A Pilot Study of Neural Correlates of Loss of Control Eating in Children With Overweight/Obesity: Probing Intermittent Access to Food as a Means of Eliciting Disinhibited Eating

Loss of control eating in children is associated with altered cortical and subcortical brain structure

Introduction

Loss of control (LOC) eating is the perceived inability to control how much is eaten, regardless of actual amount consumed. Childhood LOC-eating is a risk factor for the development of binge-eating disorder (BED), but its neurobiological basis is poorly understood. Studies in children with BED have shown both increased gray matter volume in regions related to top-down cognitive control (e.g., dorsolateral prefrontal cortex) and reward-related decision making (e.g., orbital frontal cortex) relative to healthy controls. However, no studies have examined brain structure in children with LOC-eating. To identify potential neurobiological precursors of BED, we conducted secondary analysis of five studies that conducted T1 MPRAGE scans.

Methods

A total of 143, 7-12-year-old children (M = 8.9 years, 70 boys) were included in the study, 26% of which (n = 37) reported LOC-eating (semi-structured interview). Age, sex, and obesity status did not differ by LOC-eating. Differences between children with and without LOC were examined for gray matter volume, cortical thickness, gyrification, sulci depth, and cortical complexity after adjusting for age, sex, total intercranial volume, weight status, and study.

Results

Children with LOC, relative to those without, had greater gray matter volume in right orbital frontal cortex but lower gray matter volume in right parahippocampal gyrus, left CA4/dentate gyrus, and left cerebellar lobule VI. While there were no differences in cortical thickness or gyrification, children with LOC-eating had great sulci depth in left anterior cingulate cortex and cuneus and greater cortical complexity in right insular cortex.

Discussion

Together, this indicates that children with LOC-eating have structural differences in regions related to cognitive control, reward-related decision-making, and regulation of eating behaviors.

Neural correlates of appetite in adolescents

Appetitive characteristics are associated with child adiposity, but their biological underpinnings are unclear. We sought to investigate the neural correlates of psychometric and behavioral measures of appetitive characteristics in youth. Adolescents (14-18y; 39F, 37M) varying in familial obesity risk and body weight (20% with overweight, 24% with obesity) viewed pictures of high energy-density (ED) foods, low-ED foods and non-foods during fMRI scanning on two separate days. On one day participants consumed a 474 ml preload of water (0 kcal, fasted) and on another (counter-balanced) 474 ml milkshake (480 kcal, fed), before scanning. A multi-item ad libitum meal (ALM) followed scanning. Parents completed Child Eating Behavior Questionnaire (CEBQ) sub-scales assessing food approach and food self-regulation. Caloric compensation was calculated as the percentage of preload intake compensated for by down-regulation of ALM intake in the fed vs. fasted condition. Analyses correcting for multiple comparisons demonstrated that, for the fasted condition, higher CEBQ Food Responsiveness scores were associated with greater activation to high-ED (vs. low-ED) foods in regions implicated in food reward (insula, rolandic operculum, putamen). In addition, higher caloric compensation was associated with greater fed vs. fasted activations in response to foods (vs. non-foods) in thalamus and supramarginal gyrus. Uncorrected analyses provided further support for associations of different measures of appetitive characteristics with brain responses to food cues in each condition. Measures of appetitive characteristics demonstrated overlapping and distinct associations with patterns of brain activation elicited by food cues in fasted and fed states. Understanding the neural basis of appetitive characteristics could aid development of biobehaviorally-informed obesity interventions.

Relating neighborhood deprivation to childhood obesity in the ABCD study: Evidence for theories of neuroinflammation and neuronal stress

OBJECTIVE

We evaluated whether relationships between area deprivation (ADI), body mass index (BMI) and brain structure (e.g., cortical thickness, subcortical volume) during preadolescence supported the immunologic model of self-regulation failure (NI) and/or neuronal stress (NS) theories of overeating. The NI theory proposes that ADI causes structural alteration in the brain due to the neuroinflammatory effects of overeating unhealthy foods. The NS theory proposes that ADI-related stress negatively impacts brain structure, which causes stress-related overeating and subsequent obesity.

METHOD

Data were gathered from the Adolescent Brain Cognitive Development Study (9 to 12 years old; n = 3,087, 51% male). Linear mixed-effects models identified brain regions that were associated with both ADI and BMI; longitudinal associations were evaluated with mediation models. The NI model included ADI and BMI at 9 to 10 years old and brain data at 11 to 12 years old. The NS model included ADI and brain data at 9 to 10 years old and BMI at 11 to 12 years old.

RESULTS

BMI at 9 to 10 years old partially mediated the relationship between ADI and ventral diencephalon (DC) volume at 11 to 12 years old. Additionally, the ventral DC at 9 to 10 years old partially mediated the relationship between ADI and BMI at 11 to 12 years old, even in youth who at baseline, were of a healthy weight. Results were unchanged when controlling for differences in brain structure and weight across the 2-years.

CONCLUSION

Greater area deprivation may indicate fewer access to resources that support healthy development, like nutritious food and nonstressful environments. Our findings provide evidence in support of the NI and NS theories of overeating, specifically, with greater ADI influencing health outcomes of obesity via brain structure alterations. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Biobehavioral susceptibility for obesity in childhood: Behavioral, genetic and neuroimaging studies of appetite

Modern food environments are conducive to overeating and weight gain, but not everyone develops obesity. One reason for this may be that individuals differ in appetitive characteristics, or traits, that manifest early in life and go on to influence their behavioral susceptibility to gain and maintain excess weight. Classic studies showing that eating behavior in children can be measured by behavioral paradigms such as tests of caloric compensation and eating in the absence of hunger inspired the development and validation of psychometric instruments to assess appetitive characteristics in children and infants. A large body of evidence now suggests that food approach traits increase obesity risk, while food avoidant traits, such as satiety responsiveness, decrease obesity risk. Twin studies and genetic association studies have demonstrated that appetitive characteristics are heritable, consistent with a biological etiology. However, family environment factors are also influential, with mounting evidence suggesting that genetic and environmental risk factors interact and correlate with consequences for child eating behavior and weight. Further, neuroimaging studies are revealing that individual differences in responses to visual food cues, as well as to small tastes and larger amounts of food, across a number of brain regions involved in reward/motivation, cognitive control and other functions, may contribute to individual variation in appetitive behavior. Growing evidence also suggests that variation on psychometric measures of appetite is associated with regional differences in brain structure, and differential patterns of resting state functional connectivity. Large prospective studies beginning in infancy promise to enrich our understanding of neural and other biological underpinnings of appetite and obesity development in early life, and how the interplay between genetic and environmental factors affects appetitive systems. The biobehavioral susceptibility model of obesity development and maintenance outlined in this narrative review has implications for prevention and treatment of obesity in childhood.

The influence of stress on the neural underpinnings of disinhibited eating: a systematic review and future directions for research

Disinhibited eating involves overconsumption and loss of control over food intake, and underpins many health conditions, including obesity and binge-eating related disorders. Stress has been implicated in the development and maintenance of disinhibited eating behaviours, but the mechanisms underlying this relationship are unclear. In this systematic review, we examined how the impact of stress on the neurobiological substrates of food-related reward sensitivity, interoception and cognitive control explains its role in disinhibited eating behaviours. We synthesised the findings of functional magnetic resonance imaging studies including acute and/or chronic stress exposures in participants with disinhibited eating. A systematic search of existing literature conducted in alignment with the PRISMA guidelines identified seven studies investigating neural impacts of stress in people with disinhibited eating. Five studies used food-cue reactivity tasks, one study used a social evaluation task, and one used an instrumental learning task to probe reward, interoception and control circuitry. Acute stress was associated with deactivation of regions in the prefrontal cortex implicated in cognitive control and the hippocampus. However, there were mixed findings regarding differences in reward-related circuitry. In the study using a social task, acute stress associated with deactivation of prefrontal cognitive control regions in response to negative social evaluation. In contrast, chronic stress was associated with both deactivation of reward and prefrontal regions when viewing palatable food-cues. Given the small number of identified publications and notable heterogeneity in study designs, we propose several recommendations to strengthen future research in this emerging field.

Binge-Eating Precursors in Children and Adolescents: Neurodevelopment, and the Potential Contribution of Ultra-Processed Foods

Binge-eating disorder (BED) is a highly prevalent disorder. Subthreshold BED conditions (sBED) are even more frequent in youth, but their significance regarding BED etiology and long-term prognosis is unclear. A better understanding of brain findings associated with BED and sBED, in the context of critical periods for neurodevelopment, is relevant to answer such questions. The present narrative review starts from the knowledge of the development of emotional self-regulation in youth, and the brain circuits supporting emotion-regulation and eating behaviour. Next, neuroimaging studies with sBED and BED samples will be reviewed, and their brain-circuitry overlap will be examined. Deficits in inhibition control systems are observed to precede, and hyperactivity of reward regions to characterize, sBED, with overlapping findings in BED. The imbalance between reward/inhibition systems, and the implication of interoception/homeostatic processing brain systems should be further examined. Recent knowledge of the potential impact that the high consumption of ultra-processed foods in paediatric samples may have on these sBED/BED-associated brain systems is then discussed. There is a need to identify, early on, those sBED individuals at risk of developing BED at neurodevelopmental stages when there is a great possibility of prevention. However, more neuroimaging studies with sBED/BED pediatric samples are needed.

Altered prefrontal activation during the inhibition of eating responses in women with bulimia nervosa

BACKGROUND

The sense of 'loss of control' (LOC), or a feeling of being unable to stop eating or control what or how much one is eating, is the most salient aspect of binge eating. However, the neural alterations that may contribute to this experience and eating behavior remain poorly understood.

METHODS

We used functional near-infrared spectroscopy (fNIRS) to measure activation in the prefrontal cortices of 23 women with bulimia nervosa (BN) and 23 healthy controls (HC) during two tasks: a novel go/no-go task requiring inhibition of eating responses, and a standard go/no-go task requiring inhibition of button-pressing responses.

RESULTS

Women with BN made more commission errors on both tasks. BN subgroups with the most severe LOC eating (n = 12) and those who felt most strongly that they binge ate during the task (n = 12) showed abnormally reduced bilateral ventromedial prefrontal cortex (vmPFC) and right ventrolateral prefrontal cortex (vlPFC) activation associated with eating-response inhibition. In the entire BN sample, lower eating-task activation in right vlPFC was related to more frequent and severe LOC eating, but no group differences in activation were detected on either task when this full sample was compared with HC. BN severity was unrelated to standard-task activation.

CONCLUSIONS

Results provide initial evidence that diminished PFC activation may directly contribute to more severe eating-specific control deficits in BN. Our findings support vmPFC and vlPFC dysfunction as promising treatment targets, and indicate that eating-specific tasks and fNIRS may be useful tools for identifying neural mechanisms underlying dysregulated eating.

Relation of Overweight/Obesity to Reward Region Response to Food Reward and the Moderating Effects of Parental History of Eating Pathology in Adolescent Females

OBJECTIVE

To test whether overweight/obesity is associated with an elevated reward region response to milkshake cues and a low reward region response to milkshake receipt. To test whether the risk for eating pathology moderates the effects of weight status on the neural response to milkshake cues and milkshake receipt.

METHOD

The current study used functional magnetic resonance imaging (fMRI) to examine the neuronal responses of female adolescents (n = 80; M age = 14.6 ± 0.9; M BMI = 21.9 ± 3.6; 41% with a biological parental history of eating pathology) during a food receipt paradigm.

RESULTS

Females with overweight/obesity showed a greater ventromedial prefrontal cortex (vmPFC), and ventral anterior cingulate (ACC) response to milkshake cues and a greater ventral striatum, subgenual ACC, and dorsomedial prefrontal cortex response to milkshake receipt than those with a healthy weight. Females with overweight/obesity plus a parental history of eating pathology showed a greater vmPFC/medial orbitofrontal cortex response to milkshake cues than those without a parental history of eating pathology and those with a healthy weight. Females with overweight/obesity and without a parental history of eating pathology showed a greater thalamus and striatum response to milkshake receipt.

CONCLUSIONS

Overweight/obesity is associated with an elevated reward region response to palatable food cues and food receipt. A risk for eating pathology enhances the reward region response to food cues in those with excess weight.

Associations between eating in the absence of hunger and executive functions in adolescents with binge-eating disorder: An experimental study

Eating in the absence of hunger (EAH) is one of the key behavioral features of binge-eating disorder (BED) in youth. Although preliminary evidence revealed that adolescent BED co-occurs with deficits in executive functions (EFs), it is unclear whether EFs are related to EAH. Thus, this study experimentally examined whether deficits in EFs predict EAH in adolescents with and without BED. Adolescents (12-20 years) with BED (n = 28) and age-, sex-, and weight-matched controls (n = 28) underwent an EAH paradigm in the laboratory, where they were offered snacks ad libitum after having established satiety during a lunch meal. Cognitive interference, cognitive flexibility, decision making, and EFs in daily life were assessed by neuropsychological tests and self-report. The BED group showed a significantly higher food intake in gram during the EAH trial than controls with medium effect, but no significant group differences in EFs emerged. Dysfunctional decision making in terms of risky decision making, but no other EFs, predicted increased EAH (g, kcal) in the total sample. Although increases in risky decision making over adolescence are well known, this study uniquely revealed that general decision-making abilities driven by short-term reward may account for disinhibited eating behavior. Interventions targeting decision making with focus on reward sensitivity should be evaluated for their efficacy in preventing and reducing disinhibited eating behavior in adolescents.

Gray matter volume and functional connectivity underlying binge eating in healthy children

PURPOSE

As a maladaptive disordered eating behavior, binge eating (BE) onset has been reported in children as young as eight years old and is linked with a range of negative psychological consequences. However, previous neuroimaging research of BE has mainly focused on adults in clinical conditions, and little is known about the potential neurostructural and neurofunctional bases of BE in healthy children.

METHODS

In this study, we examined these issues in 76 primary school students (mean age = 9.86 years) using voxel-based morphometry and resting-state functional connectivity (rsFC) approaches.

RESULTS

After controlling for age, sex, and total intracranial volume/head motion, we observed that higher levels of BE were correlated with greater gray matter volumes (GMV) in the left fusiform and right insula and weaker rsFC between the right insula and following three regions: right orbital frontal cortex, left cingulate gyrus, and left superior frontal gyrus. No significant associations were observed between BE and regional white matter volume. Significant sex differences were found only in the relationship between BE and GMV in the left fusiform. Furthermore, the GMV- and rsFC-based predictive models (a machine-learning method) achieved significant correlations between the actual and predicted BE values, demonstrating the robustness of our findings.

CONCLUSION

The present study provides novel evidence for the brain structural and functional substrates of children's BE, and further reveals that the weakened communication between core regions associated with negative affectivity, reward responsivity, and executive function is strongly related to dysregulated eating.

LEVEL OF EVIDENCE

Level V, descriptive study.

[Scale of Eating Behavior Phenotypes (EFCA), confirmatory factor analysis and psychometric properties]

INTRODUCTION

Weight gain depends on multiple modifiable mediating factors, including ingestive behavior phenotype. The Eating Behavior Phenotypes Scale (EFCA) is a self-administered questionnaire designed as a tool for clinical use to characterize different sub-phenotypes of ingestive behavior: hedonic, compulsive, emotional grazing, disorganized and hyperphagic.

OBJECTIVES

The aim of this study is to validate the psychometric properties of the Eating Behavior Phenotypes Scale (EFCA), to analyze the stability of the construct and its external validity.

MATERIALS AND METHODS

three hundred adult participants completed a self-administered survey developed to identify eating behavior phenotypes (EFCA). A confirmatory factor analysis was performed, internal consistency was evaluated using Cronbach's alpha coefficient, and concurrent validity was assessed using Pearson's correlation method between EFCA and BMI.

RESULTS

The EFCA scale and the subscales showed an acceptable internal consistency (α > 0.70). The confirmatory factor analysis showed a good adjustment of the data to the proposed structure (SBχ922 = 155, p < 0.05; CFI = 0.97; TLI = 0.96; RMSEA = 0.05; SRMR = 0.04). A positive and statistically significant correlation was found between BMI and both each subscale and total scale scores.

CONCLUSIONS

EFCA and its subscales are a valid instrument to assess eating phenotypes in adults. The five-component structure shows high stability and consistent results in relation to a previous study carried out with a sample of obese patients.

Association of Disinhibited Eating and Trait of Impulsivity With Insula and Amygdala Responses to Palatable Liquid Consumption

Eating behavior is not only influenced by the current energy balance, but also by the behavioral characteristics of eating. One of the recognized eating behavior constructs is ‘disinhibited eating,’ which refers to the tendency to overeat in response to negative emotional states or the presence of highly palatable foods. Food-related disinhibition is involved in binge eating, weight gain, and obesity and is also associated with the trait of impulsivity, which in turn, is linked to weight gain or maladaptive eating. However, the relationships among food-related disinhibition, the trait of impulsivity, and the neural substrates of eating behaviors in adolescence remain unclear. Therefore, we designed a functional magnetic resonance imaging (fMRI) study to examine the associations between brain responses to palatable liquid consumption and disinhibited eating behavior or impulsivity in healthy adolescents. Thirty-four adolescents (mean age ± standard deviation = 17.12 ± 1.91 years, age range = 14–19 years, boys = 15, girls = 19) participated in this study. Disinhibited eating was assessed with the disinhibition subscale of the Three-Factor Eating Questionnaire, while impulsivity was assessed using the Barratt impulsiveness scale. Participants received two fMRI sessions−a palatable liquid consumption fMRI and a resting-state fMRI. The fMRI experiment showed that increased disinhibited eating was positively associated with a greater insular response to palatable liquid consumption, while increased impulsivity was positively correlated with a greater amygdala response. The resting-state fMRI experiment showed that increased disinhibited eating was positively correlated with strengthened intrinsic functional connectivity between the insula and the amygdala, adjusting for sex (estimates of the beta coefficients = 0.146, standard error = 0.068, p = 0.040). Given that the amygdala and insular cortex are structurally and functionally connected and involved in trait impulsivity and ingestive behavior, our findings suggest that increased disinhibited eating would be associated with impulsivity via strengthened intrinsic functional connectivity between the insula and amygdala and linked to maladaptive eating.

A systematic review of neural correlates of dysregulated eating associated with obesity risk in youth

Dysregulated eating among children and adolescents is associated with a wide range of negative mental and physical health outcomes, including obesity. However, less is known regarding underlying neural mechanisms underlying such behaviors. Therefore, the present manuscript systematically reviewed neuroimaging research examining dysregulated eating behavior linked to excess weight in children and adolescents. A systematic literature search identified 23 eligible studies, the majority of which were cross-sectional functional magnetic resonance imaging (fMRI) studies and excluded participants with psychiatric disorders. Dysregulated eating was captured by measures of eating styles and eating self-regulation, eating disorder behaviors, food addiction, objective measures of non-homeostatic eating and caloric restriction. While preliminary, findings suggested eating dysregulation was related to aberrant functioning within the frontostriatal and frontoparietal regions involved in self-regulatory processes, as well as regions involved in satiety signaling and interoception. This heterogeneous body of research is continually growing and may have potential to inform future prevention and intervention approaches. Results also identified several important limitations to consider and highlight key areas for future research.

New Insights Into Causal Pathways Between the Pediatric Age-Related Physical Activity Decline and Loss of Control Eating: A Narrative Review and Proposed Conceptual Model

Research consistently suggests that loss of control (LOC) eating in children and adolescents is a key factor contributing to pediatric obesity and eating disorders. However, causes of pediatric LOC eating are yet unclear, and there is a lack of longitudinal research investigating the developmental processes contributing to LOC eating and related outcomes in youth. Physical activity is an understudied behavior that declines during middle childhood to adolescence and may exert an influence in the development of LOC eating via its impact on executive functioning. While physical activity levels and executive functioning have been linked to regulation of eating, no research has examined the mechanistic processes by which these domains may together impact LOC eating during childhood and adolescence. In the current narrative review, a model is proposed that suggests how physical activity and executive functioning influence LOC eating and related outcomes during childhood and adolescence. This model has the potential to influence future theoretical models of pediatric LOC eating and guide future prevention and intervention efforts.

A developmental framework of binge-eating disorder based on pediatric loss of control eating

Although binge-eating disorder may manifest in childhood, a significantly larger proportion of youth report episodes involving a loss of control while eating, the hallmark feature of binge eating that predicts excess weight gain and obesity. Adults with binge-eating disorder often report that symptoms emerged during childhood or adolescence, suggesting that a developmental perspective of binge eating may be warranted. Thus, loss of control eating may be a marker of prodromal binge-eating disorder among certain susceptible youth. The present article offers a broad developmental framework of binge-eating disorder and proposes areas of future research to determine which youths with loss of control eating are at risk for persistent and exacerbated behavior that may develop into binge-eating disorder and adult obesity. To this end, this article provides an overview of loss of control eating in childhood and adolescence, including its characterization, etiology, and clinical significance, with a particular focus on associations with metabolic risk, weight gain, and obesity. A conceptual model is proposed to further elucidate the mechanisms that may play a role in determining which youths with loss of control are at greatest risk for binge-eating disorder and obesity. Ways in which treatments for adult binge-eating disorder may inform approaches to reduce loss of control eating and prevent excess weight gain in youth are discussed. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Loss-of-Control Eating and Obesity Among Children and Adolescents

PURPOSE OF REVIEW

This review summarizes findings on pediatric loss-of-control (LOC) eating and obesity published since 2013 in relation to physiological, socioenvironmental, and psychological factors.

RECENT FINDINGS

LOC eating and obesity are highly comorbid in youth. Genetic and physiological risk factors are associated with the development of LOC eating. Adverse physiological outcomes of LOC eating include increased risk for overweight and obesity and greater dysfunction in components of metabolic syndrome. Socioenvironmental, psychological, and behavioral factors, such as weight-based teasing, dieting, negative affect, emotion dysregulation, and aspects of cognitive functioning, are consistently related to LOC eating in youth, independent of weight. Prospectively, LOC eating may predict the onset of anxiety disorders, depression, and more severe eating psychopathology later in life. Updates on interventions and future directions are discussed. LOC eating may be a key symptom to target adverse physiological and psychological outcomes; however, treatments are limited and require further examination.

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.