugar and fat content, a calorie-free tasteless solution, and images of appetizing foods and glasses of water.

Results

High-risk compared with low-risk adolescents showed greater blood oxygen-dependent response to milkshakes (all variants collapsed) compared with the tasteless solution in the primary gustatory and oral somatosensory cortices (P-family-wise error rate < 0.05), replicating a previous report. Notably, high-risk adolescents showed greater caudate, gustatory, and oral somatosensory responses to the high-sugar milkshake than to the tasteless solution; however, no effect of risk status was observed in the high-fat milkshake condition. Responses to food images were not related to obesity risk status.

Conclusion

Collectively, the data presented here suggest that parental weight status is associated with greater striatal, gustatory, and somatosensory responses to palatable foods-in particular, high-sugar foods-in their adolescent offspring, which theoretically contributes to an increased risk of future overeating. This trial was registered at www.clinicaltrials.gov as NCT01949636.

Dynamic fMRI networks predict success in a behavioral weight loss program among older adults

More than one-third of adults in the United States are obese, with a higher prevalence among older adults. Obesity among older adults is a major cause of physical dysfunction, hypertension, diabetes, and coronary heart diseases. Many people who engage in lifestyle weight loss interventions fail to reach targeted goals for weight loss, and most will regain what was lost within 1-2 years following cessation of treatment. This variability in treatment efficacy suggests that there are important phenotypes predictive of success with intentional weight loss that could lead to tailored treatment regimen, an idea that is consistent with the concept of precision-based medicine. Although the identification of biochemical and metabolic phenotypes are one potential direction of research, neurobiological measures may prove useful as substantial behavioral change is necessary to achieve success in a lifestyle intervention. In the present study, we use dynamic brain networks from functional magnetic resonance imaging (fMRI) data to prospectively identify individuals most likely to succeed in a behavioral weight loss intervention. Brain imaging was performed in overweight or obese older adults (age: 65-79 years) who participated in an 18-month lifestyle weight loss intervention. Machine learning and functional brain networks were combined to produce multivariate prediction models. The prediction accuracy exceeded 95%, suggesting that there exists a consistent pattern of connectivity which correctly predicts success with weight loss at the individual level. Connectivity patterns that contributed to the prediction consisted of complex multivariate network components that substantially overlapped with known brain networks that are associated with behavior emergence, self-regulation, body awareness, and the sensory features of food. Future work on independent datasets and diverse populations is needed to corroborate our findings. Additionally, we believe that efforts can begin to examine whether these models have clinical utility in tailoring treatment.

Parental feeding practices to manage snack food intake: Associations with energy intake regulation in young children

BACKGROUND

Little attention has been directed to understanding the relationship between restriction and regulation of snack food intake in toddlers.

OBJECTIVE

The aim of this study was to examine the effects of parental restriction of toddlers' eating of snacks in the absence of hunger (EAH) and to examine the impact of three contextual factors; snack food access, frequency of snack food consumption, and attraction to snack food.

DESIGN

64 parents and toddlers (aged 22-36 months) took part in a protocol to measure EAH (defined as kJ of energy-dense snack foods consumed). Mean EAH was 199 kJ (SD = 299), with 43 children consuming at least some snacks. Restriction was measured with the Child Feeding Questionnaire Restriction subscale. Snack food access was measured with Allow Access from the Toddler Snack Food Feeding Questionnaire (TSFFQ), snack food consumption was measured with a short snack food frequency questionnaire, and attraction to snack foods was measured with Child's Attraction from the TSFFQ. Moderated regression analyses tested interactions between Restriction and contextual factors in predicting EAH.

RESULTS

EAH was associated with Restriction (r = 0.25, p = .05, 95% CI 0.004 - 0.47). There was an interaction between Restriction and accessibility of snack foods (R² change = 0.08, p = .025); restriction was associated with EAH only when access to snack foods in the home was, on average, higher. The effect of Restriction on EAH was not moderated by frequency of snack food consumption or Child's Attraction.

CONCLUSIONS

These finding have practical relevance and reinforce the importance of the home food environment for managing young children's snack food intake.

Maternal restrictive feeding and eating in the absence of hunger among toddlers: a cohort study

Background

Restrictive feeding by parents has been associated with greater eating in the absence of hunger (EAH) among children, a risk factor for obesity. However, few studies have examined the association between restrictive feeding and EAH longitudinally, raising questions regarding the direction of associations between restrictive feeding and child EAH. Our objective was to examine the bidirectional prospective associations between restrictive feeding and EAH among toddlers.

Methods

Low-income mother-child dyads (n = 229) participated when children were 21, 27, and 33 months old. Restriction with regard to food amount and food quality were measured with the Infant Feeding Styles Questionnaire. EAH was measured as kilocalories of food children consumed after a satiating meal. A cross-lagged analysis adjusting for child sex and weight-for-length z-score was used to simultaneously test cross-sectional and bidirectional prospective associations between each type of restriction and children’s EAH.

Results

At 21 months, mothers of children with greater EAH reported higher restriction with regard to food amount (b = 0.17, p < .05). Restriction with regard to food amount at age 21 months was inversely associated with EAH at 27 months (b = −0.20, p < .05). Restriction with regard to food amount at 27 months was not associated with EAH at 33 months and restriction with regard to food quality was not associated with EAH. EAH did not prospectively predict maternal restriction.

Conclusions

Neither restriction with regard to food amount nor food quality increased risk for EAH among toddlers. Current US clinical practice recommendations for parents to avoid restrictive feeding, and the potential utility of restrictive feeding with regard to food amount in early toddlerhood, deserve further consideration.

Electronic supplementary material

The online version of this article (10.1186/s12966-017-0630-8) contains supplementary material, which is available to authorized users.

What Twin Studies Tell Us About Brain Responses to Food Cues

PURPOSE OF REVIEW

Functional magnetic resonance imaging (fMRI) using visual food cues provides insight into brain regulation of appetite in humans. This review sought evidence for genetic determinants of these responses.

RECENT FINDINGS

Echoing behavioral studies of food cue responsiveness, twin study approaches detect significant inherited influences on brain response to food cues. Both polygenic (whole genome) factors and polymorphisms in single genes appear to impact appetite regulation, particularly in brain regions related to satiety perception. Furthermore, genetic confounding might underlie findings linking obesity to stereotypical response patterns on fMRI, i.e., associations with obesity may actually reflect underlying inherited susceptibilities rather than acquired levels of adiposity. Insights from twin studies show that genes powerfully influence brain regulation of appetite, emphasizing the role of inherited susceptibility factors in obesity risk. Future research to delineate mechanisms of inherited obesity risk could lead to novel or more targeted interventional approaches.

Neural correlates of familial obesity risk and overweight in adolescence

BACKGROUND

Rates of adolescent obesity and overweight are high. The offspring of overweight parents are at increased risk of becoming obese later in life. Investigating neural correlates of familial obesity risk and current overweight status in adolescence could help identify biomarkers that predict future obesity and that may serve as novel targets for obesity interventions.

OBJECTIVE

Our primary aim was to use functional MRI to compare neural responses to words denoting high or low energy density (ED) foods and non-foods, in currently lean adolescents at higher compared with lower familial risk for obesity, and in overweight compared with lean adolescents. Secondary aims were to assess group differences in subjective appetite when viewing food and non-food words, and in objective ad libitum intake of high-ED foods in a laboratory setting.

DESIGN

We recruited 36 adolescents (14-19y), of whom 10 were (obese/overweight "overweight"), 16 lean with obese/overweight mothers (lean high-risk, "lean-HR"), and 10 lean with lean mothers (lean low-risk, "lean-LR"). All underwent fMRI scanning while they viewed words representing high-ED foods, low-ED foods, or non-foods, and provided appetitive ratings in response to each word stimulus. They then consumed a multi-item ad libitum buffet meal.

RESULTS

Food compared with non-food words activated a distributed emotion/reward system including insula and pregenual anterior cingulate cortex (ACC). Participants who were at increasing risk for obesity exhibited progressively weaker activation of an attentional/regulatory system including dorsolateral prefrontal cortex (PFC), dorsal ACC, and basal ganglia nuclei (activation was greatest in lean-LR, intermediate in lean-HR, and weakest in the overweight group). These group differences were most apparent for neural responses to high-compared with low-ED foods. Lean-HR (compared with lean-LR and overweight) adolescents reported greater desire for high-ED foods. Meal intake was greatest for the overweight, then lean-HR, then lean-LR groups.

CONCLUSIONS

Adolescents at higher obesity risk exhibited reduced neural responses to high-ED food cues in a neural system that subserves attention and self-regulation. They also reported heightened appetitive responses to high-ED cues. Interventions that promote the capacity for self-regulation could prevent youth who have a familial predisposition for obesity from translating risk into reality.

Feeding and Mealtime Correlates of Maternal Concern About Children's Weight

OBJECTIVE

To examine associations between maternal concern regarding their children becoming overweight and two domains of weight-related parenting; child feeding practices and family meal characteristics.

DESIGN

Cross-sectional study.

PARTICIPANTS

Low-income mothers (n = 264; 67% non-Hispanic white) and their children (51.5% male, aged 4.02-8.06 years).

VARIABLES MEASURED

Maternal concern and feeding practices, using the Child Feeding Questionnaire. Meal characteristics were assessed using video-recorded meals and meal information collected from mothers.

ANALYSIS

The authors used MANOVA and logistic regression to identify differences in maternal feeding practices and family meal characteristics across levels of maternal concern (none, some, and high).

RESULTS

Approximately half of mothers were not concerned about their child becoming overweight, 28.4% reported some concern, and 19.0% had high concern. Mothers reporting no concern described lower restrictive feeding compared with mothers who reported some or high concern (mean [SE], none = 3.1 [0.1]; some = 3.5 [0.1]; and high = 3.6 [0.1]; P = .004). No differences in other feeding practices or family meal characteristics were observed by level of concern.

CONCLUSIONS AND IMPLICATIONS

Concern regarding children becoming overweight was common. However, concern rarely translated into healthier feeding practices or family meal characteristics. Maternal concern alone may not be sufficient to motivate action to reduce children's risk of obesity.

Screening Obese Adolescents for Binge Eating Disorder in Primary Care: The Adolescent Binge Eating Scale

OBJECTIVE

To investigate the performance of a simple and developmentally appropriate 10-item questionnaire (Adolescent Binge Eating Scale) for the prediction of binge eating disorder (BED) diagnosis in adolescents seen for obesity.

STUDY DESIGN

We evaluated the performance of the questionnaire in comparison with a clinical interview, in a population of adolescents being seen for obesity. The ?² or Fisher exact tests were used.

RESULTS

There were 94 adolescents aged 12-18 years (59.6% girls) who completed the study. The questionnaire demonstrated a good association with the clinical interview and distinguished different levels of risk for having a BED: participants who responded positively to questions 1 or 2 and had more than 6 positive answers to the 8 additional questions had a high risk of subclinical and clinical BED (83.3%); participants with 3 or fewer positive answers had a low risk of clinical BED (4%).

CONCLUSIONS

The Adolescent Binge Eating Scale questionnaire is a potential screening tool to identify adolescents with obesity at high risk of BED and guide referral to a specialist to clarify the diagnosis and provide adequate care.

Maternal feeding practices and children's eating behaviours: A comparison of mothers with healthy weight versus overweight/obesity

This study aimed to explore differences between mothers with healthy weight versus overweight/obesity in a wide range of their reported child feeding practices and their reports of their children's eating behaviours. Mothers (N = 437) with a 2-6-year-old child participated. They comprised two groups, based on their BMI: healthy weight (BMI of 18.0-24.9, inclusive) or overweight/obese (BMI of 25.0 or more). All mothers provided demographic information and completed self-report measures of their child feeding practices and their child's eating behaviour. In comparison to mothers with healthy weight, mothers with overweight/obesity reported giving their child more control around eating (p < 0.001), but encouraged less balance and variety around food (p = 0.029). They also had a less healthy home food environment (p = 0.021) and demonstrated less modelling of healthy eating in front of their children (p < 0.001). There were no significant differences in mothers' use of controlling feeding practices, such as pressure to eat or restriction, based on their own weight status. Mothers with overweight/obesity reported their children to have a greater desire for drinks (p = 0.003), be more responsive to satiety (p = 0.007), and be slower eaters (p = 0.034). Mothers with overweight/obesity appear to engage in generally less healthy feeding practices with their children than mothers with healthy weight, and mothers with overweight/obesity perceive their children as more avoidant about food but not drinks. Such findings are likely to inform future intervention developments and help health workers and clinicians to better support mothers with overweight/obesity with implementing healthful feeding practices and promoting healthy eating habits in their children.

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.

High energy expenditure is not protective against increased adiposity in children

BACKGROUND

Low levels of energy expenditure (TEE) may contribute to excess weight during childhood, but limited longitudinal data exist.

OBJECTIVES

This is to test whether low TEE during the first 6 years of life could predict excess weight status at 8 years.

METHODS

Total energy expenditure from doubly labelled water, weight, stature, waist circumference and fat mass and fat-free mass (FFM) in children at 0.25, 2, 4 and 6 years of age. This cohort includes individuals at high (n = 27) and low risk (n = 26) for childhood obesity, based upon whether pre-pregnant maternal obesity. A linear mixed effects model was fit to TEE. Individual variation was accounted for as a random effect. Residual TEE was calculated for age and individually averaged across time.

RESULTS

Fat-free mass (kg) was highly correlated (R²  = 0.91) with TEE (kcal/day), and waist circumference and sex were also significant predictors of TEE. TEE residual tracked within individuals. TEE residuals did not correlate with either BMI or %fat at age 8 years.

CONCLUSION

Using the residual TEE approach to identify high and low TEE during the first 6 years of life did not explain excess weight at 8 years of life in this cohort of children at high and low risk of obesity based upon maternal obesity status.

Alternatives to restrictive feeding practices to promote self-regulation in childhood: a developmental perspective

Intake of energy-dense snack foods is high among US children. Although the use of restrictive feeding practices has been shown to be counterproductive, there is very limited evidence for effective alternatives to restriction that help children moderate their intake of these foods and that facilitate the development of self-regulation in childhood. The developmental literature on parenting and child outcomes may provide insights into alternatives to restrictive feeding practices. This review paper uses a model of parental control from the child development and parenting literatures to (i) operationally define restrictive feeding practices; (ii) summarize current evidence for antecedents and effects of parental restriction use on children's eating behaviours and weight status, and (iii) highlight alternative feeding practices that may facilitate the development of children's self-regulation and moderate children's intake of palatable snack foods. We also discuss recent empirical evidence highlighting the role of child temperament and food motivation related behaviours as factors that prompt parents to use restrictive feeding practices and, yet, may increase children's dysregulated intake of forbidden foods.

Strategies for Effective Eating Development-SEEDS: Design of an Obesity Prevention Program to Promote Healthy Food Preferences and Eating Self-Regulation in Children From Low-Income Families

OBJECTIVE

To develop a scientifically based childhood obesity prevention program supporting child eating self-regulation and taste preferences. This article describes the research methods for the Strategies for Effective Eating Development program. A logic model is provided that depicts a visual presentation of the activities that will be used to guide the development of the prevention program.

DESIGN

Randomized, controlled prevention program, pretest, posttest, 6 months, and 12 months.

SETTING

Two sites: Houston, TX and Pasco, WA. Each trial will last 7 weeks with 8-10 mother-child dyads in each arm (prevention and control).

PARTICIPANTS

Recruitment at Head Start districts (Texas; n = 160) and Inspire Child Development Center including Early Childhood Education and Head Start (Washington; n = 160). Sixteen trials with 16-20 parent-child dyads per trial will provide adequate power to detect moderate effects.

INTERVENTION

Multicomponent family-based prevention program incorporating a dialogue approach to adult learning and self-determination theory.

MAIN OUTCOME MEASURES

Child assessments will include observed taste preferences, caloric compensation, and eating in the absence of hunger. Parent assessments will include parent-reported feeding, feeding emotions, acculturation, child eating behaviors, child food preferences, and child dietary intake. Heights and weights will be measured for parent and child.

ANALYSIS

A multilevel growth modeling analysis will be employed to consider the nested nature of the data: time points (level 1) within families (level 2) within trials (level 3).

Eating in the Absence of Hunger and Weight Gain in Low-income Toddlers

OBJECTIVE

To identify predictors of eating in the absence of hunger (EAH) in low-income toddlers, describe affect during EAH, test EAH as a predictor of body mass index (BMI), and examine the type of food eaten as a predictor of BMI.

METHODS

EAH, indexed as kilocalories (sweet, salty, and total) of palatable foods consumed after a satiating meal, was measured (n = 209) at ages 21, 27, and 33 months. Child gender, age, race/ethnicity, and previous exposure to the foods; maternal education and depressive symptoms; and family chaos, food insecurity, and structure were obtained via questionnaire. Child and mother BMI were measured. Child affect was coded from videotape. Linear regression was used to examine predictors of EAH and the association of kilocalories consumed and affect with 33 month BMI z-score (BMIz).

RESULTS

Predictors of greater total kilocalories included the child being a boy (P < .01), being older (P < .001), and greater maternal education (P < .01). Being in the the top quartile of sweet kilocalories consumed at 27 months and showing negative affect at food removal had higher BMIz (β = 0.29 [95% confidence interval 0.10 to 0.48] and β = 0.34 [95% confidence interval, 0.12 to 0.56], respectively).There was no association of salty kilocalories consumed or positive affect with BMIz.

CONCLUSIONS

There was little evidence that maternal or family characteristics contribute to EAH. EAH for sweet food predicts higher BMIz in toddlerhood. Studies investigating the etiology of EAH and interventions to reduce EAH in early childhood are needed.

Eating Behaviors and Weight Development in Obesity-Prone Children and the Importance of the Research of Albert J. Stunkard

Albert J. Stunkard, MD, was an internationally recognized leader and pioneer in the field of obesity and eating disorders research. He was also among the first scientists to study eating phenotypes and early life risk factors for childhood obesity at a time when childhood obesity prevalence rates were still comparatively low. The aim of this review is to highlight select findings from the work of Albert J. Stunkard which significantly advanced our understanding of eating traits of children with a different familial predisposition to obesity and genetic and environmental influences on weight outcomes. Collectively, Stunkard's early work on childhood obesity had a significant impact on the field of ingestive behavior and obesity research in that he was one of the first investigators who pointed to genetic influences underlying behavioral eating traits and child weight status. His work also inspired numerous subsequent investigations on the relative contributions of specific genes (e.g., polymorphisms in the fat mass and obesity-associated (FTO) gene) on individual differences in child eating traits (e.g., satiety responsiveness, eating in the absence of hunger) and body weight.

Parental control and overconsumption of snack foods in overweight and obese children

The associations between snack food consumption, parent feeding practices and general parenting in overweight in obese children are largely unknown. Therefore, we examined these relationships in 117 treatment-seeking overweight and obese children (10.40 ± 1.35 years; 53% female; 52% Caucasian; BMI-z: 2.06 ± .39). Children consumed a dinner meal, completed an Eating in the Absence of Hunger (EAH) free access paradigm (total EAH intake = EAH%-total; sweet food intake = EAH%-sweet), and completed the Child Report of Parent Behavior Inventory. Parents completed the Child Feeding Questionnaire. Child EAH%-total and EAH%-sweet were positively associated with dinner consumption (p's < .01). Girls had significantly higher EAH%-total compared to boys (p < .05). In separate models, higher EAH%-total was associated with greater use of maternal psychological control (p < .05) and EAH%-sweet was positively associated with parent monitoring (p < .05). In analyses examining factors associated with the consumption of specific foods, EAH snack food, parent restriction, pressure to eat, monitoring, and maternal psychological control were positively correlated with intake of Hershey's(®) chocolate bars (p's < .05). In summary, parental monitoring is associated with child sweet snack food intake and maternal psychological control is associated with child total snack food consumption. Future research should evaluate the complex relationship between child eating and parenting, especially with regard to subgroups of foods.