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Understanding eating in the absence of hunger among young children: A systematic review of existing studies
... Eating in the absence of hunger (EAH), i.e., eating past the point of satiety, is a behavior described for the first time by Fisher and Birch in 1999 [1]. They assessed this behavior in a laboratory setting to obtain an operationalized measure of EAH, which is now considered the reference method to assess EAH [2,3]. During the assessment, the subject is first instructed to eat a meal until satiety (pre-load phase). ...
... EAH has been associated with excess body weight and with the development of obesity [2]. Childhood obesity is a major public health concern; the worldwide prevalence of childhood obesity is four times higher than in 1975, with 18% of children aged 5-19 years old that currently have overweight or obesity [7]. ...
... As previously reported by Lansigan et al., EAH has been observed in children as early as 3 years old [2], and even slightly younger in a United States (U.S.) cohort beginning at 33 months of age [10]. Twenty-two studies examined the association between age and EAH among children. ...
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.
... 2 In addition, few studies have examined the association between parenting stress and child eating behaviors, such as eating in the absence of hunger (EAH), an eating behavior associated with both psychosocial stress, and obesity among children. 8,9 Finally, few studies have examined whether associations between parenting stress and child weight-related behaviors are the same across racial groups and family structures. 7,10 Prior studies have shown that parent psychosocial stress may have a particularly negative impact on health behaviors among children of color and children living in single-parent homes. ...
... 12 The primary objective of our study was to determine whether parenting stress was associated with key child behaviors associated with child obesity (child diet, EAH, physical activity, sedentary time, and screen time). 8,13 As a secondary objective, we examined whether these associations were moderated by parent race and family structure. Finally, we assessed association between parenting stress and child weight status. ...
... The EAH test has been validated in samples of young children and adolescents. 8 Mothers were asked to have their children refrain from eating for two hours before the task and received a reminder the day before the study visit. At their appointment, children and their mothers were provided with a meal, and children were given up to 30 minutes to eat until they felt full. ...
Background: There has been limited examination of the association between parenting stress and child weight-related behaviors. We aimed to determine whether parenting stress is associated with child weight-related behaviors, including physical activity, screen time, diet, sedentary time, and eating in the absence of hunger (EAH). Secondarily, we assessed association between parenting stress and child weight status. Methods: Mother-child dyads (N = 291) enrolled in the Newborn Epigenetic STudy (NEST), a longitudinal cohort study, completed surveys to describe parenting stress, and child diet. Children participated in the EAH task and wore accelerometers to assess sedentary time and physical activity. Child weight status was assessed using measured height and weight. Outcomes and exposures were examined using generalized linear models and restricted cubic splines as appropriate based on linear lack-of-fit test. Results: Child sedentary time and vegetable consumption were inversely associated with parenting stress (Total Stress B = -0.78; 95% confidence interval [CI]: -1.35 to -0.20; p = 0.017; and Total Stress adjusted odds ratio [aOR] = 0.98; 95% CI: 0.99 to 1.00; p = 0.022, respectively). Child screen time was directly associated with parenting stress (Total Stress = aOR 1.01; 95% CI: 1.00-1.02; p = 0.032). Fast-food intake was nonlinearly associated with parenting stress. There was no evidence of association between parenting stress and child EAH, physical activity, or weight status. Associations between parenting stress and child weight-related behaviors were not moderated by race or family structure. Conclusions: Parenting stress was associated with important child weight-related behaviors but not weight status. Management of parenting stress may represent a reasonable adjunct to family-based behavioral interventions.
... For instance, individual eating behaviours affect children's responses towards food, and are related to a greater risk of overweight and obesity. [7][8][9][10][11][12] Larger appetite ratings, greater enjoyment of food, greater food responsiveness, faster eating rate, and lower satiety responsiveness were found to be related to higher body weights and faster weight gain in infants aged 3 to 15 months. 11 In addition, lower satiety responsiveness and greater food responsiveness have been associated with higher prevalence of adiposity in older children aged 3 to 5 years. ...
... 5,21 Eating in the absence of hunger (EAH) refers to the failure to selfregulate energy intake, and the susceptibility to eat palatable, often energy-dense foods despite experiencing satiety, 10 making it a behavioural risk factor for developing overweight. 7,20,22,23 Previous work in preschoolers and primary school age children has shown that EAH increases with age and is consistent within individuals over time. 20,22,[24][25][26][27] Also, EAH has been observed in children as young as 21 months 25,28 suggesting it already occurs at a very young age. ...
... This context may have triggered the majority of children eating the finger foods despite having just finished a meal. the scores 'not at all satiated' and 'not satiated' were pooled into one group resulting in a four-point scale for satiety (ie, 1 = not satiated; 2 = neutral; 3 = satiated; 4 = very satiated).Both individual traits of the child and external factors such as parental behaviour may contribute to the development of eating behaviours that make children prone to overeating at a young age.7,23,33,37,46 However, of the six child eating behaviours measured in this study, only enjoyment of food was positively related to intake of finger foods. ...
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.
... Some parents also described their child as preoccupied with food, for example, wanting to eat constantly and always asking for a second portion. Eating in absence of hunger (EAH) or eating palatable foods beyond satiety may be one possible cause of obesity in children as young as 3 years of age (Boots, Tiggemann, & Corsini, 2018;Fisher & Birch, 1999;Lansigan, Emond, & Gilbert-Diamond, 2015). EAH is a multifaceted phenomenon, and appetitive traits are thought to have both individual and familial characteristics (Fildes et al., 2014). ...
... EAH is a multifaceted phenomenon, and appetitive traits are thought to have both individual and familial characteristics (Fildes et al., 2014). Individual characteristics associated with EAH include the child's weight status, age, eating style, and genotype, whereas familial characteristics associated with EAH include maternal feeding practices, dietary disinhibition, and maternal restriction on palatable foods (Lansigan et al., 2015). Indeed, a recent study by Corsini et al. found a positive association between restriction of snack foods and EAH in toddlers; however, this association was moderated by access to snack foods in the home environment, and only observed when access was high (Corsini, Kettler, Danthiir, & Wilson, 2018). ...
... This made parents even more observant about foods they had at home and allowed them to decrease conflicts about food. To date, there is no standardized treatment for EAH; however, the use of behavioral training in order to increase selfefficacy to manage food cravings may decrease EAH in children with overweight or obesity (Lansigan et al., 2015). Many of the techniques taught in the ML program, such as diverting the child's attention from food or offering vegetables when the child was hungry, were cited by parents as especially helpful in managing cravings and hunger and reducing EAH. ...
Childhood obesity treatment involving parents is most effective during the preschool age. However, the mechanisms of change are not known. The present study reports on secondary outcomes (changes in parental feeding practices and child food habits) of early obesity treatment. The More and Less study is a randomized controlled trial conducted in Stockholm County, Sweden. Children with obesity (n = 174, mean BMI SDS 3.0, mean age 5 years, 56% girls) and their parents (60% with foreign background, 40% with a university degree) were randomized to: 1) standard treatment focusing on lifestyle recommendations (ST), 2) a parent support program with boosters (PGB), and 3) a parent support program without boosters (PGNB). The Child Feeding Questionnaire (CFQ) was used to measure parental feeding practices. Child food habits were assessed with a Food Frequency Questionnaire (FFQ). We calculated the monthly changes in CFQ practices and FFQ items based on four measurements. We did not find any significant between-group differences in parental feeding practices and child food habits over time. However, general linear models showed that changes in certain feeding practices predicted changes in child food habits. When ST was compared to the parent support groups, some associations moved in opposite directions. For example, increasing maternal restriction predicted increased consumption of cookies/buns in PGNB (b = 2.3, p < 0.05) and decreased consumption of cookies/buns in ST (b = −2.1, p < 0.05). This is the first study to examine the effect of parental feeding practices on child food habits and weight status after obesity treatment among preschoolers. We found no evidence that changes in feeding practices or changes in child food habits mediated child weight loss. Future studies should consider other intermediary processes related to general parenting practices and parent-child interactions.
... As designed, this task measures consumption of foods (mostly palatable, highly energy 42 dense) under conditions when children are not hungry, often having just consumed a meal to 43 satiation (9). EAH has been considered a potential behavioral phenotype of obesity (8); it is 44 stable over time (10,11), positively associated with weight status (e.g., (11)(12)(13)(14)(15)(16), and may emerge 45 prior to obesity (11,17,18). In addition to EAH, behaviors exhibited during eating episodes, such 46 J o u r n a l P r e -p r o o f as eating rate, have also been found to be indicators of food approach (19) that predict future 47 weight gain (20). ...
... While EAH has been described as a behavioral phenotype for obesity (8), 436 it did not explain additional variance in the PACE phenotype. Systematic reviews have found 437 EAH to be associated with adiposity in most cross-sectional studies (18,80), but it has not been 438 ...
... High food motivation is thought to be a dimension of appetite regulation in children [11,12] that shapes hunger and satiety responses and the quantity/composition of consumption. A wide range of food motivated behaviors have been associated with higher weight status among young children [13,14], including parent report of children's enjoyment of food and food responsiveness [15][16][17][18][19][20] as well as direct observations of eating in the absence of hunger [21][22][23][24]. Importantly, food motivated behaviors have a strong genetic component [25,26] and show stability over time [23,27]. ...
... This task was developed by Fisher and Birch [41] to measure child eating beyond satiation. Higher scores have been associated with higher child weight status across multiple studies ( [24,[73][74][75][76], also see Lansigan et al. [14] for a review). In order to minimize hunger prior to the task, children were provided with a standardized meal of palatable foods accounting for 40% of the estimated daily food energy needs of a four-to five-year-old. ...
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.
... Although overweight/obesity are multifactorial conditions, excess energy intake is a major determinant of weight status/regulation across the lifespan In the most basic sense, eating behavior is driven by homeostatic energy needs, mediated by metabolic (e.g., glucose depletion), hormonal (e.g., ghrelin/leptin signaling) and neural pathways (e.g., hypothalamic hunger signals; (Shin et al., 2009)). Yet, multiple environmental and psychological factors determine energy intake (French et al., 2012) and may drive eating in the absence of hunger (EAH, traditionally conceptualized via laboratory assessment of energy ingestion following eating to satiation (Lansigan et al., 2015), and more recently via momentary, naturalistic designs (Boggiano et al., 2015;Goldschmidt et al., 2017)), binge and loss of control (LOC) eating (characterized by a lack of control over what/how much one is eating, with or without ingestion of a large amount of food, i.e., overeating; (Shomaker et al., 2011)), and hedonic eating (eating driven by motivational or reinforcing properties of food, such as cravings (Myers et al., 2018) and/or perceived palatability of food (Lowe & Butryn, 2007)). These factors may overlap to some extent (Boutelle et al., 2014;Vannucci et al., 2013), may occur independently or interactively in relation to eating episodes parameters (e.g., timing/duration, content), and in some cases differ across racial/ethnic dimensions (e.g., (Lee-Winn et al., 2016)). ...
... EAH was the most common type of episode, which may reflect the sample since EAH has been associated with excess weight in youth (Lansigan et al., 2015). These episodes were less likely to co-occur with psychosocial factors (i.e., body dissatisfaction, interpersonal problems) and tended to occur earlier in the day and at home. ...
Background
Research suggests that youth with overweight/obesity can be subtyped according to disinhibited eating tendencies. No research has attempted to subtype classes of eating episodes along sensational, psychological, and hedonic dimensions.
Methods
Youth (N = 39; 55% female) aged 8–14 y with overweight/obesity completed a 2-week ecological momentary assessment protocol in which they reported on all eating episodes and their sensational, environmental, affective, and interpersonal contexts. Latent profile analysis (LPA) was used to classify episodes based on loss of control (LOC) while eating, self-reported overeating, food palatability, hunger, and cravings. Classes were compared on affective, interpersonal, appearance-related, and environmental correlates using Wald chi-square tests.
Results
LPA identified three classes of eating episodes involving high levels of LOC/self-reported overeating (“binge-like” class), low levels of hunger (“eating-in-the-absence-of-hunger” class), and high hunger and cravings (“appetitive eating” class). Binge-like eating was associated with the highest levels of body dissatisfaction, interpersonal distress, and positive affect, and was most likely to occur in the after-school hours.
Conclusions
Binge-like eating tends to occur in a psychological context relative to other types of eating episodes in youth with overweight/obesity. Future research should explore whether certain classes of eating episodes are associated with distinct weight trajectories over time.
... The mechanisms explaining the link between sleep and weight gain are not fully understood (8), but 1 possible explanation is that sleep deprivation is associated with diminished self-regulation of appetite, resulting in an increase in eating beyond being actually hungry, known as eating in the absence of hunger (EAH). This behavior is characterized by eating in response to emotional and external cues (hedonic), such as negative affect or fatigue (9), and sight or smell of food, labeled as "food responsiveness" (10,11). Both behaviors can result in eating past the point of satiation, leading to weight gain over time. ...
... We also included an adequate washout period of 1 wk to both allow children to recover from the sleep intervention and reduce carryover effects but also to give participants a break from the intensive study protocol. Furthermore, the feeding experiment was designed to reduce several of the methodological issues found in earlier research (9,15,40), including that our children completed the ad libitum phase individually rather than with others present, in order to minimize social desirability concerns that could influence eating behavior. We offered a large range of food options for both phases that were precisely the same at both experiments. ...
Background
While insufficient sleep duration has emerged as a strong, independent risk factor for obesity, the mechanisms remain unclear. One possibility is greater “eating in the absence of hunger” (EAH) or energy intake beyond the point of satiety, when tired.
Objective
The aim was to determine whether mild sleep loss increases EAH in children.
Methods
A crossover study was undertaken in 105 healthy children (8–12 y) with normal sleep (∼8–11 h/night). After randomization, children went to bed 1 h earlier (sleep extension) or 1 h later (sleep restriction) than their usual bedtime, over 2 intervention weeks separated by a 1-wk washout. At the end of each intervention week, children underwent an EAH feeding experiment involving a preloading meal until satiation, followed by an ad libitum buffet (of highly palatable snacks) to measure EAH, with each food item weighed before and after consumption.
Results
Ninety-three children completed the EAH experiment. There was no evidence of a difference in energy intake from EAH between sleep restriction and extension conditions when analyzed as a crossover design. However, a learning effect was found, with children eating significantly less (−239 kJ; 95% CI: −437, −41 kJ; P = 0.018) during the preload phase and significantly more (181 kJ; 95% CI: 38, 322 kJ; P = 0.013) in the ad libitum phase in the second week. No significant differences were seen using an underpowered parallel analysis for energy intake during the ad libitum phase when sleep deprived (106 kJ; 95% CI: −217, 431 kJ; P = 0.514).
Conclusions
Our findings suggest that measuring a difference in eating behavior in relation to sleep proved unsuitable using the EAH experiment in a crossover design in children, due to a learning effect. This trial was registered at the Australian New Zealand Clinical Trials Registry (http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367587&isReview=true) as ACTRN12618001671257 .
... Obesity tracks across the life-span, and it is likely that the long-term risks associated with obesity are magnified among youth with severe obesity. Several regulatory factors have been shown to predict the development of obesity in youth, including behavioral self-regulation (6)(7)(8)(9), eating regulation (10)(11)(12)(13), and adrenocortical regulation or hypothalamic-pituitaryadrenal (HPA) axis dysfunction (14,15). Little is known, however, about associations between longitudinal changes in BMI and HPA axis dysregulation in childhood and adolescence. ...
... Researchers have suggested that behavioral dysregulation may be a marker of dysregulation in more proximal behaviors that confer risk for obesity, including disordered eating behaviors (e.g., eating in the absence of hunger) (10,12,38). We found that youth in the severe obesity trajectory exhibited the highest level of disordered eating attitudes, namely dieting attitudes, followed by youth in the overweight/ obesity trajectory. ...
Objective
This study aimed to identify obesity trajectories from childhood to adolescence (2‐15 years of age) and investigate differences in behavioral, eating, and adrenocortical regulation by trajectory membership.
Methods
A total of 1,077 households from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development were included. Anthropometrics were measured 11 times between ages 15 months and 15 years. Behavioral self‐regulation was assessed at ages 3 and 4 years. Disordered eating behaviors and awakening cortisol were assessed at age 15 years.
Results
Latent growth curve modeling identified four BMI trajectories: two nonoverweight trajectories based on average BMI at the 40th and 70th percentiles and overweight/obesity and severe obesity trajectories. Youth in the severe obesity trajectory exhibited lower behavioral self‐regulation in early childhood and lower awakening cortisol at age 15 years compared with youth in the nonoverweight trajectories. Youth in the overweight/obesity and severe obesity trajectories showed higher levels of disordered eating behaviors at age 15 years.
Conclusions
Obesity trajectories were associated with biobehavioral markers of dysregulation in early childhood and adolescence. Dysregulation across biobehavioral domains was particularly apparent among youth who developed severe obesity. Further work is needed to better understand resilience factors that distinguish youth who develop obesity and severe obesity from those who do not.
... It has been suggested that excessive consumption of sugar is facilitated by a shift in a hunger-satiety continuum that leads an individual to feel hungry for sugar despite a lack of an actual energy need, and reaches satiety later, ultimately promoting the maintenance of its consumption (21). Eating in the absence of hunger has been shown to be positively associated with an increased weight status among young children (22). Overall, sweetness is a potent stimulus for humans of all ages, and this attraction for sweet foods and beverages may stimulate overeating and induce weight gain in the long term (23). ...
Introduction
The SmartFeeding4Kids (SF4K) program is an online self-guided intervention for parents with the propose of changing parental feeding practices and children’s dietary intake, focusing on the intake of added sugars, fruit, vegetables, and legumes. This paper aims to describe children’s dietary pattern at baseline through a 24-h food recall, the SmartKidsDiet24.
Methods
Overall, 89 participants recorded at least one meal of the 3-day food recall. Mean age was 36.22 ± 6.05 years and 53.09 ± 15.42 months old for parents and children, respectively. Of these, 22 participants were considered to have 2 days of near complete 24-h food recalls. Children’s dietary intake are reported for these 22 participants based on parents reports and, thus, represent estimations only, as it remains unknown whether children consumed other non-reported foods.
Results
Fruit was the group with the highest daily intake among children (mean 1.77 ± 1.10 portions/day), followed by added sugar foods (mean 1.48 ± 0.89 portions/day), vegetables [median 1.27 (1.64) portions/day] and legumes [median 0.12 (0.39) portions/day]. Fruit intake was positively correlated with vegetable intake (p = 0.008). Regarding Dietary Reference Values accomplishment, 13.6% of children exceeded the daily safe and adequate intake of sodium, 77.3% did not meet potassium and fiber recommendations, and 31.8% did not meet vitamin C recommendations.
Discussion
All children did not meet calcium, vitamin B12 and vitamin D intake recommendations. Our findings further justify the need for dietary interventions in this field, to improve young children’s diets.
Clinical trial registration
ClinicalTrials.gov, identifier NCT04591496.
... Most commonly, EAH is operationalized in an experimental paradigm in which high-calorie snack foods are served ad libitum to participants after having received a standardized lunch meal (Fisher & Birch, 1999). The great majority of research on EAH has been conducted in population-based samples below age 13, demonstrating relative stability over childhood and positive associations with child weight status, both cross-sectionally and longitudinally (for reviews, see Lansigan, Emond, & Gilbert-Diamond, 2015;Russell & Russell, 2021), but not consistently (e.g., Adise, White, Roberts, Geier, & Keller, 2021;Fuchs et al., 2021;Giuliani & Kelly, 2021). Among 8-13-year-old children with overweight, EAH was significantly associated with loss of control eating, a precursor of BED (Hilbert & Brauhardt, 2014;Tanofsky-Kraff et al., 2011), based on child and parent-report (Eichen, Strong, Rhee, & Boutelle, 2022). ...
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.
... The development of eating behaviours across childhood is important for children's current and later dietary intakes and weight (Carnell et al., 2016;Derks et al., 2018Derks et al., , 2019Hill et al., 2008;Jackson et al., 2021;Kininmonth et al., 2021a;Lansigan et al., 2015;Parkinson et al., 2010;Power et al., 2022;Somaraki et al., 2021;Steinsbekk & Wichstrøm, 2015;Taylor et al., 2019;Viana et al., 2008). Accordingly, research on children's eating and weight has expanded rapidly over recent decades with a wide-ranging focus on attendant processes, factors, correlates, and outcomes. ...
Eating behaviours affect food intakes and are involved in the aetiology of obesity. There has been impetus to translate findings about children's eating behaviour into intervention and policy programs. However, measurement limitations have hindered our capacity to understand and influence children's eating behaviours. In the present paper we provide an overview of some of the key methodological and measurement issues facing the field of children's eating behaviours and highlight implications for research and health promotion. Drawing on insight from parallel issues that occur in the measurement of early social and emotional development, we examine two overlapping themes in children's (aged 0-∼12 years) eating behaviours (Somaraki et al., 2021) measurement issues related to validity and reliability, and (Steinsbekk & Wichstrøm, 2015) associated methodological challenges, such as contextual influences and the importance of designing studies that use multiple informants and multiple methods. We then suggest insights and strategies aimed at advancing approaches to measurement of children's eating behaviours. To progress our understanding of children's eating behaviours, we conclude that a range of psychometrically sound, fit-for-purpose measurement instruments and procedures are needed for use in multi-trait, multi-method, multi-informant studies in a range of populations and contexts.
... One difference between this study and the Geda et al. (2013) study is that the latter defined overeating in terms of estimated daily calorie consumption which was based on participants' responses to a food frequency questionnaire they had completed at intermittent times during the previous year, whereas we defined overeating in terms of participants' self-rated tendency to eat in the absence of hunger (EAH). EAH is typically assessed behaviorally as the amount of snack food eaten after satiating on a preload meal (e.g., Kral et al., 2012), which has been shown to be associated with obesity and future weight gain (Lansigan, Emond, & Gilbert-Diamond, 2015). Only limited research has been conducted on the relationship of EAH to cognitive functioning. ...
Research has shown that dietary patterns and obesity are associated with cognitive deficits. The present study examined the extent to which undergraduate students' tendency to overeat was associated with difficulties in cognitive functioning. Participants (n = 300) completed an online survey that assessed the relationship of dietary patterns to various aspects of psychological functioning. Regression analyses revealed that students' perceived tendency to overeat was negatively associated with their perceived ability to concentrate on academic tasks (β = −2.73, p = .007) and level of cognitive functioning during daily activities (β = −2.93, p = .004), even after controlling for such factors as body mass index and tendency toward uncontrolled eating. The results suggest that overeating, independent of obesity and difficulties in the self-regulation of eating, may be associated with cognitive deficits. Implications of the findings are discussed along with its limitations. Historical references to the possibility that overeating may undermine cognitive functioning are also presented.
... Classically, EAH is a laboratory-based protocol where children are provided an ad libitum standardized meal, then a hunger assessment is completed, followed by free access to a variety of palatable snack foods and non-food alternatives such as toys [15]. Although there are large interindividual differences in how many calories children consume during the EAH protocol, greater energy intake from palatable foods is consistently associated with increased adiposity across childhood [16]. Pertinent for the current study, there may be individual differences in how children respond to food cues when candy is available before and after a meal, such as with child temperament. ...
Candy provides little nutritional value and contributes to children’s energy intake from added sugars. Factors influencing children’s candy intake remain largely unknown. This study describes children’s total candy intake (kcal) before and after a meal and examines associations of candy intake in both conditions with children’s temperament and appetite among a predominantly White, highly educated sample. Children (n = 38, age 5–8 years) were given free access to 11 candies (5 chocolate, 6 non-chocolate) and non-food alternatives during a pre-meal and a post-meal condition. Parents completed the Child Behavior Questionnaire and the Child Eating Behavior Questionnaire. Total candy intake was less when offered after a meal (209.3 kcal; SD = 111.25) than before a meal when still hungry (283.6 kcal; SD = 167.3), but not statistically different. Individual differences in candy intake between conditions was calculated to categorize children into three groups: “Better Regulators” consumed more candy before a meal (39%), “Consistent/Poorer Regulators” consumed similar amounts before and after a meal regardless of hunger (32%), and “Most Disinhibited” children consumed more candy after a meal when not hungry (29%). The “Better Regulators” group was lowest in negative affect and the “Consistent/Poorer Regulators” group was highest in food responsiveness. Children’s candy intake was high relative to daily energy needs both before and after a meal. Child negative affect and food responsiveness appear to be child characteristics that predispose children to poor self-regulation of candy intake before and after a meal.
... In the present study, control pattern was associated with increased risk of general and central obesity among both children ≤ 12 years and > 12 years. These findings may be potentially due to the fact that controlling a child's food intake may limit his/her ability to self-regulate food consumption and to properly identify and react to hunger and satiety cues, which may be potentially associated with obesity [45,46]. Further stratified analyses found that the effect of control pattern on childhood obesity only for children whose maternal education was college or above. ...
This study examined the longitudinal associations between parental feeding practices and child weight status, and their potential modification effects by child sex, age, and maternal and paternal educations among children. Data were collected from 2015 to 2017 of 2139 children aged 6–17 years and their parents in five Chinese mega-cities. Parental feeding practices were assessed using 11-items from Child Feeding Questionnaire. Waist-to-height ratio (WHtR), body mass index (BMI), and general and central obesity were measured and analyzed using a mixed-effects model. Three parental feeding patterns were identified by factor analysis including “concern”, “pressure to eat”, and “control”. Concern was associated with higher BMI z-score, WHtR (βs ranged from 0.01 to 0.16), and general obesity (ORs ranged from 1.29 to 6.41) among children aged ≤12 years and >12 years, regardless of child sex and parental educations. Pressure to eat was associated with lower BMI z-score (β = −0.08, p < 0.001), WHtR (β = −0.004, p < 0.01), and general (OR = 0.53, 95%CI = 0.42, 0.66) and central obesity (OR = 0.72, 95%CI = 0.58, 0.90) among children aged ≤12 years. Further analyses showed that significant associations were found for children with maternal or paternal education of college and above. Control was associated with increased risk of general and central obesity among children with maternal education of college and above, regardless of age. Our study indicates that higher concern and lower pressure to eat were associated with increased risk of obesity among children. Control was associated with increased risk of obesity among children with maternal education of college and above. Future childhood obesity preventions may optimize parental feeding practices.
... Recent behavioral studies demonstrate that uncontrolled eating, such as increased eating in the absence of hunger and poor satiety responsiveness (5,6), are more frequent among children with obesity (OB), who find food more rewarding and who are also more responsive to food cues than lean children (6). These findings are supported by recent functional magnetic resonance imaging (fMRI) studies, which demonstrated hyperactivation in response to food images in reward regions in obese adults (7,8) and children (9)(10)(11). ...
Context
Obesity interventions often result in increased motivation to eat.
Objective
We investigated relationships between obesity outcomes and changes in brain activation by visual food cues and hormone levels in response to obesity intervention by family-based behavioral treatment (FBT).
Design and Participants
Neuroimaging and hormone assessments before and after 24-week FBT intervention in children with obesity (OB, n=28), or children of healthy weight without intervention (HW, n=17), all 9-11-year-old males and females.
Main Outcome Measure(s)
Evaluation of meal-induced changes in neural activation to high- vs. low-calorie food cues across appetite-processing brain regions and gut hormones.
Results
Among children with OB who underwent FBT, greater declines of BMI z-score were associated with less reductions after the FBT intervention in meal-induced changes in neural activation to high- vs. low-calorie food cues across appetite-processing brain regions (p<0.05), and the slope of relationship was significantly different compared to children of HW. In children with OB, less reduction in brain responses to a meal from before to after FBT was associated with greater meal-induced reduction in ghrelin and increased meal-induced stimulation in peptide YY and glucagon-like peptide-1 (all p<0.05).
Conclusions
In response to FBT, adaptations of central satiety responses and peripheral satiety-regulating hormones were noted. After weight loss, changes of peripheral hormone secretion support weight loss, but there was a weaker central satiety response. The findings suggest that even when peripheral satiety responses by gut hormones are intact, the central regulation of satiety is disturbed in children with OB who significantly improve their weight status during FBT, which could favor future weight regain.
... A systematic review reported the factors that contribute to postoperative WR [31], but there are few reports of the relationship between CO and WR. The reason for the association between CO and WR is not clear, but as there are reports about obesity and appetite abnormalities in children [33,34], the presence of genetic abnormality influencing appetite regulation in the central nervous system in CO is plausible. On the other hand, for obese patients with CO and mental retardation or developmental disorders, genetic abnormalities such as Prader-Willi syndrome, Cohen syndrome, and Bardet-Biedl syndrome should be carefully excluded preoperatively [35]. ...
Introduction:
The psychosocial background of subjects with severe obesity developed from childhood onset obesity (CO) and their outcomes after bariatric surgery have not been fully investigated.
Methods:
305 subjects were enrolled in the J-SMART study, which examined the effects of laparoscopic sleeve gastrectomy (LSG) in Japan, and categorized into two groups: CO defined as onset up to 13 years of age (CO group) and post-puberty onset obesity defined as onset after 13 years of age (PPO group). The subjects were followed up for at least 2 years and up to 5 years after LSG. Changes in physical parameters and remission of obesity-related comorbidities were assessed at 2 years after LSG. Weight regain (WR) was also assessed by evaluating the nadir weight after LSG and maximum weight thereafter during follow-up period.
Results:
The mean postoperative follow-up period was 3.0 ± 1.1 years. 40.0% of the subjects had CO and these subjects had higher BMI and HOMA-β, and lower age, HbA1c, HDL cholesterol, and visceral/subcutaneous fat area ratio compared to those with PPO. The CO group was also characterized by having higher rates of mental retardation, developmental disorders and obesity in either parent, and lower rate of marriage compared to the PPO group. Two years after LSG, there were no differences in total weight loss and remission rates of diabetes, dyslipidemia and sleep apnea syndrome between the two groups, although remission rate of hypertension was higher in the CO group. The CO group also had a higher rate of WR after LSG than the PPO group, with CO, BMI, mental disorder and binge eating contributing to WR.
Conclusion:
This study suggests that CO might be associated with genetic and psychosocial factors. CO and PPO probably differ in pathogenesis and may require different treatment strategies.
... To assess validity, Pearson correlations between EAH kcal in both conditions and theoretically related constructs derived from literature were examined. Theoretical correlates included child BMI z-score, age, total and subscale scores from the EAH-Q, and child appetitive traits from the CEBQ (23). To further explore the validity of the classroom EAH protocol, all analyses were performed in subgroups of participants divided by age, sex, and weight status. ...
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.
... Given known sex differences in brain maturation during adolescence 30 as well as in eating behavior 20 , obesity 23 , and neural responses to food cues 31,32 , likely driven by social environment as well as biological factors 25 , we examined relationships in females and males separately. Since obesity is associated with eating in the presence of satiety 33 , and with reduced neural satiety responses 32 , we examined effects of DRD4 PFC expression on neural food cue responses in the satiated/fed, rather than the fasted, state. ...
The dopamine receptor 4 (DRD4) in the prefrontal cortex (PFC) acts to modulate behaviours including cognitive control and motivation, and has been implicated in behavioral inhibition and responsivity to food cues. Adolescence is a sensitive period for the development of habitual eating behaviors and obesity risk, with potential mediation by development of the PFC. We previously found that genetic variations influencing DRD4 function or expression were associated with measures of laboratory and real-world eating behavior in girls and boys. Here we investigated brain responses to high energy–density (ED) and low-ED food cues using an fMRI task conducted in the satiated state. We used the gene-based association method PrediXcan to estimate tissue-specific DRD4 gene expression in prefrontal brain areas from individual genotypes. Among girls, those with lower vs. higher predicted prefrontal DRD4 expression showed lesser activation to high-ED and low-ED vs. non-food cues in a distributed network of regions implicated in attention and sensorimotor processing including middle frontal gyrus, and lesser activation to low-ED vs non-food cues in key regions implicated in valuation including orbitofrontal cortex and ventromedial PFC. In contrast, males with lower vs. higher predicted prefrontal DRD4 expression showed minimal differences in food cue response, namely relatively greater activation to high-ED and low-ED vs. non-food cues in the inferior parietal lobule. Our data suggest sex-specific effects of prefrontal DRD4 on brain food responsiveness in adolescence, with modulation of distributed regions relevant to cognitive control and motivation observable in female adolescents.
... This relationship is further complicated by evidence that parental concerns about a child's future weight gain may explain their decision to restrict food intake, independently of a child's actual weight (Ek et al., 2016;Gregory et al., 2010;May et al., 2007;Webber et al., 2010). Although parents may adopt restrictive feeding practices in response to, or in the hope of preventing, weight gain, children whose food is restricted by their parents may be more likely to eat in the absence of hunger (Birch et al., 2003;Fisher & Birch, 1999, 2002Haines et al., 2019;Lansigan et al., 2015;Yee et al., 2017) and develop eating disorder symptomatology (e.g., Allen et al., 2009;Reba-Harrelson et al., 2010). Moreover, researchers have found that restrictive feeding practices do not lead to weight loss, and can even lead to weight gain in children (Campbell et al., 2010;Couch et al., 2014;Faith, 2004;Farrow et al., 2018;Rodgers et al., 2013;Webber et al., 2010). ...
Parental restriction of food intake has been associated with heightened eating disorder psychopathology in some longitudinal research. Yet, relatively little is known about the determinants of restrictive feeding practices. This cross-sectional study explored the association between parents' anti-fat attitudes and their use of restrictive feeding practices in a mixed British (41.10% England, 39.90% Scotland, 4.20% Other) and Irish (14.80%) sample. Parents and caregivers (N = 472; 94.10% female; 70.90% university level education) of children between the ages of 4-8 (48.20% female; 91.10% rated as "normal weight" by their parents) completed self-report questionnaires assessing their anti-fat attitudes (dislike, fear, and blame subscales), use of restrictive feeding practices (for weight control, health purposes, and covert restriction), and how influential their child's body-weight and -shape is for their perception of themselves as parents. Overall, our hypothesis that parental anti-fat attitudes would be significantly associated with restrictive feeding practices was supported. Anti-fat attitudes related to disliking higher body-weight people and blaming parents for their child's weight were significant predictors of all forms of restrictive feeding (all ps < .05). However, anti-fat attitudes related to fearing being a higher body-weight were not significant predictors of restrictive feeding for the purposes of health nor for covert restriction (ps > .05). Additionally, our hypothesis that the associations between anti-fat attitudes and restrictive feeding practices would be stronger for parents for whom their child's body-weight and -shape more strongly influenced how they judged themselves as parents was not supported (the interaction term was not significant in two out of three analyses). Future research is needed to investigate these associations across time and in samples of higher body-weight children.
... These behaviors have not been examined as indicators of satiation later in childhood, however. Instead, many studies with children have assessed satiety responsiveness using laboratory-based tasks such as the eating in the absence of hunger protocol (Lansigan et al., 2015) and caloric compensation protocols (e. g., Kral et al., 2012). Previous research suggests that lower satiety responsiveness, as measured by lab protocols (Asta et al., 2016;Fisher et al., 2007;Kral et al., 2012) and parent-reported measures (Carnell & Wardle, 2007;Mallan et al., 2014;van Jaarsveld et al., 2011), predicts greater obesity risk. ...
The notion of promoting parents' recognition of child satiation to reduce overfeeding and overeating in children is prevalent. To do so, it is important to identify common behaviors that may indicate satiation and can be easily recognized by parents. Relatively little work has focused on identifying behaviors that may indicate child satiation as they occur during naturalistic mealtimes, which is an important context for parents to observe their children's eating behavior. Hence, the goal of the current study is to examine whether observed behavioral indicators of child satiation at mealtimes are associated with child characteristics (i.e., sex, age, and BMIz) and parent-reported child appetitive traits. We coded observed behaviors thought to indicate satiation, specifically mealtime disengagement and mealtime negativity, in a cohort of 240 families with children between 4- and 8-years old (53% boys). First, we documented the occurrence of child disengagement and negativity during naturalistic mealtimes. Second, we found that lower child BMIz and being a boy were associated with greater mealtime disengagement, but child age was not associated with mealtime disengagement. No associations were found between child characteristics and mealtime negativity. Third, we found that mealtime disengagement and mealtime negativity were associated with mother-reported satiety responsiveness on the Child Eating Behavior Questionnaire. Taken together, our findings suggest observed mealtime disengagement and mealtime negativity behaviors could be helpful indicators of child satiation in a naturalistic mealtime context.
... This allows bidirectional interpretation; the association could either reflect the parents' response to the preexisting child's feeding problem or, on the contrary, may depict the contribution of parental practices on the onset and maintenance of a feeding problem. Practices that had the strongest correlation in the present study have been associated with adverse effects on food intake [13,[64][65][66][67] and trying to limit them may prove beneficial. The present study thus highlights the urgent need of properly informing parents about the implementation of favorable practices or potential need for professional consultation with the aim of optimal management of the underlying problem. ...
Feeding problems are associated with the consumption of a limited amount or restricted variety of foods and often occur in children with gastrointestinal diseases. The majority of studies to date do not use valid and reliable measurements to detect feeding problems. The aim of this cross-sectional study was to assess behavioral and skill-based feeding problems in young children with gastrointestinal diseases by using a well-established parent-reported feeding measure and identify demographic, anthropometric, and environmental factors associated with maladaptive feeding behaviors in this pediatric population. Parents completed the Greek version of the Behavioral Pediatrics Feeding Assessment Scale (BPFAS) and self-reported questionnaires assessing mealtime environment and parental feeding practices. It was found that 18.6% of the sample had abnormal Total Frequency Score (TFS) (frequency of problematic feeding behaviors) and 39.5% had abnormal Total Problem Score (TPS) (number of behaviors perceived as problematic by parents). Younger children, with lower body mass index, lower birth weight, and only children were more likely to have feeding problems. The study showed that parent-reported feeding problems are increased in young children with gastrointestinal diseases and are associated with specific aspects of mealtime environment and parental feeding practices.
... Several EAH studies have compared children of different ages. In a systematic review of children 12 years of age and younger, Lansigan et al. (Lansigan, Emond, & Gilbert-Diamond, 2015) concluded that there was a positive association between weight status and EAH, and that absolute levels of EAH increased with age. The age trend is evident even from early ages. ...
This narrative review discusses the origins and development of appetite self-regulation (ASR) in childhood (from infancy to age 6 or 7 years). The origins, or foundations, are the biological infrastructure associated with appetite regulation and appetite self-regulation. Homeostatic regulation in infancy is examined and then evidence about developmental change in components of ASR. The main ASR-related components covered are: delay-of-gratification, caloric compensation, eating in the absence of hunger, food responsiveness/hedonics and fussy eating. The research included behavioral measures, parent-reports of appetitive traits and fMRI studies. There were two main trends in the evidence: a decline across childhood in the components of ASR associated with food approach (and therefore an increase in disinhibited eating), and wide individual differences. The decline in ASR contrasts with general self-regulation (GSR) where the evidence is of an improvement across childhood. For many children, bottom-up automatic reactive processes via food reward/hedonics or food avoidance as in fussy eating, appear not to be matched by improvements in top-down regulatory capacities. The prominence of bottom-up processes in ASR could be the main factor in possible differences in developmental paths for GSR and ASR. GSR research is situated in developmental science with its focus on developmental processes, theory and methodology. In contrast, the development of ASR at present does not have a strong developmental tradition to access and there is no unifying model of ASR and its development. We concluded (1) outside of mean-level or normative changes in the components of ASR, individual differences are prominent, and (2) there is a need to formulate models of developmental change in ASR together with appropriate measurement, research designs and data analysis strategies.
... Studies have predominantly examined EAH as a behavioral risk factor for weight outcomes in children or used EAH to investigate the influence of maternal feeding practices on child eating behaviors. 7 However, whereas the controlled conditions of laboratory-assessed EAH eliminates measurement error due to response bias, no studies have examined the relationship of EAH with longterm dietary intake in free-living settings. Understanding whether EAH relates to long-term dietary intake could assist with interventions to improve dietary behaviors. ...
Background
Scant research has examined whether laboratory assessments of eating in the absence of hunger (EAH) relates to long-term diet quality.
Objective
This study investigates the association of EAH with diet quality during pregnancy.
Design
Pregnancy diet quality was assessed using 24-hour diet recalls collected in each pregnancy trimester. EAH was assessed in a counterbalanced, crossover laboratory feeding substudy in which participants completed two free access eating occasions following a standardized meal during their second pregnancy trimester.
Participants/setting
Data were collected from March 2015 to December 2016 from a subsample of participants (n = 46) enrolled at ≤12 weeks’ gestation in an observational, prospective cohort study (the Pregnancy Eating Attributes Study) in North Carolina.
Intervention
Participants were presented with highly processed (HP) and minimally processed (MP) foods in two separate assessments.
Main outcome measures
Scores for total Healthy Eating Index-2015 (HEI-2015) and adherence to adequacy and moderation components were calculated from the diet recalls. Higher scores reflect better diet quality.
Statistical analyses performed
Linear regressions estimated associations of pregnancy diet quality with EAH (energy, EAH-kcal; and percent offered, EAH-%) in each condition for all foods, and separately for sweet and savory foods.
Results
Lower pregnancy diet quality (all indicators) was associated with greater EAH (EAH-kcal and EAH-%) of all foods and sweet foods in the HP condition. Each 100-kcal increase in EAH of HP foods was associated with a 2- to 3-point decrease (standard error = 0.7 to 0.8) in HEI-2015 (P < 0.01); each 10% increase in EAH of HP foods was associated with a 5- to 7-point decrease (standard error = 2.0) in HEI-2015 (P < 0.01). Greater EAH (energy and percent offered) of savory food intake in the HP condition was associated with a lower HEI-2015 adequacy component score, but was not associated with the HEI-2015 or HEI-2015 moderation component scores. EAH in the MP condition was not associated with pregnancy diet quality.
Conclusions
Greater EAH of HP, especially sweet, foods was related to worse pregnancy diet quality. Consuming HP sweets after meal termination may reflect a tendency for eating beyond satiation and may be a useful intervention target for improving maternal diet quality.
... EAH is quantified as the amount of energy consumed (Kcals) during the taste test and ad libitum access. Like the questionnaires, laboratory-based measures of EAH have been associated with (the risk of) obesity and excessive weight gain in children (Lansigan et al., 2015) and overeating and higher BMI in adults (Fay et al., 2015); however, findings have not always been consistent, particularly in older adolescents and adults (Kelly et al., 2015). Furthermore, there is questionable ecological validity to laboratory-based eating behavior paradigms. ...
Our ability to understand and intervene on eating in the absence of hunger (EAH) as it occurs in peoples' natural environments is hindered by biased methods that lack ecological validity. One promising indicator of EAH that does not rely on self-report and is easily assessed in free-living individuals is glucose. Here, we hypothesize that elevated pre-prandial blood glucose concentrations (PPBG), which reflect a source of readily-available, short-term energy, are a biological indicator of EAH. This was a 7-day observational study of N = 41, 18–24 year old men and women with BMI < 25 kg/m² (60%) or BMI ≥ 25 kg/m² (40%). We collected data using ecological momentary assessment from people in their natural environments. We defined EAH by self-report (perceived EAH) and by PPBG thresholds using two methods (standardized, PPBG < 85 mg/dl; personalized, PPBG<individual fasting levels). Multilevel modeling was used to analyze the data. N = 963 eating events were reported. There were significantly (p < .05) fewer perceived EAH events (25%) as compared to standardized (62%) and personalized PPBG-defined EAH events (51%). Consistent with published literature, perceived EAH was more likely to occur at a higher PPBG (p < .01), particularly among participants with a BMI ≥ 25 kg/m² (pint < .01). Additionally, discordance between perceived EAH and PPBG-defined EAH, indicating a perception of hunger at an eating event when PPBS was elevated, was less likely among participants with a BMI < 25 kg/m² vs. those with a BMI ≥ 25 kg/m² (pint < .01) as well as at snacks vs. meals (pint < .01). These findings provide preliminary support for using PPBG as a biological indicator of EAH in free-living individuals.
... Already at 4.5 y of age faster eating rates facilitate larger energy intakes at a meal and are linked with higher adiposity (13) and larger increases in BMI over time (14). Similarly, higher intake of energy-dense snacks in an eating in the absence of hunger (EAH) paradigm (15) has been linked with higher overall energy intakes (16), higher prevalence of overweight (17), and accelerated weight gain over time (18,19). Because risk factors in the first 1000 d predict future obesity risk, it is plausible that they are also linked with eating behaviors that facilitate greater energy intakes and increased adiposity. ...
Background:
Several risk factors in the first 1000 d are linked with increased obesity risk in later childhood. The role of potentially modifiable eating behaviors in this association is unclear.
Objectives:
This study examined whether the association between cumulated risk factors in the first 1000 d and adiposity at 6 y is moderated by eating behaviors.
Methods:
Participants were 302 children from the GUSTO (Growing Up in Singapore Towards healthy Outcomes) cohort. Risk factors included maternal prepregnancy and paternal overweight, excessive gestational weight gain, raised fasting plasma glucose during pregnancy, short breastfeeding duration, and early introduction of solid foods. Composite risk scores reflecting the prevalence and the importance of the risk factors present were computed. Adiposity outcomes were child BMI and sum of skinfolds (SSF), and candidate eating behavior moderators were portion size, eating rate, and energy intake during lunch and in an eating in the absence of hunger task.
Results:
Higher composite risk score predicted higher BMI z scores (B = 0.08; 95% CI: 0.04, 0.13) and larger SSF (0.70 mm; 0.23, 1.18 mm), and was associated with larger self-served food portions (5.03 kcal; 0.47, 9.60 kcal), faster eating rates (0.40 g/min; 0.21, 0.59 g/min), and larger lunch intakes (7.05 kcal; 3.37, 10.74 kcal). Importantly, the association between composite risk score and adiposity was moderated by eating behaviors. The composite risk score was unrelated to SSF in children who selected smaller food portions, ate slower, and consumed less energy, but was positively associated with SSF among children who selected larger food portions, ate faster, and consumed more energy (eating behavior × risk score interactions: P < 0.05).
Conclusions:
The association between risk factors in the first 1000 d and adiposity at 6 y varies by eating behaviors, highlighting modifiable behavioral targets for interventions.This trial was registered at clinicaltrials.gov as NCT01174875.
Obesity in children remains a major public health problem, with the current prevalence in youth ages 2–19 years estimated to be 19.7%. Despite progress in identifying risk factors, current models do not accurately predict development of obesity in early childhood. There is also substantial individual variability in response to a given intervention that is not well understood. On April 29–30, 2021, the National Institutes of Health convened a virtual workshop on “Understanding Risk and Causal Mechanisms for Developing Obesity in Infants and Young Children.” The workshop brought together scientists from diverse disciplines to discuss (1) what is known regarding epidemiology and underlying biological and behavioral mechanisms for rapid weight gain and development of obesity and (2) what new approaches can improve risk prediction and gain novel insights into causes of obesity in early life. Participants identified gaps and opportunities for future research to advance understanding of risk and underlying mechanisms for development of obesity in early life. It was emphasized that future studies will require multi‐disciplinary efforts across basic, behavioral, and clinical sciences. An exposome framework is needed to elucidate how behavioral, biological, and environmental risk factors interact. Use of novel statistical methods may provide greater insights into causal mechanisms.
Introduction
The obesity rate among adults in Indonesia continues to increase, and even almost doubles in a decade. In the study of eating behavior, one of the causes of obesity is due to eating out of hunger. The study has proposed a conceptual model of eating in the absence of hunger [EAH]. EAH was examined through the influence of eating styles and hedonic hunger. In addition, the mediating role of palatable eating motives and loss of control over eating were also included in the model. In this paper, we mainly focused on the influence of environmental situation namely the occurrence of the COVID-19 pandemic. It was necessary to see whether the COVID-19 pandemic situation would make a difference to the proposed model. The study aimed to compare data taken before COVID-19 with data taken during the COVID-19 pandemic.
Methods
This study involved 753 respondents who were dominated by female and university students aged 18-25 years who were studying in Jakarta using convenience sampling. Data were collected using a self-report questionnaire. The data before the COVID-19 pandemic was collected in February -March 2020 by paper and pencil. The data during COVID-19 was collected using the online form in June-July 2020. Data were analyzed using multigroup analysis.
Results
The analysis results denoted that the model proposed was fit with the data even though the two data groups were not invariant.
Conclusion
This means that special situations, such as the COVID-19 pandemic have an impact on EAH.
Context:
Reward-based eating is a trait that increases risk for eating in the absence of hunger (EAH) and obesity. Eating behaviors such as switching more frequently between different foods may increase intake during EAH by delaying the onset of sensory-specific satiation (SSS); however, this question has not been empirically tested.
Objectives:
1) Test whether switching between foods mediates the relationship between reward-based eating and EAH intake. 2) Test whether switching between foods during EAH moderates the relationship between reward-based eating and weight status.
Methods:
Data were analyzed from a study assessing decision-making in children (n = 63 children; 9.4 ± 1.4 years, 77.0 ± 22.4 BMI %tile). Reward-based eating was quantified using the Children's Eating Behaviour Questionnaire. EAH was assessed as the amount of palatable food consumed following ad libitum consumption of a standard meal. Videos of eating behavior were coded for eating time, number of different foods consumed, and food switches. Ordinary least squares regressions were conducted to test hypotheses.
Results:
Switching was positively associated with EAH intake for both kcal (p < 0.01) and grams (p < 0.01) such that each additional switch was associated with an increased intake of 17.0 kcal or 3.5 grams. Switching mediated the relationship between reward-based eating and EAH (p < 0.01) such that more frequent switching fully accounted for the positive association between reward-based eating and EAH (ps < 0.01). While reward-based eating was also positively associated with weight status (p < 0.01), this association was moderated by food switching (p < 0.01) such that the relationship was stronger for children who switch more frequently (p < 0.01).
Conclusions:
Frequent switching between foods was positively associated with EAH intake and mediated the relationship between reward-based eating and EAH. Moreover, reward-based eating was more strongly related to weight status in children who switched more frequently. Thus, food switching may contribute to overconsumption and be an important behavioral indicator of increased obesity risk in children. Studies across multiple meals and contexts will help determine if switching is a reliable behavioral phenotype.
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.
Epidemiological evidence supports a positive association between ultra-processed food (UPF) consumption and BMI. This has led to recommendations to avoid UPF despite very limited evidence establishing causality. Many mechanisms have been proposed and this review critically evaluates selected possibilities for specificity, clarity, and consistency related to food choice (i.e., low cost, shelf-life, food packaging, hyper-palatability, and stimulation hunger/suppression of fullness); food composition (i.e., macronutrients, food texture, added sugar, fat salt, energy density, low calorie sweeteners, and additives); and digestive processes (i.e., oral processing/eating rate, gastric emptying time, gastrointestinal transit time, and microbiome). For some purported mechanisms (e.g., fiber content, texture, gastric emptying, intestinal transit time), data directly contrasting effects of UPF and non-UPF food intake on indices of appetite, food intake and adiposity are available and do not support a unique contribution of UPF. In other instances, data are not available (e.g., microbiome, food additives) or are insufficient (e.g., packaging, food cost, shelf life, macronutrient intake, appetite stimulation) to judge the benefits versus risks of UPF avoidance. There are yet other evoked mechanisms where the preponderance of evidence indicates ingredients in UPF actually moderate body weight (e.g., LCS use for weight management; beverage consumption as it dilutes energy density; higher fat content because it reduces glycemic responses). Because avoidance of UPF holds potential adverse effects (e.g., reduced diet quality, increased risk of food poisoning, food wastage), it is imprudent to make recommendations about their role in diets before causality and plausible mechanisms have been verified.
Background:
There is growing evidence that an addictive-eating phenotype may exist. There is significant debate regarding whether highly processed foods (HPFs; foods with refined carbohydrates and/or added fats) are addictive. The lack of scientifically grounded criteria to evaluate the addictive nature of HPFs has hindered the resolution of this debate.
Analysis:
The most recent scientific debate regarding a substance's addictive potential centered around tobacco. In 1988, the Surgeon General issued a report identifying tobacco products as addictive based on three primary scientific criteria: their ability to (1) cause highly controlled or compulsive use, (2) cause psychoactive (i.e. mood-altering) effects via their effect on the brain and (3) reinforce behavior. Scientific advances have now identified the ability of tobacco products to (4) trigger strong urges or craving as another important indicator of addictive potential. Here, we propose that these four criteria provide scientifically valid benchmarks that can be used to evaluate the addictiveness of HPFs. Then, we review the evidence regarding whether HPFs meet each criterion. Finally, we consider the implications of labeling HPFs as addictive.
Conclusion:
Highly processed foods (HPFs) can meet the criteria to be labeled as addictive substances using the standards set for tobacco products. The addictive potential of HPFs may be a key factor contributing to the high public health costs associated with a food environment dominated by cheap, accessible and heavily marketed HPFs.
Eating in the absence of hunger (EAH) has been identified as a behavioral phenotype for obesity. Few studies have reported on objective measures of EAH in adolescents, and fewer yet have objectively measured EAH in a naturalistic, home setting. The purpose of this paper was to examine relations between objective, adolescent-report and parent-report measures of EAH, and to examine variation by sex and race. Participants included 295 predominantly low-income and rural adolescents (mean age = 14.2 ± 0.6 years) and their parents, drawn from the Family Life Project. An EAH task was administered in the home following an ad-libitum meal and compulsory milkshake; EAH was also reported on a web-based survey (both adolescent and parent reports) and adolescents’ BMIz was calculated from height and weight, measured in the home or self-reported on the web survey. A high degree of variability in EAH intake was observed (range = 8–741 kcals). Parent and adolescent reports of EAH were weakly correlated and unrelated to observed EAH consumption; only adolescent reports of EAH were related to their BMIz. Several relations varied by sex and race. Positive associations between reported and observed EAH was only observed in girls, and positive associations between observed EAH and BMI was only observed in boys and in white adolescents. Overall EAH consumption was significantly greater in boys and in white adolescents. These findings suggest that EAH can be measured in adolescents in the home. In this sample of youth experiencing rural poverty, this home-based measure appears most valid for white adolescent girls.
Strategies used by parents to restrict children's access to highly palatable but unhealthy foods have been described collectively as restrictive feeding practices. Ironically, evidence shows these practices may foster maladaptive eating behaviours and increase children's risk of obesity. This systematic review and series of meta-analyses aim to estimate the relationships between different operationalisations of parental restrictive feeding practices and children's eating behaviours measured by either the Children's Eating Behaviour Questionnaire (Wardle et al., 2001) or eating in the absence of hunger paradigm. PsycINFO, Medline Complete, CINAHL, Scopus and Web of Science databases were searched on April 22nd, 2021 for terms relating to restrictive feeding practices, children and eating behaviours. Eligible studies (n = 24) reported a correlation between restrictive feeding and children's (2-12-years) eating behaviours. Meta-analyses were conducted on different operationalisations of restrictive feeding practices and different eating behaviours where there were three or more effects to analyse. Studies that were not meta-analysed were synthesised qualitatively. All studies were quality assessed using a standard checklist. Restrictive feeding (Child Feeding Questionnaire; Birch et al., 2001), was significantly correlated with higher food responsiveness, food fussiness, emotional overeating, and lower slowness in eating. Overt restriction (Feeding Practices and Structure Questionnaire, E. Jansen et al., 2014) was significantly correlated with higher food responsiveness. The qualitative synthesis suggests overt restriction is related to maladaptive eating behaviours, but that other operationalisations of restrictive feeding, especially covert restriction, are not. Future research should examine whether covert restriction provides an alternative, non-harmful approach to restriction, by which parents can control children's diet quality without negatively impacting their eating behaviours.
Parents' symptoms of anxiety and depression are associated with their increased likelihood of using nonresponsive feeding practices and with children's elevated obesity risk. These feeding practices, particularly persuasive-controlling feeding practices, have further been linked to children's emotional eating, including both emotional overeating and undereating. To help future research identify points of interventions to reduce children's maladaptive eating behaviors, the goal of this study was to determine whether persuasive-controlling feeding practices mediated the link between parent mental health and children's emotional eating. Feeding practices were measured by the FPSQ. Anxiety was measured by the GAD-7. Depression was measured by the CESD-R. Emotional eating was measured by the CEBQ. Survey data were collected from 259 U.S. parents of preschool children as a part of a larger study. Results from structural equation modeling showed that nonresponsive feeding behaviors mediated the relationship between parent mental health and children's emotional eating. Future clinical trials may examine whether alleviating parents' mental health symptoms is associated with a reduction in children's maladaptive eating behaviors, including emotional eating.
Dr. Leann Birch, an innovator in the field of children's eating behavior, was the first scientist to synergize the fields of developmental psychology and nutrition science. One of Leann's groundbreaking projects was the Girls' NEEDS Project (GNP), an NIH-funded observational study of the longitudinal development of eating and weight-related behaviors of girls across middle childhood and adolescence. At the time of GNP, obesity prevalence during childhood had roughly doubled during the previous two decades, research interest in dieting had increased as societal expectations of the ‘thin ideal’ got even thinner, and little was known about how environmental factors such as parenting influenced the development of maladaptive eating and weight-related behaviors. GNP resulted in over 70 publications, covering a range of topics from girls' dietary intake and physical activity to parental influences on girls' eating behavior, thus laying the groundwork for many topics in the obesity, food parenting, and dieting literature today. Therefore, this narrative review aims to summarize and synthesize the literature that resulted from the GNP and provide implications for future work building from this foundation.
A variety of eating behaviors among children have been associated with obesity risk and are thought to broadly reflect child appetite self-regulation (ASR). While ASR is thought to occur on cognitive, emotional, motivational, biological, and behavioral levels, the inter-relatedness of ASR constructs as assessed by different methods/measures is not well-characterized. This narrative review describes the correspondence between different methods/measures of child ASR constructs as assessed by self-report questionnaires and/or observational tasks and their relationship to child standardized body mass index (BMIz). Research involving at least two different methods/measures is presented including observational tasks such as the Eating in the Absence of Hunger task, compensation trials, and eating rate, as well as various child eating behavior self-report questionnaires. Keyword searches in the PubMed and PsycINFO databases for articles published between 2000 and July 2021 identified 21,042 articles. Eighteen articles met the inclusion criteria and examined at least two of the targeted measures. Studies comparing questionnaire data with other questionnaire data showed the most evidence of significant associations (r values ranging from −0.45 to 0.49), whereas studies comparing questionnaires with observational tasks mostly showed weak (r values ranging from −0.17 to 0.19) or not significant associations, with only few studies finding moderate associations (r values ranging from −0.38 to 0.33). Studies comparing different observational tasks showed no significant associations. Overall, studies comparing self-report questionnaires showed the most correspondence, whereas those comparing observational tasks showed no correspondence. Studies across methods (questionnaires with tasks) showed less correspondence. Significant associations were found between ASR constructs and child BMIz across five studies using self-report questionnaires and two studies using observational tasks. Future research is needed to clearly define the various ASR constructs, their expected correspondence, and the strength of that correspondence, as well as the relations between ASR constructs and child weight among youth with and without overweight/obesity.
Developing healthy eating behaviours is important to assist children in maintaining good health and decrease the risk of chronic health conditions. Recent nutrition promotion efforts in Australian primary schools have mainly focused on canteen guideline compliance and obesity prevention interventions. The aim of this study was to investigate the primary school food environment, specifically, allocated lunch eating duration and the governance of children's lunch breaks. Parents (n = 402) and teachers (n = 123) were asked via an online survey, about school allocated lunch eating duration and its adequacy. Respondents were asked about the supervision, monitoring and feedback of children's lunches, as well as how they felt about these practices. Parents (n = 308) and teachers (n = 102) also responded to the open-ended question “What could be done to improve the school food environment at your school?“.
Ten minutes was the allocated lunch eating duration reported by most parents and teachers and 54% of those parents and 30% of those teachers rated this as inadequate. Increasing the allocated lunch eating duration was frequently cited as a way to improve the school food environment. A similar proportion of parents and teachers agreed with teachers monitoring food intake, not providing feedback on food brought to school, and that parents should decide what children eat. More parents (44%) than teachers (23%) believed that teachers should eat their own lunch with the children. These findings provide an insight into the primary school lunch environment and the views of two key stakeholder groups. School food policies should consider these findings in future revisions, particularly with regards to eating times.
Over the last decade, longitudinal research has shown that children's general, top-down self-regulation during early childhood is negatively associated with children's weight status in elementary school. The samples in these previous studies have been primarily White, and no study to date has examined this issue in a sample of Hispanic children from low-income families—a population at high risk for childhood obesity. The present study followed 130 Hispanic children over a time period of three to just under five years, examining the degree to which multiple measures of general, top-down self-regulation, along with a measure of appetite regulation (eating in the absence of hunger), predicted children's BMI z-scores in the early elementary school years. Results showed that children's ability to delay gratification in the preschool years was negatively associated with later BMI z-scores and that children's eating in the absence of hunger was positively associated. In separate models by gender, these relationships were significant only for girls. Moreover, analyses run separately for children of mothers low or high on acculturation showed that the relationship between delay of gratification and later BMI z-scores was significant only for children whose mothers were low on acculturation. Possible socialization and environmental factors contributing to these findings are considered.
Stress is associated with a range of unhealthy eating habits, yet few studies have examined how stress may influence the intergenerational transmission of eating habits from parents to their children. Specifically, there is a lack of data regarding the role of stress on feeding practices. Moreover, most work investigating the associations between parental stress and their feeding behaviors has been correlational, limiting our understanding of causality. In the current study, we used an experimental design, induced high and low stress in mothers using a standard laboratory stressor, and observed mother-child interactions during a snack break. We also examined the potential role of maternal executive functioning (EF) for buffering the effects of stress on maternal feeding behaviors. Levels of maternal stress were manipulated with the Trier Social Stress Task (TSST) in a community sample (N = 80 dyads, Child Mage = 41.89 months, female = 43). We measured maternal EF with a series of computerized tasks. Maternal feeding behaviors were coded for controlling behaviors, which included pressuring and restricting behaviors. Results indicate a main effect of stress on controlling feeding behaviors, such that mothers in the high-stress condition exhibited higher levels of controlling behaviors. The effect of stress on controlling feeding behaviors was ameliorated among mothers with higher levels of EF after controlling for child age and income. Results provide causal evidence for the role of stress on feeding behaviors and suggest EF as a factor to be considered in the treatment and prevention of diet-related illnesses.
L’objectif de ce chapitre est de répondre à la question suivante : le plaisir est-il l’ennemi de l’adoption de bonnes pratiques alimentaires ? Cette question sera abordée selon un découpage classique qui répond à la problématique du QUOI (diversité alimentaire, aliments acceptés et rejetés) et celle du COMBIEN (régulation des prises énergétiques). Une emphase sera portée à la population des enfants dans la mesure où les comportements alimentaires se construisent dès la petite enfance. Un intérêt particulier a été porté aux enfants en surpoids dont on préjuge souvent qu’ils entretiennent un rapport spécifique au plaisir dans le domaine alimentaire.
The Child Eating Behaviour Questionnaire (CEBQ) is designed to measure ‘usual’ eating behaviour, with no time period attached, thus may not be suitable for assessing the effectiveness of short-term experimental studies. The aim of this study was to validate i) the CEBQ adapted to measure ‘past week’ rather than ‘usual’ eating behaviour, and ii) a computerized questionnaire assessing desire to eat core and non-core foods, against an objective measure of eating behaviour and food intake (eating in the absence of hunger (EAH) experiment). Children (n = 103) aged 8–12 years completed the desire to eat questionnaire followed by the EAH experiment while primary caregivers completed the adapted CEBQ. Results from the CEBQ showed that children with greater ‘satiety responsiveness’ (1-point higher) consumed less energy (−342 kJ; 95% CI -574, −110) whereas those with greater ‘enjoyment of food’ scale consumed more energy (380 kJ; 95% CI 124, 636) during the ad-libitum phase of the EAH experiment. Higher scores for slowness in eating (−705 kJ; 95% CI -1157, −254), emotional undereating (−590 kJ; 95% CI -1074, −106) and food fussiness (−629 kJ; 95% CI -1103, −155) were associated with lower total energy intake. Children who expressed greater desire to eat non-core foods consumed more energy in total (275 kJ; 95% CI 87, 463). Overall, this adapted CEBQ appears valid for measuring several short-term eating behaviours in children. The desire to eat questionnaire may be useful for identifying short-term susceptibility to overeating, however further investigation into how ratings of desire relate to the intake of highly palatable, energy dense foods is warranted.
Appetite dysregulation contributes to obesity development. Increasing evidence supports a neurobehavioral model of obesity risk and maintenance in which appetite plays a central role. According to this model, individuals differ in appetitive characteristics which influence their behavioral susceptibility to gain and maintain excess weight. Food approach traits increase obesity risk, while food avoidant traits, such as satiety responsiveness, decrease obesity risk. Evidence additionally suggests that obesity is associated with impaired performance on tasks eliciting cognitive control in relation to food intake. Appetitive characteristics are driven and maintained by individual differences in the structure and function of neural circuits relevant to appetitive behavior. In general, human neuroimaging studies suggest that in individuals with raised risk for obesity, satiety and regulatory signals from homeostatic and cognitive control regions are compromised, while food approach signals from regions implicated in motivation/reward, emotion/memory, and sensory/motor function, are heightened. Appetite is under substantial genetic influence. For example, obesity-associated variants in the fat mass and obesity-associated (FTO) gene are associated with heightened appetite, as well as altered neural responses to food cues. Further research is necessary to understand the functional significance of common variations at FTO and other loci identified in genome-wide association studies. Large prospective studies beginning in infancy are needed to further elucidate the model we present and determine bidirectional relationships. Nevertheless, extant evidence supports the use of neurobehaviorally targeted interventions, which could include centrally-acting drugs, but also behavioral interventions able to alter obesity-associated phenotypes at a behavioral and neural level.
Objective
Assess effects of an obesity prevention program promoting eating self-regulation and healthy preferences in Hispanic preschool children.
Design
Randomized controlled trial with pretest, posttest, 6- and 12-month assessments. Fourteen waves, each lasting 7 weeks.
Setting
Families recruited from Head Start across 2 sites.
Participants
Two hundred fifty-five families randomized into prevention (n = 136) or control (n = 119).
Intervention
Prevention received curriculum; control received no curriculum.
Main Outcome Measure(s)
Feeding knowledge/practices/styles (parent); body mass index percentile, eating self-regulation, trying new foods, and fruit/vegetable consumption (child).
Analysis
Multilevel analyses for nested data (time points within families; families within waves) and multinomial regression.
Results
Program increased mothers’ repeated presentation of new foods (P < 0.05), measured portion sizes (P < 0.05), child involvement in food preparation (P < 0.001), feeding responsiveness (P < 0.001), knowledge of best feeding practices (P < 0.001), and feeding efficacy (P < 0.05); reduced feeding misconceptions (P < 0.01) and uninvolved feeding (P < 0.01). Effects on child eating behavior were minimal. At 12 months, children in the prevention group were less likely to have overweight (P < 0.05) or obesity (P < 0.05).
Conclusions and Implications
Program effects emphasize the importance of feeding approaches in reducing childhood obesity.
Evidence is growing that highly processed (HP) foods (i.e., foods high in refined carbohydrates and fat) are highly effective in activating reward systems and may even be capable of triggering addictive processes. Unlike traditional drugs of abuse, exposure to HP foods is common very early in development. HP food addiction has been associated with negative outcomes, including higher body mass index (BMI), more frequent binge eating, greater failure in weight loss treatment trials, and poorer mental and physical health. Although most research on HP food addiction has been conducted using adult samples, research on this topic now spans across the life span beginning in utero and extending through older adulthood. HP food addiction and related reward-based changes are associated with negative outcomes at every life stage, which has important implications for developmentally tailored prevention and treatment efforts. Using a developmentally informed approach, the current study comprehensively reviews the existing research on HP food addiction across the lifespan and highlights important areas of future research.
Wellness in health is a state of complete physical, mental, and social wellbeing and not merely the absence of disease or infirmity. Obese adolescents are at particular risk for low wellness due to weight stigma, weight-based teasing/bullying and increased risk of metabolic syndrome, social isolation, avoidance of health care, depression, anxiety, substance use, low self-esteem, self-harm, poor body image, and suicide. The appropriate identification of teens experiencing excessive weight gain and potential comorbidities is important to make sure helpful services can be offered, ideally by an interdisciplinary team with adolescent expertise. Nutrition providers play an important role in helping teens to improve their relationship with food, prevent disordered eating and promote whole-person health.
Individuals with overweight or obesity (OW/OB) are at increased risk for significant physical and psychological comorbidities. The current treatment for OW/OB is behavioral weight loss, which provides psychoeducation on nutrition and physical activity, as well as behavior therapy skills. However, behavioral weight loss is not effective for the majority of the individuals who participate. Research suggests that overeating, or eating past nutritional needs, is one of the leading causes of weight gain. Accumulating evidence suggests that appetitive traits, such as food cue responsiveness and satiety responsiveness, are associated with overeating and weight in youth and adults. The following review presents the current literature on the relationship between food cue responsiveness, satiety responsiveness, overeating, and OW/OB. Research suggests that higher food cue responsiveness and lower satiety responsiveness are associated with overeating and OW/OB cross-sectionally and longitudinally. Emerging data suggest that food cue responsiveness and satiety responsiveness may exist along the same continuum, and can be targeted to manage overeating and reduce weight. We have developed a treatment model targeting food cue responsiveness and satiety responsiveness, to reduce overeating and weight and have preliminary feasibility, acceptability, and efficacy data, with testing currently being conducting in larger trials. Through programs targeting appetitive traits we hope to develop an alternative weight loss model to assist individuals with a propensity to overeat.
Proper nutrition during infancy and early childhood is fundamental to the development of a healthy adult. Given the high nutrient demands of children, they are easily one of the population groups most susceptible to micronutrient deficiencies. Early weaning is one of the leading causes of child malnutrition and ultimately increases the risk of infant morbidity and mortality. After the first six months postpartum, breast milk becomes inadequate for the optimal growth and development of babies, and cereal-based foods are often introduced to increase nutrient intake and energy levels. Until children reach 3–5 years old their digestive systems are not yet fully developed and the food that is provided should thus contain all the nutrients necessary for a healthy development. Cereal-based foods are by far the major source of energy, protein, vitamins and minerals for infants from 6 to nearly 36 months old. This chapter deals principally with infant vitality and the importance of cereal foods for infant nutrition, the various types of cereal foods, the nutrients they contain, commercial infant cereals and cereal-based complementary foods for babies. Towards the end of the chapter, potential allergies and food safety parameters for these cereal foods are also discussed.
Milk is the most important nutritional source for newborns and infants during the initial months of their lives. Breast milk is healthy for infants as it is easily digestible. Apart from its nutritional value, breast milk is known to have a positive impact on infants’ growth and development as it provides biochemical and immunological components including proteins, cytokines and hormones. Breast milk also decreases the risk of diarrhea, and morbidity from respiratory tract and urinary tract infections. In addition, breast feeding helps mothers to regain pre-pregnancy body weight and to return the uterus to its normal size and shape. In a few cases, however, breastfeeding is not possible due to conditions associated with the modern era such as malnutrition, the absence of the mother, insufficient lactation, food allergies and other maternal health issues. Because of these problems, infant milk formula may be preferred as an alternative, and is manufactured by industries to mimic the nutritional value of breast milk. Infant formulas, baby formulas or baby milk commonly use cow’s milk or soymilk as a base with added nutritional supplements. Nevertheless, infants fed with formula are at a higher risk from acute otitis media, asthma, type 1 and 2 diabetes, eczema, lower respiratory tract infections, sudden infant death syndrome (SIDS) and obesity. This article reviews human breast milk and problems associated with breast feeding, the need for infant formulas as an alternative form of nutrition, different types of infant formulas, the health benefits and risks of infant formulas, guidelines for the manufacture of infant formulas, and the global market.
Pediatric obesity results from a daily energy imbalance between intake and expenditure, an imbalance potentially as slight as ∼30-50 kcal/day (e.g., a few extra sips of cola or bites of a cookie). That an 'energy gap' so small may be so powerful suggests the importance of understanding mechanisms of food intake self-regulation (FISR). This review focuses on 4 behavioral indices of FISR in childhood: (1) eating in the absence of hunger; (2) eating rate; (3) caloric compensation and satiety responsiveness, and (4) food responsiveness. Evidence from pediatric samples around the world indicates that these traits are associated with body mass index, are heritable, and are linked to polymorphisms in the FTO gene. We review these data, also discussing their relevance to practical issues of parental feeding styles, portion sizes, and health literacy and numeracy. Research gaps and opportunities for future investigation are discussed. Multidisciplinary approaches and study designs that can address gene-environment interactions are needed to advance the science of FISR and stimulate new avenues for childhood obesity prevention. © 2013 S. Karger AG, Basel.
Childhood obesity is a serious health problem in the United States and worldwide. More than 30 percent of American children and adolescents are overweight or obese. We assessed the effectiveness of childhood obesity prevention programs by reviewing all interventional studies that aimed to improve diet, physical activity, or both and that were conducted in schools, homes, primary care clinics, childcare settings, the community, or combinations of these settings in high-income countries. We also reviewed consumer health informatics interventions. We compared the effects of the interventions on weight-related outcomes (e.g., body mass index [BMI], waist circumference, percent body fat, skinfold thickness, prevalence of obesity and overweight); intermediate outcomes (e.g., diet, physical activity); and obesity-related clinical outcomes (e.g., blood pressure, blood lipids). We searched MEDLINE(R), Embase(R), PsycInfo(R), CINAHL(R), clinicaltrials.gov, and the Cochrane Library through August 11, 2012. Two reviewers independently reviewed each article for eligibility. For each study, one reviewer extracted the data and a second reviewer verified the accuracy. Both reviewers assessed the risk of bias for each study. Together, the reviewers graded the strength of the evidence (SOE) supporting interventions-diet, physical activity, or both-in each setting for the outcomes of interest. We quantitatively pooled the results of studies that were sufficiently similar. Only experimental studies with followup of at least 1 year (6 months for studies in school settings) were included. We abstracted data on comparisons of intervention versus control. We identified 34,545 unique citations and included 131 articles describing 124 interventional studies. The majority of the interventions (104 studies) were school based, although many of them included components delivered in other settings. Most were conducted in the United States and in the past decade. Results of four studies were pooled for BMI and four for BMI z-score in the school-only setting; results of five school-home studies were pooled for BMI. Other studies tested interventions delivered at home (n=6), in primary care (n=1), in childcare (n=4), and in the community (n=9). Six studies tested consumer health informatics interventions. For obesity prevention, the following settings and interventions showed benefit: school-based-diet or physical activity interventions (SOE moderate); school-based with a home component-physical activity interventions (SOE high) and both diet and physical activity (SOE moderate); school-based with home and community components-diet and physical activity interventions (SOE high); school-based with a community component-diet and physical activity interventions (SOE moderate); community with a school component-diet and physical activity interventions (SOE moderate). The strength of the evidence is either low or insufficient for the remainder of the interventions and settings. The evidence is moderate about the effectiveness of school-based interventions for childhood obesity prevention. Physical activity interventions in a school-based setting with a family component or diet and physical activity interventions in a school-based setting with home and community components have the most evidence for effectiveness. More research is needed to test interventions in other settings, such as those testing policy, environmental, and consumer health informatics strategies.
The most recent national data on obesity prevalence among U.S. adults, adolescents, and children show that more than one-third of adults and almost 17% of children and adolescents were obese in 2009–2010. Differences in prevalence between men and women diminished between 1999–2000 and 2009–2010, with the prevalence of obesity among men reaching the same level as that among women. Age differences in obesity prevalence varied between men and women. The prevalence of obesity was higher among older women compared with younger women, but there was no difference by age in obesity prevalence among men. Among children and adolescents, the prevalence of obesity was higher among adolescents than among preschool-aged children. There has been no change in obesity prevalence in recent years; however, over the last decade there has been a significant increase in obesity prevalence among men and boys but not among women and girls overall. The Healthy People 2010 goals of 15% obesity among adults and 5% obesity among children were not met (6).
To examine associations of television viewing with eating behaviors in a representative sample of US adolescents.
Cross-sectional survey.
Public and private schools in the United States during the 2009-2010 school year.
A total of 12,642 students in grades 5 to 10 (mean [SD] age, 13.4 [0.09] years; 86.5% participation).
Television viewing (hours per day) and snacking while watching television (days per week).
Eating (≥1 instance per day) fruit, vegetables, sweets, and sugary soft drinks; eating at a fast food restaurant (≥1 d/wk); and skipping breakfast (≥1 d/wk).
Television viewing was inversely related to intake of fruit (adjusted odds ratio, 0.92; 95% CI, 0.88-0.96) and vegetables (0.95; 0.91-1.00) and positively related to intake of candy (1.18; 1.14-1.23) and fast food (1.14; 1.09-1.19) and skipping breakfast (1.06; 1.02-1.10) after adjustment for socioeconomic factors, computer use, and physical activity. Television snacking was related to increased intake of fruit (adjusted odds ratio, 1.06; 95% CI, 1.02-1.10), candy (1.20; 1.16-1.24), soda (1.15; 1.11-1.18), and fast food (1.09; 1.06-1.13), independent of television viewing. The relationships of television viewing with fruit and vegetable intake and with skipping breakfast were essentially unchanged after adjustment for television snacking; the relationships with intake of candy, soda, and fast food were moderately attenuated. Age and race/ethnicity modified relationships of television viewing with soda and fast food intake and with skipping breakfast.
Television viewing was associated with a cluster of unhealthy eating behaviors in US adolescents after adjustment for socioeconomic and behavioral covariates.
Our purpose in this study was to examine 2 treatments targeted at reducing eating in the absence of hunger in overweight and obese children.
Thirty-six overweight and obese 8- to 12-year-old children (58% female; mean age = 10.3 years, SD = 1.3), with high scores on eating in the absence of hunger, and their parents were randomly assigned to an 8-week children's appetite awareness training or cue exposure treatment-food. Children completed an eating in the absence of hunger (EAH) paradigm, an Eating Disorder Examination interview for children, and three 24-hr dietary recalls, and their height and weight were measured. Parents completed the EAH Questionnaire and the Binge Eating Scale, and their height and weight were measured. Assessments were conducted at baseline, posttreatment, and 6 and 12 months posttreatment.
Results showed that both treatments resulted in significant decreases in binge eating in children over time. Additionally, children in the food cue exposure treatment showed significant decreases in EAH posttreatment and 6 months posttreatment, but children in the appetite awareness training showed no change in EAH. Neither treatment produced significant effects on caloric intake in children or on any of the parent outcomes.
This study demonstrates that training in food cue responsitivity and appetite awareness has the potential to be efficacious for reducing EAH and binge eating in children. Because these data are preliminary, further treatment development and randomized controlled studies are needed.
To examine the association between eating in the absence of hunger (EAH) and adiposity in children.
Two cross-sectional studies in community settings.
For study 1, 348 children (178 girls and 170 boys) aged 7-9 years were recruited as part of the Physical Exercise and Appetite in Children Study. In study 2, participants were a subsample of children aged 9-12 years (N=316; 192 girls and 124 boys) from the Twins Early Development Study.
EAH was operationalized as intake of highly palatable sweet snacks after a mixed meal at school (study 1) or home (study 2). Weight (kg) and height (m) measurements were used to calculate the body mass index (BMI) s.d. scores. Children were grouped using the standard criteria for underweight, healthy weight, overweight and obesity. The healthy weight range was further subdivided into lower healthy weight (<or=50th centile) and higher healthy weight (>50th centile) to examine the distribution of EAH across the adiposity continuum.
In both studies, EAH showed a significant positive association with adiposity in boys after adjusting for covariates (P<0.001), with a linear increase in the intake across underweight, healthy weight and overweight groups. The association between EAH and adiposity was not significant in girls in either study, although in study 1, results showed a quadratic trend, with EAH increasing through the underweight and healthy weight ranges and decreasing in overweight and obese groups.
EAH is a behavioural phenotype that is not specific to overweight children but instead shows a graded association with adiposity across the weight continuum, particularly in boys. In this study, the effect was less pronounced in girls, which may reflect social desirability pressures constraining food intake among heavier girls.
Physical inactivity contributes to weight gain in adults, but whether this relationship is true for children of different ethnic groups is not well established.
To assess participation in vigorous activity and television watching habits and their relationship to body weight and fatness in US children.
Nationally representative cross-sectional survey with an in-person interview and medical examination. SETTING and
Between 1988 and 1994, 4063 children aged 8 through 16 years were examined as part of the National Health and Nutrition Examination Survey III. Mexican Americans and non-Hispanic blacks were oversampled to produce reliable estimates for these groups.
Episodes of weekly vigorous activity and daily hours of television watched, and their relationship to body mass index and body fatness.
Eighty percent of US children reported performing 3 or more bouts of vigorous activity each week. This rate was lower in non-Hispanic black and Mexican American girls (69% and 73%, respectively). Twenty percent of US children participated in 2 or fewer bouts of vigorous activity perweek, and the rate was higher in girls (26%) than in boys (17%). Overall, 26% of US children watched 4 or more hours of television per day and 67% watched at least 2 hours per day. Non-Hispanic black children had the highest rates of watching 4 or more hours of television per day (42%). Boys and girls who watch 4 or more hours of television each day had greater body fat (P<.001) and had a greater body mass index (P<.001) than those who watched less than 2 hours per day.
Many US children watch a great deal of television and are inadequately vigorously active. Vigorous activity levels are lowest among girls, non-Hispanic blacks, and Mexican Americans. Intervention strategies to promote lifelong physical activity among US children are needed to stem the adverse health consequences of inactivity.
This study examined whether physical, social, cultural and economical environmental factors are associated with obesogenic dietary behaviours and overweight/obesity among adults. Literature searches of databases (i.e. PubMed, CSA Illumina, Web of Science, PsychInfo) identified studies examining environmental factors and the consumption of energy, fat, fibre, fruit, vegetables, sugar-sweetened drinks, meal patterns and weight status. Twenty-eight studies were in-scope, the majority (n= 16) were conducted in the USA. Weight status was consistently associated with the food environment; greater accessibility to supermarkets or less access to takeaway outlets were associated with a lower BMI or prevalence of overweight/obesity. However, obesogenic dietary behaviours did not mirror these associations; mixed associations were found between the environment and obesogenic dietary behaviours. Living in a socioeconomically-deprived area was the only environmental factor consistently associated with a number of obesogenic dietary behaviours. Associations between the environment and weight status are more consistent than that seen between the environment and dietary behaviours. The environment may play an important role in the development of overweight/obesity, however the dietary mechanisms that contribute to this remain unclear and the physical activity environment may also play an important role in weight gain, overweight and obesity.
Children's emotional eating is related to greater body mass index and a less-healthy diet, but little is known about the early development of this behavior.
This study aimed to examine the relations between preschool children's emotional eating and parental feeding practices by using experimental manipulation of child mood and food intake in a laboratory setting.
Twenty-five 3-5-y-old children and their mothers sat together and ate a standard meal to satiety. Mothers completed questionnaires regarding their feeding practices. Children were assigned to a control or negative mood condition, and their consumption of snack foods in the absence of hunger was measured.
Children whose mothers often used food to regulate emotions ate more cookies in the absence of hunger than did children whose mothers used this feeding practice infrequently, regardless of condition. Children whose mothers often used food for emotion regulation purposes ate more chocolate in the experimental condition than in the control condition. The pattern was reversed for children of mothers who did not tend to use food for emotion regulation. There were no significant effects of maternal use of restriction, pressure to eat, and use of foods as a reward on children's snack food consumption. Conclusions: Children of mothers who use food for emotion regulation consume more sweet palatable foods in the absence of hunger than do children of mothers who use this feeding practice infrequently. Emotional overeating behavior may occur in the context of negative mood in children whose mothers use food for emotion regulation purposes. This trial was registered at clinicaltrials.gov as NCT01122290.
The prevalence and severity of obesity have increased in recent years, likely the result of complex interactions between genes, dietary intake, physical activity, and the environment. The expression of genes favoring the storage of excess calories as fat, which have been selected for over many millennia and are relatively static, has become maladaptive in a rapidly changing environment that minimizes opportunities for energy expenditure and maximizes opportunities for energy intake. The consequences of childhood and adolescent obesity include earlier puberty and menarche in girls, type 2 diabetes and increased incidence of the metabolic syndrome in youth and adults, and obesity in adulthood. These changes are associated with cardiovascular disease as well as with several cancers in adults, likely through insulin resistance and production of inflammatory cytokines. Although concerns have arisen regarding environmental exposures, there have been no formal expert recommendations. Currently, the most important factors underlying the obesity epidemic are the current opportunities for energy intake coupled with limited energy expenditure.
Polymorphisms in the obesity-associated gene, FTO, have been linked with sensitivity to satiety in children, indicating FTO may be influencing one of the regulatory drivers underlying food intake. In this study, we tested the hypothesis that food intake in a standard eating behaviour paradigm in which palatable food is offered under conditions of satiety would be associated with FTO genotype status, after controlling for differences in body mass index (BMI).
Participants were 131 children aged 4-5 years, taking part in a behavioural study of food intake for whom DNA was available for genotyping. The phenotypic indicator of intake was the child's consumption of palatable food presented after having eaten a meal. We also assessed physical activity using parental reports of the child's enjoyment of active games, their level of activity relative to other children and a standard measure of fidgetiness. Associations between polymorphisms of the intronic FTO single nucleotide polymorphism (rs9939609) and behaviour (food intake and activity) were assessed by analysis of variance controlling for sex, age and BMI s.d. scores.
The distribution of AA (homogenous for A allele), AT (heterogeneous T and A alleles) and TT (homogenous for T allele) genotypes was 18, 50 and 32%, respectively. As predicted, TT homozygotes ate significantly less than heterozygotes (P=0.03) or AA homozygotes (P=0.02). The effect was not diminished by controlling for BMI s.d. scores. There were no significant associations between FTO genotype and any marker of physical activity.
We showed that children with two copies of the lower-risk FTO alleles ate less than those with one or two higher-risk alleles. We conclude that the T allele is protective against overeating by promoting responsiveness to internal signals of satiety.
The "obesogenicity" of modern environments is fueling the obesity pandemic. We describe a framework, known as ANGELO (analysis grid for environments linked to obesity), which is a conceptual model for understanding the obesogenicity of environments and a practical tool for prioritizing environmental elements for research and intervention.
Development of the ANGELO framework. The basic framework is a 2 x 4 grid which dissects the environment into environmental size (micro and macro) by type: physical (what is available), economic (what are the costs), political (what are the "rules"), and sociocultural (what are the attitudes and beliefs). Within this grid, the elements which influence food intake and physical activity are characterized as obesogenic or "leptogenic" (promoting leanness).
Application of the ANGELO framework. The ANGELO framework has been piloted at the population level (island communities) to prioritize the settings/sectors for intervention and at the setting level (fast food outlets) to prioritize research needs and interventions. Environmental elements were prioritized by rating their validity (evidence of impact), relevance (to the local context), and potential changeability.
The ANGELO framework appears to be a flexible and robust instrument for the needs analysis and problem identification stages of reducing the obesogenicity of modern environments.
The Child Feeding Questionnaire (CFQ) is a self-report measure to assess parental beliefs, attitudes, and practices regarding child feeding, with a focus on obesity proneness in children. Confirmatory factor analysis tested a 7-factor model, which included four factors measuring parental beliefs related to child's obesity proneness, and three factors measuring parental control practices and attitudes regarding child feeding. Using a sample of 394 mothers and fathers, three models were tested, and the third model confirmed an acceptable fit, including correlated factors. Internal consistencies for the seven factors were above 0.70. With minor changes, this same 7-factor model was also confirmed in a second sample of 148 mothers and fathers, and a third sample of 126 Hispanic mothers and fathers. As predicted, four of the seven factors were related to an independent measure of children's weight status, providing initial support for the validity of the instrument. The CFQ can be used to assess aspects of child-feeding perceptions, attitudes, and practices and their relationships to children's developing food acceptance patterns, the controls of food intake, and obesity. The CFQ is designed for use with parents of children ranging in age from about 2 to 11 years of age.
Eating when exposed to large portions of palatable foods in the absence of hunger has been suggested to contribute to overweight.
This research evaluated whether young girls' eating in the absence of hunger was stable across a 2-y period in middle childhood, was associated with an increased risk of overweight, and could be predicted by parents' use of restriction in child feeding.
The participants were 192 non-Hispanic white girls and their parents, assessed when the girls were 5 and 7 y of age. The girls' eating when exposed to palatable foods in the absence of hunger was measured after they consumed a standard lunch and indicated that they were no longer hungry.
Eating in the absence of hunger showed moderate stability across the 2-y period for most of the girls. The girls who ate large amounts of snack foods in the absence of hunger at 5 and 7 y of age were 4.6 times as likely to be overweight at both ages. Parents' reports of restricting their daughter's access to foods at age 5 y predicted girls' eating in the absence of hunger at age 7 y, even when the girls' weight status and eating in the absence of hunger at age 5 y were controlled for.
This study provides the first evidence that young girls' eating in the absence of hunger may represent a stable phenotypic behavior of young overweight girls. In addition, these findings are consistent with previous work indicating that parents' restrictive feeding practices may contribute to this behavior.
To prospectively examine the relation between television watching and body fat change in children from preschool to early adolescence.
In a longitudinal study, 106 children were enrolled during preschool years (mean age 4.0 y) and followed into early adolescence (mean age 11.1 y). Parents completed an annual questionnaire on the child's television and video habits. Body mass index (BMI), triceps skinfolds, and sum of five skinfolds were recorded yearly at annual clinic visits. Longitudinal statistical analyses were carried out using mixed modeling procedures to control for potential confounding by a number of factors.
Television watching was an independent predictor of the change in the child's BMI, triceps, and sum of five skinfolds throughout childhood. Its effect was only slightly attenuated by controlling for the baseline body fat, level of physical activity (as measured repeatedly by Caltrac accelerometer), percent of calories from fat, total calorie intake, or the parents' BMI or education. By age 11, children who watched 3.0 h or more of television per day had a mean sum of skinfolds of 106.2 mm, compared with a mean sum of skinfolds of 76.5 mm for those who watched less than 1.75 h per day (P=0.007). Furthermore, the adverse effect of television viewing was worse for those children who were also sedentary or had a higher-fat diet.
Children who watched the most television during childhood had the greatest increase in body fat over time. Healthy lifestyle education designed to prevent obesity and its consequences should target television-watching habits of children.
Experimental findings causally link restrictive child-feeding practices to overeating in children. However, longitudinal data are needed to determine the extent to which restrictive feeding practices promote overeating.
Our objectives were to determine whether restrictive feeding practices foster girls' eating in the absence of hunger (EAH) and whether girls' weight status moderates the effects of restrictive feeding practices.
Longitudinal data were used to create a study design featuring 2 maternal restriction factors (low and high), 2 weight-status factors (nonoverweight and overweight), and 3 time factors (ages 5, 7, and 9 y).
Mean EAH increased significantly (P < 0.0001) from 5 to 9 y of age. Higher levels of restriction at 5 y of age predicted higher EAH at 7 y of age (P < 0.001) and at 9 y of age (P < 0.01). Girls who were already overweight at 5 y of age and who received higher levels of restriction had the highest EAH scores at 9 y of age (P < 0.05) and the greatest increases in EAH from 5 to 9 y of age (P < 0.01).
The developmental increase in EAH from 5 to 9 y of age may be especially problematic in obesigenic environments. These longitudinal data provide evidence that maternal restriction can promote overeating. Girls who are already overweight at 5 y of age may be genetically predisposed to be especially responsive to environmental cues. These findings are not expected to be generalized to boys or to other racial and ethnic groups.
To explore the accuracy of various body mass index (BMI) cutpoints in identifying children who have excess adiposity (based on skinfold thicknesses), adverse levels of lipids, insulin, and blood pressures, and a high risk for severe adult obesity.
Cross-sectional (n = 10,099) and longitudinal (n = 2392) analyses were performed among subjects who participated in the Bogalusa Heart Study.
Of children with a BMI > or =95th percentile (P) of the Centers for Disease Control (CDC) growth charts, 39% had at least two risk factors, 65% had excess adiposity, and 65% had an adult BMI of > or =35 kg/m(2). Of those with a BMI > or =99th P, 59% had at least two risk factors, 94% had excess adiposity, and 88% had an adult BMI of > or =35 kg/m(2). About 4% of children in the US now have a BMI > or =99th P.
The 99th P of BMI-for-age may be appropriate for identifying children who are at very high risk for biochemical abnormalities and severe adult obesity. More aggressive weight control strategies may be warranted for this subgroup.
Obesity is a serious international health problem that increases the risk of several common diseases. The genetic factors
predisposing to obesity are poorly understood. A genome-wide search for type 2 diabetes–susceptibility genes identified a
common variant in the FTO (fat mass and obesity associated) gene that predisposes to diabetes through an effect on body mass index (BMI). An additive
association of the variant with BMI was replicated in 13 cohorts with 38,759 participants. The 16% of adults who are homozygous
for the risk allele weighed about 3 kilograms more and had 1.67-fold increased odds of obesity when compared with those not
inheriting a risk allele. This association was observed from age 7 years upward and reflects a specific increase in fat mass.
We identified a set of SNPs in the first intron of the FTO (fat mass and obesity associated) gene on chromosome 16q12.2 that is consistently strongly associated with early-onset and severe obesity in both adults and children of European ancestry with an experiment-wise P value of 1.67 x 10(-26) in 2,900 affected individuals and 5,100 controls. The at-risk haplotype yields a proportion of attributable risk of 22% for common obesity. We conclude that FTO contributes to human obesity and hence may be a target for subsequent functional analyses.
Despite the high prevalence of overweight among Hispanic children in the United States, definitive predictors of weight gain have not been identified in this population.
The study objective was to test sociodemographic, metabolic, and behavioral predictors of 1-y weight gains in a large cohort of Hispanic children studied longitudinally.
Subjects (n = 879) were siblings from 319 Hispanic families enrolled in the Viva la Familia Study. Families were required to have at least one overweight child aged 4-19 y. One-year changes in weight and body composition by dual-energy X-ray absorptiometry were measured. Data were from parental interviews, birth certificates, multiple-pass 24-h dietary recalls, 3-d accelerometry, 24-h respiration calorimetry, measurements of eating in the absence of hunger, and measurement of fasting blood biochemistry indexes by radioimmunoassay. Generalized estimating equations and principal component analysis were applied.
Weight gain increased with age (P = 0.001), peaking at approximately 10 y of age in girls and approximately 11 y of age in boys. Mean (+/-SD) weight gain was significantly higher in overweight (7.5 +/- 3.7 kg/y) than in nonoverweight (4.4 +/- 2.4 kg/y) children and in boys than in girls. When adjusted for age, age squared, sex, and Tanner stage, the final model indicated a child's body mass index (BMI; kg/m2) status, maternal BMI, energy expenditure (total energy expenditure, basal metabolic rate, and sleeping metabolic rate), and fasting blood biochemistry indexes (total triiodothyronine, insulin, leptin, and ghrelin) as independent, positive predictors of weight gain (P = 0.01-0.001).
Knowledge of the metabolic and behavioral predictors of weight gain in Hispanic children will inform prevention and treatment efforts to address this serious public health problem in the United States.
The development of the Dutch Eating Behaviour Questionnaire (DEBQ) with scales for restrained, emotional, and external eating is described. Factor analyses have shown that all items on restrained and external eating each have high loadings on one factor, but items on emotional eating have two dimensions, one dealing with eating in response to diffuse emotions, and the other with eating in response to clearly labelled emotions. The pattern of corrected item-total correlation coefficients and of the factors was very similar for various subsamples, which indicates a high degree of stability of dimensions on the eating behavior scales. The norms and Cronbach's alpha coefficients of the scales and also the Pearson's correlation coefficients to assess interrelationships between scales indicate that the scales have a high internal consistency and factorial validity. However, their external validity has yet to be investigated.
• In the late 1970s, the prevalence of childhood obesity was the same in Canada and the United States, but recently the prevalence is 4.5 percentage points higher in the United States than in Canada. • No change has been seen over the last decade in the prevalence of obesity among children and adolescents in Canada or the United States. • The prevalence of obesity among children and adolescents aged 3-19 in Canada was lower (13.0%) than in the United States (17.5%) in recent years. • There was no difference between Canada and the United States in the prevalence of obesity among children aged 3-6 years. • In the non-Hispanic white population, the prevalence of obesity among girls was lower in Canada than in the United States, but there was no difference between the two countries among boys. About one-quarter of Canadian adults and more than one-third of adults in the United States are obese [1]. Obese children are at risk of becoming obese adults [2] and can experience immediate health consequences such as psychosocial stress, elevated blood pressure and cholesterol, and abnormal glucose tolerance [3]. Monitoring trends in childhood obesity is important in order to assess interventions aimed at reducing the burden of obesity.
Objectives
To examine the relationship between television watching, energy intake, physical activity, and obesity status in US boys and girls, aged 8 to 16 years.Methods
We used a nationally representative cross-sectional survey with an in-person interview and a medical examination, which included measurements of height and weight, daily hours of television watching, weekly participation in physical activity, and a dietary interview. Between 1988 and 1994, the Third National Health and Nutrition Examination Survey collected data on 4069 children. Mexican Americans and non-Hispanic blacks were oversampled to produce reliable estimates for these groups.Results
The prevalence of obesity is lowest among children watching 1 or fewer hours of television a day, and highest among those watching 4 or more hours of television a day. Girls engaged in less physical activity and consumed fewer joules per day than boys. A higher percentage of non-Hispanic white boys reported participating in physical activity 5 or more times per week than any other race/ethnic and sex group. Television watching was positively associated with obesity among girls, even after controlling for age, race/ethnicity, family income, weekly physical activity, and energy intake.Conclusions
As the prevalence of overweight increases, the need to reduce sedentary behaviors and to promote a more active lifestyle becomes essential. Clinicians and public health interventionists should encourage active lifestyles to balance the energy intake of children.
The development of the Dutch Eating Behaviour Questionnaire (DEBQ) with scales for restrained, emotional, and external eating is described. Factor analyses have shown that all items on restrained and external eating each have high loadings on one factor, but items on emotional eating have two dimensions, one dealing with eating in response to diffuse emotions, and the other with eating in response to clearly labelled emotions. The pattern of corrected item-total correlation coefficients and of the factors was very similar for various subsamples, which indicates a high degree of stability of dimensions on the eating behavior scales. The norms and Cronbach's alpha coefficients of the scales and also the Pearson's correlation coefficients to assess interrelationships between scales indicate that the scales have a high internal consistency and factorial validity. However, their external validity has yet to be investigated.
An impaired ability to compensate for calories and increased eating in the absence of hunger (EAH) has been associated with increased energy intake and weight gain in unrelated children.
The aims of this study were to compare caloric compensation [the percentage compensation index (%COMPX)] and EAH in weight-discordant siblings aged 5-12 y.
In a crossover, behavioral genetics design, 47 same-sex sibling pairs (53% female, 55% full siblings) were served dinner once a week for 3 wk. Across conditions, siblings were served the same dinner, but 25 min before dinner, they either consumed in full or did not consume 1 of 2 preloads that varied in energy density (ED; 0.57 or 0.97 kcal/g). On the day when no preload was consumed, EAH was assessed after dinner and defined as the number of calories consumed from snacks.
Overweight/obese siblings undercompensated [%COMPX: -48.8 ± 56.3 (mean ± SEM)] and therefore overate after the high-ED preload, whereas normal-weight siblings showed accurate compensation (%COMPX: 101.3 ± 51.9; P = 0.03). Furthermore, overweight/obese siblings consumed 34% more calories (93 kcal) in the absence of hunger than did normal-weight siblings (P = 0.01). Within-pair resemblances for %COMPX and EAH were stronger for full siblings (P < 0.049) than for half siblings (P > 0.23).
An impaired ability to regulate short-term energy intake, which includes incomplete adjustment for calorie differences in a preload and eating when satiated, may represent a behavioral phenotype for obesity in children. Future studies should test whether teaching children to focus on internal satiety cues may prevent at-risk children from overeating.
Greater TV-viewing time is generally associated with unhealthy dietary behaviors; however, few studies have examined associations between TV-viewing time and composite measures of dietary quality. Most studies have focused on energy intake or intake of specific foods. But overall dietary quality is important to health and weight status.
To examine the relationship between TV-viewing time and dietary quality using a nationally representative U.S. sample.
Participants in the 2003-2006 National Health and Nutrition Examination Surveys were included (analyses conducted in Fall 2011). Dietary quality was determined by Healthy Eating Index (HEI)-2005 calculated from two 24-hour recalls. TV-viewing time was categorized as lower (≤1 hour/day); moderate (2-3 hours/day); and higher (≥4 hours/day; referent). Multivariate linear regression models were used to estimate the TV-viewing time and HEI-2005, adjusted for BMI (percentile for children aged 2-18 years); age; ethnicity; physical activity; and total energy intake. Analyses were conducted separately for gender-age groups (preschool=aged 2-5 years [n=1423]; school-aged=6-11 years [n=1749], adolescent=aged 12-18 years [n=3343], and adult=aged ≥19 years [n=8222]).
Lower TV-viewing time was associated with higher HEI-2005 (i.e., healthier diet) for all gender and age groups. Compared with higher TV-viewing time, in each case, HEI-2005 was higher in groups with low TV-viewing time, ranging from 47.0-52.3 in ≤1 hour/day to 44.7-48.9 in ≥4 hours/day (all p<0.05).
Less time spent watching TV was associated with better dietary quality in U.S. children and adults.
The purpose of this review is to spark integrative thinking in the area of eating behaviors by critically examining research on exemplary constructs in this area. The eating behaviors food responsiveness, enjoyment of eating, satiety responsiveness, eating in the absence of hunger, reinforcing value of food, eating disinhibition and impulsivity/self-control are reviewed in relation to energy intake, body mass index and weight gain over time. Each of these constructs has been developed independently, and little research has explored the extent to which they overlap or whether they differentially predict food choices, energy intake and weight gain in the naturalistic environment. Most available data show positive cross-sectional associations with body mass index, but fewer studies report associations with energy intake or food choices. Little prospective data are available to link measures of eating behaviors with weight gain. Disinhibition has the largest and most consistent body of empirical data that link it prospectively with weight gain. An overarching conceptual model to integrate the conceptual and empirical research base for the role of eating behavior dimensions in the field of obesity research would highlight potential patterns of interaction between individual differences in eating behaviors, specific aspects of the individual's food environment and individual variation in state levels of hunger and satiety.
To assess the measurement properties of several scales modified or created to assess factors related to fruit and vegetable intake within a young adolescent population.
Cross-sectional with data collected via self-report.
Data were collected in regularly scheduled classes in the school setting.
African American and Caucasian middle school students (ages 11-15 years).
Self-efficacy, modeling, outcome expectations, normative beliefs, parental food management practices, and influences on food choice.
Pearson correlations, factor analysis, and Cronbach α.
Subscales with adequate to good internal consistencies (0.65-0.88) were established. Fruit and vegetable intake was significantly correlated with self-efficacy, parent and peer modeling, family and peer normative beliefs, and social and health outcome expectations. Fruit and vegetable intake was not significantly correlated with permissive eating, food self-preparation, or the 3 subscales measuring influences on food choice (social influence, avoiding weight-gain food, and appeal and access).
These measures, most originally developed for children and adults and modified for this study, demonstrated adequate measurement properties for an adolescent sample.
As the prevalence of childhood obesity has risen in past decades, more attention has been given to how the neighborhood food environment affects children's health outcomes.
This exploratory study examined the relationship between the presence of neighborhood food stores within a girl's neighborhood and 3-year risk of overweight/obesity and change in BMI, in girls aged 6 or 7 years at baseline.
A longitudinal analysis of participants in the Cohort Study of Young Girls' Nutrition, Environment and Transitions (CYGNET) was conducted from 2005 to 2008. Neighborhood food stores were identified from a commercial database and classified according to industry codes in 2006. Generalized linear and logistic models were used to examine how availability of food stores within 0.25-mile and 1.0-mile network buffers of a girl's residence were associated with BMI z-score change and risk of overweight or obesity, adjusting for baseline BMI/weight and family sociodemographic characteristics. Data were analyzed in 2010.
Availability of convenience stores within a 0.25-mile network buffer of a girl's residence was associated with greater risk of overweight/obesity (OR=3.38, 95% CI=1.07, 10.68) and an increase in BMI z-score (β=0.13, 95% CI=0.00, 0.25). Availability of produce vendors/farmer's markets within a 1.0-mile network buffer of a girl's residence was inversely associated with overweight/obesity (OR=0.22, 95% CI=0.05, 1.06). A significant trend was observed between availability of produce vendors/farmer's markets and lower risk of overweight/obesity after 3 years.
Although food store inventories were not assessed and food store indices were not created, the availability of neighborhood food stores may affect a young girl's weight trajectory over time.
The genetic contribution to interindividual variation in common obesity has been estimated at 40-70%. Yet, despite a relatively high heritability, the search for obesity susceptibility genes has been an arduous task. This paper reviews recent progress made in the obesity genetics field with an emphasis on established obesity susceptibility loci identified through candidate gene as well as genome-wide studies. For the last 15 years, candidate gene and genome-wide linkage studies have been the two main genetic epidemiological approaches to identify genetic loci for common traits, yet progress has been slow and success limited. Only recently have candidate gene studies started to succeed; by means of large-scale studies and meta-analyses at least five variants in four candidate genes have been found to be robustly associated with obesity-related traits. Genome-wide linkage studies, however, have so far not been able to pinpoint genetic loci for common obesity. The genome-wide association approach, which has become available in recent years, has dramatically changed the pace of gene discoveries for common disease, including obesity. Three waves of large-scale high-density genome-wide association studies have already discovered at least 15 previously unanticipated genetic loci incontrovertibly associated with body mass index and extreme obesity risk. Although the combined contribution of these loci to the variation in obesity risk at the population level is small and their predictive value is typically low, these recently discovered loci are set to improve fundamentally our insights into the pathophysiology of obesity.
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.
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.
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).
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.
To examine the association between television/video (TV) viewing and markers of diet quality among 3-year-old children.
We studied 613 boys and 590 girls, age 3 years old, who were participants in Project Viva. Each mother reported the number of hours her child watched TV on an average weekday and weekend day in the past month, from which we calculated a weighted mean. The main outcomes were intakes of selected foods and nutrients from a validated food frequency questionnaire. In linear regression models we adjusted for mother's sociodemographic information, parental body mass index (BMI), and child's age, sex, race/ethnicity, BMI z-score, sleep duration, and breast feeding duration.
Mean (standard deviation, SD) age of subjects was 3.2 (0.2) years; 372 children (31%) were non-white and 151 (13%) had a household income < $40 000, and 330 mothers (28%) had completed less than a college degree. Mean (SD) TV viewing was 1.7 (1.0) hours per day. For each 1-hour increment of TV viewing per day, we found higher intakes of sugar-sweetened beverages (0.06 servings/day [95% CI 0.03, 0.10]), fast food (0.32 servings/month [95% CI 0.16, 0.49]), red and processed meat (0.06 servings/day [95% CI 0.02, 0.09]), total energy intake (48.7 kcal/day [95% CI 18.7, 78.6]), and percent energy intake from trans fat (0.05 [95% CI 0.03, 0.07]). We found lower intakes of fruit and vegetables (-0.18 servings/day [95% CI -0.32, -0.05]), calcium (-24.6 mg/day [95% CI -41.0, -8.1]), and dietary fiber (-0.44 g/day [95% CI -0.65, -0.22]).
Among 3-year-olds, more TV viewing is associated with adverse dietary practices. Interventions to reduce TV viewing in this age group may lead to improved diet quality.
This report describes the construction of a questionnaire to measure three dimensions of human eating behavior. The first step was a collation of items from two existing questionnaires that measure the related concepts of 'restrained eating' and 'latent obesity', to which were added items newly written to elucidate these concepts. This version was administered to several populations selected to include persons who exhibited the spectrum from extreme dietary restraint to extreme lack of restraint. The resulting responses were factor analyzed and the resulting factor structure was used to revise the questionnaire. This process was then repeated: administration of the revised questionnaire to groups representing extremes of dietary restraint, factor analysis of the results and questionnaire revision. Three stable factors emerged: (1) 'cognitive restraint of eating', (2) 'disinhibition' and (3) 'hunger'. The new 51-item questionnaire measuring these factors is presented.
Obese parents are more likely to have obese children. Parents provide both the genes and eating environment for their children and familial patterns of adiposity are the result of gene-environment interactions. Environmental factors are implicated in the rapid increases in prevalence of childhood overweight that have occurred in the past 2 decades. Examination of aspects of the family environment may provide insight into increases in childhood overweight over time.
We examined parental characteristics associated with overweight and eating behaviors in preschool children.
Seventy-five preschool children and their parents were recruited from local daycare centers. Information was obtained on parents' body mass indexes (BMIs), dietary restraint, and dietary disinhibition. A behavioral index of disinhibited eating in children was used to measure children's eating when given free access to palatable snack foods in the absence of hunger. Children's weight-for-height values were also calculated.
Maternal dietary disinhibition (R2 = 0.35, P < 0.01) and maternal BMI (R2 = 0.19, P < 0.05) positively predicted daughters' overweight. Maternal disinhibition (R2 = 0.35, P < 0.05) mediated the relation between mothers' BMI and daughters' overweight when both maternal disinhibition and maternal BMI were used to predict daughters' overweight. Furthermore, when both mothers' disinhibition and daughters' free access intakes were used to predict daughters' overweight, mothers' disinhibition (P < 0.05) showed independent prediction.
These findings suggest that familial influences on child overweight differ according to parent and child sex. Also, these results suggest that mothers' dietary disinhibition mediates familial similarities in degree of overweight for mothers and daughters.
This study evaluated maternal restriction of children's access to snack foods as a predictor of children's intake of those foods when they were made freely available. In addition, child and parent eating-related "risk" factors were used to predict maternal reports of restricting access. Participants were 71, 3-to-5-year-old children (36 boys, 35 girls) and their parents. Children's snack food intake was measured immediately following a meal, in a setting offering free access to palatable snack foods. Child and maternal reports of restricting children's access to those snack foods were obtained. In addition, information on child and parent adiposity as well as parents' restrained and disinhibited eating was used to examine "risk" factors for restricting access. For girls only, child and maternal reports of restricting access predicted girls' snack food intake, with higher levels of restriction predicting higher levels of snack food intake. Maternal restriction, in turn, was predicted by children's adiposity. Additionally, parents' own restrained eating style predicted maternal restriction of girls' access to snack foods.
Body mass index (BMI; in kg/m2) values at or above the 75th percentile are associated with increased morbidity and mortality in adulthood, and there are significant correlations between BMI values in childhood and in adulthood. The present study addresses the predictive value of childhood BMI for overweight at 35 ± 5 y, defined as BMI >28 for men and BMI >26 for women. Analyses of data from 555 white children showed that overweight at age 35 y could be predicted from BMI at younger ages. The prediction is excellent at age 18 y, good at age 13 y, but only moderate at ages < 13 y. For 18-y- olds with BMIs above the 60th percentile, the probability of overweight at age 35 y is 34% for men and 37% for women. A clinically applicable method is provided to assign an overweight child to a group with a known probability of high BMI values in adulthood.
Childhood overweight has increased dramatically, particularly among young girls. Genetic and environmental factors produce the overweight phenotype. Nonshared environments appear to account for a substantial proportion of the population variance in overweight but remain largely unspecified and unmeasured.
Our goal was to evaluate the influence of maternal control in feeding, an aspect of nonshared family environment, on daughters' eating and relative weight.
Structural equation modeling was used to test models that describe maternal influences on daughters' eating and relative weight. The participants were 197 white, non-Hispanic families with 5-y-old daughters. The mothers' own dietary restraint and their perceptions of their daughters' risk of overweight were used to predict maternal control in feeding, which was used to predict the daughters' eating and weight outcomes.
Maternal body mass index was a modest predictor of daughters' relative weight. The addition of the family-environment pathway provided a good fit and showed additional, independent prediction of daughters' relative weight. Mothers' dietary restraint and perceptions of their daughters' risk of overweight predicted maternal child-feeding practices, which in turn predicted daughters' eating and relative weight.
Child-specific aspects of the family environment, including mothers' child-feeding practices and perceptions of their daughters' risk of overweight, may represent important, nonshared, environmental influences on daughters' eating and relative weight. The environmental effects noted were modest but comparable in magnitude to the direct association between maternal and child weight, which indicates that measuring family environmental factors can enhance our understanding of the etiology of childhood overweight.
This study was conducted to determine whether parents' restriction of young girls' access to palatable foods promotes the consumption of those foods while evoking negative self-evaluation.
Girls' intake of 10 snack foods was measured immediately following a standard lunch, in a setting with free access to palatable snack foods. Girls' self-evaluation about their eating was assessed following the free access snack session. In addition, reports of parental restriction were obtained from mothers, fathers, and girls.
Participants were 197 girls aged 4.6 to 6.4 years and their parents.
Structural equation modeling was used to test models describing relationships between parents' restriction and girls' eating.
Following the standard lunch, girls' snack food intake during the 10-minute free access session ranged from 0 to 436 kcal, with a mean of 123 +/- 7 kcal. Approximately half of the girls reported negative self-evaluation about eating 1 or more of the 10 foods provided. The revised path model indicated that parents' restriction predicted both girls' snack food intake and girls' negative self-evaluation of eating. Girls' negative self-evaluation of eating was not associated with the amount of food that they consumed when not hungry, but was linked to their perceptions of being restricted from those foods.
These findings indicate that restricting young girls' access to palatable foods may promote the intake of restricted foods and may also generate negative feelings about eating restricted foods.
To examine the relationship between television watching, energy intake, physical activity, and obesity status in US boys and girls, aged 8 to 16 years.
We used a nationally representative cross-sectional survey with an in-person interview and a medical examination, which included measurements of height and weight, daily hours of television watching, weekly participation in physical activity, and a dietary interview. Between 1988 and 1994, the Third National Health and Nutrition Examination Survey collected data on 4069 children. Mexican Americans and non-Hispanic blacks were oversampled to produce reliable estimates for these groups.
The prevalence of obesity is lowest among children watching 1 or fewer hours of television a day, and highest among those watching 4 or more hours of television a day. Girls engaged in less physical activity and consumed fewer joules per day than boys. A higher percentage of non-Hispanic white boys reported participating in physical activity 5 or more times per week than any other race/ethnic and sex group. Television watching was positively associated with obesity among girls, even after controlling for age, race/ethnicity, family income, weekly physical activity, and energy intake.
As the prevalence of overweight increases, the need to reduce sedentary behaviors and to promote a more active lifestyle becomes essential. Clinicians and public health interventionists should encourage active lifestyles to balance the energy intake of children.
Children of obese parents have a substantially higher risk of adult obesity than children of lean parents. Adoption and twin studies have shown that this risk is largely genetic but the proximal mechanisms of the genetic risk are not known. Comparisons of energy intake or expenditure in children of obese and lean parents have produced mixed, but generally negative results. An alternative hypothesis is that the early expression of obesity risk is through food and activity preferences, which provides a basis for later weight gain. The aim of this study was therefore to compare food and activity preferences in a large sample of young children from obese and lean families using parental obesity as a marker of the obesity-risk phenotype. Because the children from the families with obese parents were not yet overweight, differences observed in the two types of families are more likely to be causes than effects of obesity.
A total of 428 children aged 4-5 y, whose parents were either obese/overweight or normal-weight/lean were selected from a population sample of families with twin births. Food and activity preferences were assessed with a combination of food intake and taste tasks, and questionnaires completed by the mother during a home visit.
Children from the obese/overweight families had a higher preference for fatty foods in a taste test, a lower liking for vegetables, and a more 'overeating-type' eating style. They also had a stronger preference for sedentary activities, and spent more time in sedentary pastimes. There were no differences in speed of eating or reported frequency of intake of high-fat foods.
Part of the process whereby a genetic risk of obesity is transmitted to the next generation could be through differences in diet and activity preferences, which would place susceptible individuals at risk of positive energy balance in the permissive nutritional environment of industrialised countries today.
The goal of this study was to investigate the emergence of dietary restraint, disinhibited eating, weight concerns, and body dissatisfaction among girls from 5 to 9 years old, and to assess whether girls at risk for overweight at age 5 were at greater risk for the emergence of restraint, disinhibited overeating, weight concerns, and body dissatisfaction.
Longitudinal data were used to assess the relationship between weight status and the development of dietary restraint, aspects of disinhibited overeating, weight concern, and body dissatisfaction at ages 5, 7, and 9 years.
Participants were 153 girls from predominately middle class and exclusively non-Hispanic white families living in central Pennsylvania. Statistical analyses Differences in weight status, dietary restraint, disinhibition, weight concern, and body dissatisfaction between girls at risk (>85th percentile body mass index) or not at risk for overweight at age 5 were assessed using repeated measures analysis of variance at ages 5, 7, and 9 years.
Girls who were at risk for overweight at age 5 reported significantly higher levels of restraint, disinhibition, weight concern, and body dissatisfaction by age 9. Girls at risk for overweight at age 5 also showed greater increases in weight status from 5 to 9 years of age.
Higher levels of dietary restraint, weight concern, and body dissatisfaction among young girls at risk for overweight were accompanied by greater weight gain from 5 to 9 years of age, consistent with other recent findings suggesting that youths' attempts at weight control may promote weight gain. Positive alternatives to attempts at dietary restriction are essential to promoting healthful weight status among children, and should include encouraging physical activity, promoting children's acceptance of a variety of low-energy-density foods, and providing guides to appropriate portion sizes.
The prevalence of overweight doubled among children 6 to 11 years of age and tripled among those 12 to 17 years of age between the second National Health and Nutrition Examination Survey, conducted between 1976 and 1980, and the most recent such survey, conducted in 1999 and 2000. Overweight in children and adolescents, defined as a body-mass index (the weight in kilograms divided by the square of the height in meters) at or above the 95th percentile for children of the same age and sex, is epidemic. Black and Mexican-American children and adolescents are disproportionately affected. Although only 25 to . . .
To examine the effects of overweight and normal-weight mothers' restriction in child feeding on daughters' eating in the absence of hunger (EAH) and body mass index (BMI) change from age 5 to age 9 y.
Longitudinal study of the health and development of young girls.
A total of 91 overweight and 80 normal-weight mothers and their daughters, assessed when daughters were ages 5, 7, and 9 y.
Measures included maternal restriction of daughters' intake at age 5 y, and daughters' EAH and BMI change from age 5 to 9 y.
There were no overall differences in the level of restriction that overweight and normal-weight mothers used. However, overweight mothers' restrictive feeding practices when daughters were age 5 y predicted daughters' EAH over time, and higher EAH scores were associated with greater BMI change from age 5 to 9 y. These relationships did not hold for daughters of normal-weight mothers.
More adverse effects of restriction on daughters' EAH, and links between EAH and BMI change were only noted among daughters of overweight mothers. These findings highlight the need for a better understanding of factors that contribute to within-group variation in eating behavior and weight status.
The prevalence of overweight among children and adolescents has dramatically increased. There may be vulnerable periods for weight gain during childhood and adolescence that also offer opportunities for prevention of overweight. Overweight in children and adolescents can result in a variety of adverse health outcomes, including type 2 diabetes, obstructive sleep apnea, hypertension, dyslipidemia, and the metabolic syndrome. The best approach to this problem is prevention of abnormal weight gain. Several strategies for prevention are presented. In addition, treatment approaches are presented, including behavioral, pharmacological, and surgical treatment. Childhood and adolescent overweight is one of the most important current public health concerns.
Eating in the absence of hunger (EAH) may be a behavioral trait through which obesity-promoting genes promote positive energy balance. The primary aim of this study was to compare children born at high vs. low risk for obesity with respect to EAH at 5 years of age.
This was an observational investigation of families enrolled in the University of Pennsylvania and The Children's Hospital of Philadelphia's Infant Growth Study. Five-year-old children born at high (N = 28) or low (N = 25) risk for obesity on the basis of maternal prepregnancy body weight were evaluated at a hospital-based laboratory. Children consumed 11 snack foods ad libitum after consuming an ad libitum dinner and reporting fullness. Parents reported on snack foods at home and their own eating styles. Nutritive sucking at 3 months of age was evaluated by computerized apparatus.
EAH in high-risk boys (mean +/- standard error = 326 +/- 66 kJ] was more than twice that of low-risk boys (mean +/- standard error = 151 +/- 39 kJ), p = 0.03. Among girls, there was a trend for EAH to be associated with increased parental limitations on daughter snack food consumption at home (p = 0.06). EAH was unrelated to 3-month sucking behavior.
Genes that promote childhood obesity may partially exert their influence through EAH, an effect that was limited to boys born at risk for obesity. The unique influences of genes and home environment on this trait should be disaggregated in subsequent studies.
This study examined how 7-13-year-old children with and without overweight respond to free access to snack food in the absence of hunger and whether this eating behaviour could be predicted by parental feeding strategies and child's characteristics.
A total of 52 children (26 normal weight and 26 overweight children) were exposed to snack food after consuming a typical meal. Parental feeding practices and child's variables were assessed via self-report.
Two-third of the sample ate of the presented snacks and consumed an average of 68 g. Overweight boys consumed twice as much than the normal weight boys. Parental feeding strategies did not contribute to the prediction of this eating behaviour. Regardless of the children's weight status, the child's eating style strongly predicted snack intake.
This study provides evidence that overweight boys show difficulties in regulating their eating behaviour. Inconsistent with previous work, no evidence for parental contribution of snack intake was found. The present findings suggest that in older children especially children's own eating style account for the variance in snack eating behaviour.
To identify eating and activity factors associated with school-aged children's onset of overweight and persistent overweight.
Data were gathered at four time points between kindergarten entry and spring of third grade. Children were directly weighed and measured and categorized as not overweight (<95th percentile of body mass index) or overweight (> or =95th percentile body mass index); parents were interviewed by telephone or in person.
Subjects were participants in the Early Childhood Longitudinal Study-Kindergarten Cohort, a nationally representative sample of children who entered kindergarten during 1998-1999. Children who weighed <2,000 g at birth, received therapeutic services before kindergarten, skipped or repeated a grade, or without complete height and weight data were excluded, resulting in 8,459 participants. Children with intermittent overweight were not examined (n=459); analyses addressed 8,000 children.
Three mutually exclusive groups of children were identified: never overweight, overweight onset, and persistent overweight.
Multilevel, multivariate logistic regression analyses estimated the effects of eating and activity factors on the odds of overweight onset and persistent overweight above child sex, race, and family socioeconomic status.
Children who watched more television (odds ratio [OR] 1.02) and ate fewer family meals (OR 1.08) were more likely to be overweight for the first time at spring semester of third grade. Children who watched more television (OR 1.03), ate fewer family meals (OR 1.08), and lived in neighborhoods perceived by parents as less safe for outdoor play (OR 1.32) were more likely to be persistently overweight. Child aerobic exercise and opportunities for activity were not associated with a greater likelihood of weight problems.
This study supports theories regarding the contributions of television watching, family meals, and neighborhood safety to childhood weight status. When working with families to prevent and treat childhood weight problems, food and nutrition professionals should attend to children's time spent with screen media, the frequency of family mealtimes, and parents' perceptions of neighborhood safety for children's outdoor play.
Leptin and ghrelin are two hormones that have been recognized to have a major influence on energy balance. Leptin is a mediator of long-term regulation of energy balance, suppressing food intake and thereby inducing weight loss. Ghrelin on the other hand is a fast-acting hormone, seemingly playing a role in meal initiation. As a growing number of people suffer from obesity, understanding the mechanisms by which various hormones and neurotransmitters have influence on energy balance has been a subject of intensive research. In obese subjects the circulating level of the anorexigenic hormone leptin is increased, whereas surprisingly, the level of the orexigenic hormone ghrelin is decreased. It is now established that obese patients are leptin-resistant. However, the manner in which both the leptin and ghrelin systems contribute to the development or maintenance of obesity is as yet not clear. The purpose of this review is to provide background information on the leptin and ghrelin hormones, their role in food intake and body weight in humans, and their mechanism of action. Possible abnormalities in the leptin and ghrelin systems that may contribute to the development of obesity will be mentioned. In addition, the potentials of leptin and ghrelin as drug targets will be discussed. Finally, the influence of the diet on leptin and ghrelin secretion and functioning will be described.
To assess whether parental overweight status and disinhibited overeating are predictive of daughters' accelerated weight gain and disinhibited overeating.
Participants were part of a longitudinal study of girls (N = 197) and their parents. Measured height and weight were used to calculate BMI [weight (kilograms)/height (meters)(2)]. Parents' disinhibited eating behavior was assessed using the Eating Inventory. Girls' disinhibited eating was assessed using a behavioral protocol to measure eating in the absence of hunger. Girls were classified based on parental overweight at study entry into four groups: neither, mother only, father only, or both parents overweight.
Girls with both parents overweight had the most rapid increases in BMI from 5 to 13 years of age; BMI increased most slowly among the neither parent overweight group, with intermediate increases in BMI among mother only and father only overweight groups. Daughters with both parents overweight at study entry were eight times more likely to be overweight at age 13, controlling for daughters' weight at age 5. Girls with both parents overweight had higher levels of disinhibited eating across all ages than all other groups. Although girls in all parental weight status groups showed increases in disinhibited eating over time, girls with both parents overweight had larger increases in disinhibited eating over time compared with all other groups.
Girls growing up in families differing in parental overweight had divergent developmental trajectories for BMI and disinhibited overeating. Findings reveal the need to focus prevention efforts on overweight parents of young children.