A prospective study of pediatric loss of control eating and psychological outcomes

Loss of control (LOC) eating in youth is associated cross-sectionally with eating-related and psychosocial distress and is predictive of excessive weight gain. However, few longitudinal studies have examined the psychological impact and persistence of pediatric LOC eating. We administered the Eating Disorder Examination and self-reported measures of depressive and anxiety symptoms to 195 boys and girls (mean age = 10.4 years, SD = 1.5) at baseline and again 4.7 years (SD = 1.2) later to 118 of these youth. Missing data were imputed. Baseline report of LOC was associated with the development of partial- or full-syndrome binge eating disorder (p = .03), even after accounting for the contribution of sex, race, baseline characteristics (age, disordered eating attitudes, and mood symptoms), body mass index growth between baseline and follow-up, and years in study. Half (52.2%; 95% CI [1.15, 6.22]) of children who endorsed experiencing LOC at baseline reported persistence of LOC at follow-up (p = .02). Compared with children who never reported LOC eating or reported LOC only at baseline, those with persistent LOC experienced significantly greater increases in disordered eating attitudes (ps < .001) and depressive symptoms (p = .027) over time. These data suggest that LOC eating in children is a problematic behavior that frequently persists into adolescence and that persistent LOC eating is associated with worsening of emotional distress.

Self-reported vs. actual energy intake in youth with and without loss of control eating

Episodes of loss of control over eating (LOC) in children and adolescents--often characterized by the consumption of highly palatable dessert and snack-type foods--have been associated with a lack of awareness while eating that could lead to under- or over-estimation of how much food is consumed. However, little is known about the reporting accuracy of food intake in youth with and without LOC eating. One hundred fifty-six girls and boys were administered the Eating Disorder Examination to assess for the presence of LOC eating. Youth were queried regarding the amounts of foods consumed directly following a multi-item, laboratory buffet test meal. Children with LOC (n=42) did not differ significantly from youth without LOC (n=114) in reporting accuracy of total food intake (reported minus actual energy intake: 153.0 ± 59.6 vs. 96.9 ± 36.0 kcal; p=0.42). However, compared to those without LOC, children with LOC were less accurate at reporting percentage of energy intake from carbohydrate (p=0.01). Youth with LOC were also less accurate at reporting their intake of desserts (p=0.04). Findings point to the possibility that youth with LOC may have poorer recall of sweet food consumption. Future research is required to examine whether poorer recall reflects a lack of awareness while eating palatable, sweet foods.

Links between mothers' and children's disinhibited eating and children's adiposity

Few studies have examined relationships between parents' and children's specific disinhibited eating behaviors. We investigated links among mothers' and children's binge/loss of control eating, eating in the absence of hunger, and children's adiposity in 305 non-treatment-seeking youth, aged 8-17 years (13.62±2.65 years; 49.8% female) and their mothers. Youths' loss of control eating and eating in the absence of hunger were assessed by interview and self-report questionnaire. Children's adiposity was assessed with BMI-z and air displacement plethysmography. Maternal binge eating, eating in the absence of hunger and highest, non-pregnant BMI were self-reported. In structural equation models controlling for mothers' BMI, mothers' binge eating related to children's loss of control eating, and mothers' eating in the absence of hunger related to children's eating in the absence of hunger. Mothers' binge eating and children's eating in the absence of hunger were unrelated, as were mothers' eating in the absence of hunger and children's loss of control. Further, mothers' binge eating was indirectly related to children's adiposity through children's loss of control eating. Likewise, mothers' eating in the absence of hunger indirectly related to children's adiposity through children's eating in the absence of hunger. Mothers and children share similar, specific disinhibited eating styles.

Salience of loss of control for pediatric binge episodes: does size really matter?

OBJECTIVE

The subjective experience of loss of control (LOC) during eating, independent of overeating, may be a salient marker of disordered eating and risk for overweight in youth. However, few studies have directly tested this notion in an adequately powered sample.

METHOD

Three-hundred-sixty-seven youth (M ± SD age = 12.7 ± 2.8 y) were categorized as reporting objective binge eating (OBE; 12.5%), subjective binge eating (SBE; 11.4%), objective overeating without LOC (OO; 18.5%), or no episodes (NE; 57.5%). Disordered eating attitudes, general psychopathology, and adiposity were assessed.

RESULTS

Children with OBE and SBE generally did not differ in their disordered eating attitudes, emotional eating, eating in the absence of hunger, depressive and anxiety symptoms, or adiposity. However, both OBE and SBE youth had significantly greater disordered eating attitudes, emotional eating, eating in the absence of hunger, depressive and anxiety symptoms, and adiposity compared to those with OO or NE (ps < .05).

DISCUSSION

For non-treatment-seeking youth, LOC during eating episodes, rather than episode size, appears to be the most salient marker of eating and weight problems.

Eating in the absence of hunger in adolescents: intake after a large-array meal compared with that after a standardized meal

BACKGROUND

Eating in the absence of hunger (EAH) is typically assessed by measuring youths' intake of palatable snack foods after a standard meal designed to reduce hunger. Because energy intake required to reach satiety varies among individuals, a standard meal may not ensure the absence of hunger among participants of all weight strata.

OBJECTIVE

The objective of this study was to compare adolescents' EAH observed after access to a very large food array with EAH observed after a standardized meal.

DESIGN

Seventy-eight adolescents participated in a randomized crossover study during which EAH was measured as intake of palatable snacks after ad libitum access to a very large array of lunch-type foods (>10,000 kcal) and after a lunch meal standardized to provide 50% of the daily estimated energy requirements.

RESULTS

The adolescents consumed more energy and reported less hunger after the large-array meal than after the standardized meal (P values < 0.001). They consumed ≈70 kcal less EAH after the large-array meal than after the standardized meal (295 ± 18 compared with 365 ± 20 kcal; P < 0.001), but EAH intakes after the large-array meal and after the standardized meal were positively correlated (P values < 0.001). The body mass index z score and overweight were positively associated with EAH in both paradigms after age, sex, race, pubertal stage, and meal intake were controlled for (P values ≤ 0.05).

CONCLUSION

EAH is observable and positively related to body weight regardless of whether youth eat in the absence of hunger from a very large-array meal or from a standardized meal. This trial was registered at clinicaltrials.gov as NCT00631644.

Puberty and observed energy intake: boy, can they eat!

BACKGROUND

Anecdotal reports suggest that adolescent males consume large quantities of food to meet the growth demands of pubertal development. However, limited experimental data exist to support this impression.

OBJECTIVE

The objective was to measure energy intakes of youth at different pubertal stages.

DESIGN

Participants were 204 volunteers (50.5% male) aged 8-17 y. Pubertal development was categorized by physical examination into prepuberty (males: testes < 4 mL; females: Tanner breast stage 1), early-mid puberty (males: testes = 4-12 mL; females: Tanner breast stages 2-3), or late puberty (males: testes >12 mL; females: Tanner breast stages 4-5). Energy intake was measured as consumption from a 9835-kcal food array during 2 lunch time meals.

RESULTS

Males consumed more energy than did females across all pubertal stages (P < 0.001). Intake increased with pubertal development (P < 0.001), but the timing and magnitude of change varied by sex (P = 0.02). Males' unadjusted energy intake was greater in late puberty (mean +/- SE: 1955 +/- 70 kcal) than in prepuberty (1287 +/- 90 kcal) or early-mid puberty (1413 +/- 92 kcal) (P < 0.001). Females' unadjusted energy intake tended to be lower among prepubertal girls (905 +/- 140 kcal) than among females in early-mid puberty (1278 +/- 82 kcal, P = 0.07) or late puberty (1388 +/- 68 kcal, P = 0.01). After adjustment for fat-free mass, fat mass, height, overweight status, race, and meal instruction, the main effect of sex (P < 0.001) remained significant, but the effect of puberty was not significant (P = 0.66).

CONCLUSIONS

The observed intake patterns are congruent with known sexual dimorphisms for body composition, peak growth velocity, and pubertal development. Consistent with their higher energy requirements, males can consume significantly larger amounts of food than females, especially during later puberty. This trial was registered at clinicaltrials.gov as NCT00320177.

An examination of the interpersonal model of loss of control eating in children and adolescents

The interpersonal model of binge eating disorder proposes that social problems lead to negative affect which, in turn, precipitates binge eating episodes. However, no study to date has examined this model among youth who report loss of control (LOC) eating. Participants were 219 non-treatment-seeking children and adolescent volunteers, age 8-17 years (13.1 +/- 2.8 y; 50% female). Children's social problems were assessed by parent report. Youth completed self-report questionnaires of negative affect that assessed depressive symptoms and anxiety. Participants were interviewed to determine the presence or absence of LOC eating in the month prior to assessment. Structural equation modeling analyses found that social problems were positively related to LOC eating presence (p = .02). Negative affect mediated the relationship between social problems and LOC eating (95% CI Product = .00247, .01336). These preliminary results suggest that the interpersonal model of binge eating may describe one possible pathway for the development of LOC eating among non-treatment-seeking youth.

The FTO gene rs9939609 obesity-risk allele and loss of control over eating

BACKGROUND

Children with rs9939609 FTO variant alleles (homozygous = AA and heterozygous = AT) are predisposed to greater adiposity than are those with 2 wild-type alleles (TT).

OBJECTIVE

Because FTO is highly expressed in hypothalamic regions that are important for appetite, FTO genotype may affect energy balance by influencing eating behavior. Loss of control (LOC) eating, a behavior commonly reported by overweight youth, predicts excessive weight gain in children. However, the relation between FTO genotype and LOC eating has not been previously examined.

DESIGN

Two-hundred eighty-nine youth aged 6-19 y were genotyped for rs9939609, underwent body-composition measurements, and were interviewed to determine the presence or absence of LOC eating. A subset (n = 190) participated in a lunch buffet test meal designed to model an LOC eating episode. Subjects with AA and AT genotypes were grouped together for comparison with wild-type TT subjects.

RESULTS

Subjects with at least one A allele (67.7%) had significantly greater body mass indexes, body mass index z scores (P < 0.01), and fat mass (P < 0.05). Of the AA/AT subjects, 34.7% reported LOC compared with 18.2% of the TT subjects (P = 0.002). Although total energy intake at the test meal did not differ significantly by genotype (P = 0.61), AA/AT subjects consumed a greater percentage of energy from fat than did the TT subjects (P < 0.01).

CONCLUSIONS

Children and adolescents with 1 or 2 FTO rs9939609 obesity-risk alleles report more frequent LOC eating episodes and select foods higher in fat at a buffet meal. Both LOC eating and more frequent selection of energy-dense, palatable foods may be mechanisms through which variant FTO alleles lead to excess body weight.