The longitudinal relationship between set-shifting at 4 years of age and eating disorder related features at 9 years of age in the general pediatric population

State-level working memory and dysregulated eating in children and adolescents: An exploratory ecological momentary assessment study

BACKGROUND

Children with loss of control (LOC) eating and overweight/obesity have relative deficiencies in trait-level working memory (WM), which may limit adaptive responding to intra- and extra-personal cues related to eating. Understanding of how WM performance relates to eating behavior in real-time is currently limited.

METHODS

We studied 32 youth (ages 10-17 years) with LOC eating and overweight/obesity (LOC-OW; n = 9), overweight/obesity only (OW; n = 16), and non-overweight status (NW; n = 7). Youth completed spatial and numerical WM tasks requiring varying degrees of cognitive effort and reported on their eating behavior daily for 14 days via smartphone-based ecological momentary assessment. Linear mixed effects models estimated group-level differences in WM performance, as well as associations between contemporaneously completed measures of WM and dysregulated eating.

RESULTS

LOC-OW were less accurate on numerical WM tasks compared to OW and NW (ps < .01); groups did not differ on spatial task accuracy (p = .41). Adjusting for between-subject effects (reflecting differences between individuals in their mean WM performance and its association with eating behavior), within-subject effects (reflecting variations in moment-to-moment associations) revealed that more accurate responding on the less demanding numerical WM task, compared to one's own average, was associated with greater overeating severity across the full sample (p = .013). There were no associations between WM performance and LOC eating severity (ps > .05).

CONCLUSIONS

Youth with LOC eating and overweight/obesity demonstrated difficulties mentally retaining and manipulating numerical information in daily life, replicating prior laboratory-based research. Overeating may be related to improved WM, regardless of LOC status, but temporality and causality should be further explored.

PUBLIC SIGNIFICANCE STATEMENT

Our findings suggest that youth with loss of control eating and overweight/obesity may experience difficulties mentally retaining and manipulating numerical information in daily life relative to their peers with overweight/obesity and normal-weight status, which may contribute to the maintenance of dysregulated eating and/or elevated body weight. However, it is unclear whether these individual differences are related to eating behavior on a moment-to-moment basis.

Associations between childhood autistic traits and adolescent eating disorder behaviours are partially mediated by fussy eating

Objective

Previous literature shows an increased risk for eating disorders in autistic individuals. This study tested whether fussy eating contributes to the association between childhood autistic traits and adolescent eating disorder behaviours.

Method

Using data from the Avon Longitudinal Study of Parents and Children, we estimated the intercept and slope of parent‐rated autistic traits and fussy eating between 7 and 14 years (N = 8982) and their association with self‐reported eating disorder behaviours at age 14 years, including the indirect path from autistic traits to eating disorder behaviours via fussy eating. Analyses were adjusted for child sex, maternal age at delivery, maternal body mass index and maternal education.

Results

Analyses found a small indirect pathway from autistic traits intercept to eating disorder behaviours via fussy eating slope (b = 0.017, 95% CI = 0.002–0.032, p = 0.026), with higher levels of autistic traits at age 7 years being associated with a shallower decline in fussy eating, which in turn was associated with greater eating disorder behaviours.

Conclusion

Findings point towards fussy eating as a potential link between childhood autistic traits and later disordered eating. Addressing fussy eating patterns before they become entrenched may decrease risk for eating disorders later in development.

There is evidence that high levels of autistic traits are associated with an increased likelihood of experiencing an eating disorder.

The current study sought to test whether the link between autism and eating disorders could in part be explained by variation in fussy eating.

In a large prospective cohort study, we found a significant indirect effect of fussy eating, such that higher childhood autistic traits were associated with a shallower decline in fussy eating between childhood and adolescence, which in turn was associated with higher levels of eating disorder behaviours in adolescence.

Is set-shifting a risk factor for anorexia nervosa or a broader range of disordered eating?

Steegers et al. using data from the Generation R cohort study examined whether set-shifting difficulties at age 4 predict body dissatisfaction, weight status, and restrictive eating at age 9 as a way to examine whether cognitive rigidity was a risk factor for an eating disorder. The authors concluded that set-shifting difficulties problems were predictive of features of anorexia nervosa. An alternative interpretation is that set shifting is predictive of large weight changes and eating behaviors more generally. It is not clear that set-shifting predicts becoming underweight. Set shifting appears protective against larger weight gains. It is possible that set shifting is related to degree to which the children resist the myriad of cues to eat for reasons other than hunger. Whether this is due to a higher degree of awareness, genetics, or other reasons should be investigated. The results demonstrate that the cognitive process that relate to restrictive behaviors are complex. To better understand those relationships, it will be essential for the field to adopt a conceptualization of eating disorders that includes the earliest stages (disordered eating) of the full range of eating disorders.

Executive functions and eating behavior: Commentary on Steegers et al. (2021)

Alterations in executive functions have repeatedly been found in individuals suffering from eating and weight disorders. However, less is known about how these cognitive processes might contribute to the etiology of the disorders, as large prospective population-based studies have been missing. Here, we comment on the results of Steegers et al. (2021), a study that helped to fill this gap with a focus on set-shifting abilities predicting symptoms of anorexia nervosa (AN) in children. The main goal of this commentary is to encourage further interpretation of the population-based data beyond its relevance to AN. More specifically, we discuss the role of impaired inhibition as a risk factor for weight gain and obesity.