Subtyping youngsters with obesity: A theory-based cluster analysis

L Vervoort,T Naets,L Goossens,S Verbeken,L Claes,A Tanghe,C Braet

doi:10.1016/j.appet.2021.105723

L Vervoort, T Naets + Show 5 more

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https://doi.org/10.1016/j.appet.2021.105723

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Abstract

Psychological mechanisms play a crucial role in explaining weight gain. Aim of the present study was to identify subtypes in youngsters with obesity in line with these mechanisms. Defining homogeneous clusters within this heterogeneous group provides relevant information for personalized treatments.Data were collected in N = 572 participants (51% boys, aged 7–19) with extreme obesity (%BMI M = 187.8; SD = 30.9) recruited in an inpatient treatment centre. Based on psychological models of overweight/obesity, the Affect Regulation Model, the Reward Deficiency Model and The Dual Pathway Model, cluster variables were selected assessing emotional eating, reward reactivity and regulative capacities. Youngsters reported on emotional eating (DEBQ Emotional Eating) and reward sensitivity (BAS), while parents reported on children's regulative Executive Functions (BRIEF). Characteristics of the different clusters were examined concerning weight variables (pre and post treatment) and variables indexing problematic eating (DEBQ External Eating, Ch-EDE), affect regulation (FEEL-KJ) and depressive symptoms (CDI). Hierarchical cluster analyses supported the presence of three clusters, further evaluated by K-means cluster analyses. The cluster solutions differed according to age and sex (boys 7–13, boys 14–19, girls 7–13, girls 14–19). In all four age and gender subsamples, an “Emotional Eating” cluster displaying a vulnerable profile (high depression, maladaptive emotion regulation, problematic eating) and a “Reward Deficiency” cluster displaying a more resilient profile were detected. In girls 7–13, a “Weak Executive Functioning” indicative of insufficient self-regulative capacities, showed moderate to high emotional problems and problematic eating. In the other subgroups, the “Mean Level Functioning” cluster also showed elevated emotional problems and problematic eating. Given that different clusters can be identified, and given that these clusters have different profiles on emotional problems and problematic eating, subtyping youngsters with severe obesity is indicated, setting the stage for personalized treatments.

Highlights

The epidemic increase in obesity is often interpreted as inevitable, given the current western obesogenic environment characterized by an oversupply of energy-dense food, an absence of the need for being physically active and a strong inclination to a sedentary life style (O’Brien et al, 2007)
We aim to examine whether we can identify in youngsters with obesity a group (1) showing dominant emotional eating, reflecting the assumptions of the Affective Model (i.e., “Emotional Eating” cluster), (2) a group displaying the profile proposed by the Dual-Process Model, showing an unsuccessful self-regulative system, which is related to non-optimal executive functioning and altered automatic reward processing (i.e., “Weak executive functions/ strong reward processing” cluster) and (3) a group demonstrating dominantly low levels of reward processing, independent from levels of executive functioning (i.e., “Reward deficiency” cluster) as described by the Reward Deficiency Model
Given the large hetereogeneity between youngsters with weight problems, it is questionable that these different psychological mechanisms would be meaningful in all individuals with obesity

Summary

Introduction

The epidemic increase in obesity is often interpreted as inevitable, given the current western obesogenic environment characterized by an oversupply of energy-dense food, an absence of the need for being physically active and a strong inclination to a sedentary life style (O’Brien et al, 2007). Several psychological determinants of eating behavior and weight are especially relevant in developing youth. & Braet, 2017; Ernst, Pine, & Hardin, 2009) make children and youth highly vulnerable for unhealthy eating behaviors and weight gain (Russell & Russell, 2019). Several models describe the role of psychological variables in determining the risk for developing weight problems, providing targets for interventions (Durks et al, 2017; Russell & Russell, 2019; Vervoort, Naets, De Guchtenaere, Tanghe, & Braet, 2020). Within the Affective Model of overweight, weight problems are assumed to result from overeating as a response to cope with negative feelings, and ignoring internal cues of satiety (Ganley, 1989). Emotional eating and problems with emotion regulation are considered determinants for overweight

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