Eating In Youth Research Articles

Ecological momentary assessment of maladaptive eating in children and adolescents with overweight or obesity.

Contextual factors related to maladaptive eating behavior in youth with overweight/obesity are poorly understood. This pilot study sought to elucidate immediate internal and external cues related to perceptions of overeating and loss of control (LOC) over eating in a heterogeneous sample of children and adolescents with overweight/obesity assessed in their natural environments. Community-based youth [N = 40; 55% female (n = 22)], aged 8-14 y (M age = 11.2 ± 1.9 y), with overweight/obesity (M z-BMI = 2.07 ± 0.49) reported on all eating episodes and their physiological, environmental, affective, and interpersonal antecedents and correlates via ecological momentary assessment over a 2-week period. Generalized estimating equations were used to assess the relationship between contextual variables and degree of overeating and LOC. Eating occasions involving greater food hedonics (i.e., perceived palatability of food being consumed) were associated with greater LOC severity (within-subjects effect: B = 0.01, p = .015), although youth with lower overall levels of food hedonics reported higher LOC severity ratings on average (between-subjects effect: B = -0.04, p = .005). Youth reporting higher overall cravings reported higher average ratings of LOC severity (between-subjects effect: B = 0.20, p = .001). Finally, youth reporting greater overall influence of others on eating behavior evidenced greater average levels of overeating severity (between-subjects effect: B = 0.17, p < .001). Eating-related factors appear to be most strongly associated with LOC severity, while environmental factors were most associated with overeating severity. Interventions targeting maladaptive eating in youth with overweight/obesity may benefit from helping youth incorporate palatable foods and satisfy cravings in a planned and controlled manner, and enhancing awareness of social-contextual effects on eating.

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

Neural substrates of loss of control (LOC) eating are undercharacterized. We aimed to model intermittent access to food to elicit disinhibited eating in youth undergoing neuroimaging, given evidence that restricted food access may increase subsequent food intake via enhancing reward value of food and diminishing eating-related self-control. Participants were 18 preadolescents (aged 9-12 years) who were overweight/obese with recent LOC eating (OW-LOC; n = 6); overweight/obese with no history of LOC eating (OW-CON; n = 5); or non-overweight with no history of LOC eating (NW-CON; n = 7). Participants underwent functional magnetic resonance imaging during a simulated food restriction paradigm in which they were alternately given restricted or unrestricted access to milkshake solutions. There were no significant main effects of restricted versus unrestricted access to milkshake flavors. Group main effects revealed increased activation for OW-LOC relative to OW-CON in areas related to attentional processes (right middle frontal gyrus), inhibitory control/attentional shifts (right and left cuneus), and emotion regulation (left cingulate gyrus); and for OW-LOC relative to NW-CON in areas related to response inhibition (right inferior frontal gyrus). Significant block type × group interaction effects were found for the right middle frontal gyrus, left cingulate gyrus, and left cuneus, but these appeared to be accounted for primarily by group. There were clear group differences in neural activity in brain regions related to self-regulation during a food restriction paradigm. Elevations in these regions among OW-LOC relative to OW-CON and NW-CON, respectively, may suggest that youth with LOC eating expended more cognitive effort to regulate ingestive behavior.

The BUFFET Program: Development of a Cognitive Behavioral Treatment for Selective Eating in Youth with Autism Spectrum Disorder.

Selective eating (often referred to as "picky" eating) is common in individuals with autism spectrum disorder (ASD) across the lifespan. Behavioral interventions are widely used to treat selective eating; however, most of these programs are time intensive, have not been evaluated for use in outpatient settings, and do not typically include youth beyond early childhood. Despite the functional impact and risk for negative outcomes associated with selective eating, there are no empirically supported treatments available for older children, adolescents, or adults, either with or without ASD. To address this treatment gap, we developed BUFFET: the Building Up Food Flexibility and Exposure Treatment program. BUFFET is a 14-week, multi-family group cognitive behavioral treatment for selective eating in children (8-12years) with ASD. In this paper, we will (1) discuss the theoretical conceptualization of BUFFET, (2) describe the treatment content and structure, (3) present feasibility data from the initial pilot trial, and (4) consider next steps in treatment development.

Secretive eating among youth with overweight or obesity

PurposeSecretive eating, characterized by eating privately to conceal being seen, may reflect eating- and/or body-related shame, be associated with depression, and correlate with binge eating, which predicts weight gain and eating disorder onset. Increasing understanding of secretive eating in youth may improve weight status and reduce eating disorder risk. This study evaluated the prevalence and correlates of secretive eating in youth with overweight or obesity. MethodsYouth (N = 577) presented to five research/clinical institutions. Using a cross-sectional design, secretive eating was evaluated in relation to eating-related and general psychopathology via linear and logistic regression analyses. ResultsSecretive eating was endorsed by 111 youth, who were, on average, older than youth who denied secretive eating (mean age = 12.07 ± 2.83 versus 10.97 ± 2.31). Controlling for study site and age, youth who endorsed secretive eating had higher eating-related psychopathology and were more likely to endorse loss of control eating and purging than their counterparts who did not endorse secretive eating. Groups did not differ in excessive exercise or behavioral problems. Dietary restraint and purging were elevated among adolescents (≥13y) but not children (<13y) who endorsed secretive eating; depression was elevated among children, but not adolescents, who endorsed secretive eating. ConclusionsSecretive eating may portend heightened risk for eating disorders, and correlates of secretive eating may differ across pediatric development. Screening for secretive eating may inform identification of problematic eating behaviors, and understanding factors motivating secretive eating may improve intervention tailoring.

Psychometric evaluation of the youth eating disorder examination questionnaire in children with overweight or obesity.

This study evaluated the psychometric properties of the Youth Eating Disorder Examination Questionnaire (YEDE-Q) and its utility for detecting loss of control (LOC) eating (i.e., eating episodes, regardless of size, involving a perceived inability to control what or how much one is eating) among school-age children with overweight or obesity. Identifying eating pathology, particularly LOC eating, in this population may facilitate treatment that improves weight outcomes and reduces eating disorder risk. Children with overweight or obesity (N = 241; 7-11 years) completed the YEDE-Q and abbreviated Child EDE (ChEDE) to assess LOC eating, prior to entering a weight management treatment trial. Confirmatory factor analyses (CFA) were conducted on children's YEDE-Q responses and compared to the standard adult EDE-Q factor structure and newer, alternate factor structures. CFA supported a three-factor structure, which distinguished youth with versus without LOC. The YEDE-Q showed low accuracy for detecting LOC eating as measured by the ChEDE, which served as the gold-standard benchmark (AUC = 0.69). Among children who endorsed LOC eating, more episodes per month were reported on the YEDE-Q than ChEDE (p < .001). The YEDE-Q may not have utility as a screener for identifying true cases of LOC eating among school-age children with overweight or obesity. Further evaluation of the YEDE-Q and the alternate three-factor structure is warranted.

School Breakfast-Club Program Changes and Youth Eating Breakfast During the School Week in the COMPASS Study.

Despite the importance of breakfast consumption, breakfast skipping is common among Canadian youth. This study examines how changes to school-based breakfast programs are associated with breakfast-skipping behavior. Using school-level longitudinal data from Year 1 (Y1 : 2012-2013) and Year 2 (Y2 : 2013-2014) of the COMPASS study, quasi-experimental methods evaluated the impact over time that changes to school-based breakfast programs had on breakfast skipping or participating in school-based breakfast program. Between Y1 and Y2 , the school-level prevalence of breakfast skipping (54.5%-54.9%) and breakfast program participation (12.3%-13.6%) increased. Of the 43 participating schools, 5 implemented a new school breakfast program. Among the intervention schools, 1 school (School 4) observed a significant, and 1 school (School 3) observed a significant increase in the school-level prevalence of skipping breakfast; there was no significant change in the other 3 intervention schools. Despite the availability of free school breakfast programs, the majority of youth skipped breakfast at least once a school week. Owing to the variation in the types of programs implemented, additional evaluation evidence is necessary to determine which students benefited the most from these programs.

Obesity and Disordered Eating in Youth ? Discernment and Sensitivity are Required

While much is known about the perils and societal costs of obesity, less is known about the perils of disordered eating, poor body image and food fixations. Both obesity and disordered eating have complex etiologies and continued research is necessary for us to better understand and treat these diseases. These conditions cause untold misery and damage physical, emotional, mental and social well-being, especially in the period of adolescence and early adulthood. For instance, anorexia nervosa is a psychiatric illness with the highest mortality rate – 10% will die within 10 years of the onset of the illness.

Providing collaborative clinician and carer training experiences in eating disorders

The Victorian Centre of Excellence in Eating Disorders is a state-wide service providing leadership in eating disorders across the Victorian public mental health system. The service has recently employed a carer consultant to enhance their role in consultation, service development and education. One innovative use of this position was to begin delivering joint education seminars. Five carers (who have a child with an eating disorder) were invited to participate in a focus group, informing the development of possible seminar topics. Subsequently, a senior clinician and carer consultant collaboratively designed and facilitated a pioneering seminar entitled ‘Developing a Roadmap for Recovery in Youth Eating Disorders’ to an audience of carers and clinicians. Written evaluations were completed by participants, which revealed very high satisfaction with the sessions and indicated the value of this training for both clinicians and carers. Delivering state-wide co-produced seminars to carers and clinicians provide a valuable opportunity to encourage collaboration and empower both parties' to facilitate reciprocal sharing of expertise for continued improvement of service delivery. Further opportunities to work in partnership with carers and consumers should be encouraged, with consideration given to the benefits and challenges of developing and delivering workshops for two different audiences.

Autonomous and Controlled Motivation for Healthful Eating in Youth with Type 1 Diabetes (T1D) and Their Parents

Autonomous and Controlled Motivation for Healthful Eating in Youth with Type 1 Diabetes (T1D) and Their Parents

Addictive-Like Eating, Body Mass Index, and Psychological Correlates in a Community Sample of Preadolescents

IntroductionThe two main objectives were to identify addictive-like eating in youth and determine the relationship between addictive-like eating, hedonic hunger, and psychological variables. MethodA cross-sectional design was used. Each subject's objective heights and weights were measured. Subjects completed questionnaires about anxiety, depression, appetitive responsiveness, addictive-like eating, other forms of disordered eating, and exercise patterns. ResultsSixty-five children, ages 9 to 14 years, participated in the study. The mean body mass index percentile for age and gender was 69%. Thirty-eight percent of the children were either overweight or obese. Sixteen percent reported three or more addictive-like eating behaviors, and 4% met the criteria for “food addiction.” Addictive-like eating was significantly correlated with appetitive responsiveness but not body mass index, anxiety, depression, or other measures of disordered eating. DiscussionAddictive-like eating occurs in children as young as 9 years and appears to be a different type of disordered eating. The hedonic value and proximity of food is a contributor to addictive-like eating behaviors.

Topical review: a comprehensive risk model for disordered eating in youth with type 1 diabetes.

Provide an updated literature review on prevalence, measurement, and correlates of disordered eating in youth with Type 1 diabetes (T1D), present a novel theoretical risk model (i.e., The Modified Dual Pathway Model) for disordered eating in youth with T1D incorporating psychosocial and physiological risk factors, and discuss clinical implications. Literature review of prevalence, correlates, risk factors, and outcomes of disordered eating behavior (DEB) in youth with T1D. Insulin treatment, subsequent weight gain, and disruptions to hunger and satiety regulation are hypothesized disease-related mechanisms through which the treatment of T1D may increase vulnerability to development of behavior characterized as DEB. The Modified Dual Pathway Model integrates these factors with a validated psychosocial risk (body dissatisfaction, depression, and abstinence violation) model for DEB in nondiabetic youth. The Modified Dual Pathway model of DEB in youth with T1D is a comprehensive representation of both psychosocial and T1D-related risk factors with the potential to inform future interventions for this population.

Environmental Influences on Youth Eating Habits: Insights From Parents and Teachers In South Korea

Youth obesity has increased over the past two decades in South Korea. Researchers employed in-depth interviews and focus-group discussions with parents and teachers from 26 schools in metropolitan South Korea, to examine environmental factors affecting youth eating habits. Home environment and exposure to healthy foods were the most important factors influencing healthy eating habits. Families with working mothers eat out more than do families with stay-at-home mothers. Poor nutrition education is associated with low vegetable intake in elementary school lunches. A cultural emphasis on academic achievement adversely affects children’s eating practices. Findings can guide future studies and inform program development.

Responses of Youth With Diabetes and Their Parents to the Youth Eating Perceptions Survey

The purpose of this study was to investigate the perceptions of youth with diabetes mellitus (DM) and their parents/guardians about issues related to eating habits and to identify the relationships between treatment and lifestyle/daily care factors, youth characteristics, and eating habits of youth with DM. Methods included medical chart review and a written survey for youth with DM (n = 125) aged 10 to 20 years and their parents/guardians (n = 125) at Miller Children’s Hospital in Long Beach, California. Healthier eating was associated with stronger parent-youth relationships (P = .000), eating meals at home (P = .047), parent/guardian involvement in DM management (P = .039), younger age of youth (P = .008), and youth being male (P = .017) but not with treatment duration, special meetings with a registered dietitian, parent/guardian age, BMI z score, race/ethnicity, or language of youth. This study suggests that family-centered interventions for youth with DM should promote strong parent-youth relationships, eating at home, parent involvement in DM management for younger patients with special attention to transition to self-care among older patients, and healthy food choices for older youth with DM, especially girls.

Disturbed eating behaviours and thoughts in Australian adolescents with type 1 diabetes

To describe the presence and type of disturbed eating behaviours and thoughts in a combined male/female Australian sample of adolescents with type 1 diabetes, and examine the association of eating behaviours and thoughts with glycaemic control as evidenced by high glycosylated haemoglobin levels (HbA1c). In this cross-sectional descriptive study, 124 adolescents aged 13-18 years were invited to complete three self-administered questionnaires. The Youth Eating Disorder Examination Questionnaire (YEDE-Q) and the Eating Disorder Inventory -3 Risk Composite (EDI-3RC) assessed risk for an eating disorder. The third questionnaire, the Strengths and Difficulties Questionnaire (SDQ) assessed emotional and behavioural concerns. Clinical data were collected from the medical records, routine clinic appointments and the adolescent. Any disturbed eating behaviour was reported by approximately one-third of participants (32.3%) and was common in females and males (37.9% vs. 25.9%). Binge eating (17.7%), driven exercise (13.0%) and dietary restraint (8.9%) were the most common disturbed eating behaviours, although restraint was not evident in males. Insulin manipulation/omission (5.6%), vomiting (3.3%), laxative (0.8%) or diuretic use (0.8%) were less common. Regression analysis showed a significant association between HbA1c and more disturbed eating behaviours and thoughts which remained significant when adjusted for confounders. High rates of disturbed eating behaviours and thoughts were seen in this Australian sample of adolescents with type 1 diabetes. High scores on both eating disorder measures were associated with poorer glycaemic control. These results highlight the need to screen for disordered eating in adolescents with type 1 diabetes.

Concurrent validity of self-report measures of eating disorders in adolescents with type 1 diabetes

Eating disorder screening tools have not been adequately validated for use with adolescents with type 1 diabetes. This study compared the Youth Eating Disorder Examination-Questionnaire (YEDE-Q) and the Eating Disorder Inventory-3 Risk Composite (EDI-3RC) against the child Eating Disorder Examination (chEDE). These screening tools were chosen because they broadly assess eating disorder psychopathology and have subscales helpful for clinical management. In this cross-sectional study, 124 adolescents with type 1 diabetes aged 13-18 years completed two self-administered questionnaires, the YEDE-Q and the EDI-3RC. Cronbach's alpha was used to assess internal consistency of the tools. Fifty-one adolescents, randomly selected, participated in the chEDE. Intraclass correlations and Spearman's correlations were used to measure concordance of the chEDE with the YEDE-Q and EDI-3RC. The YEDE-Q and EDI-3RC demonstrated good subscale internal consistency; Cronbach's alpha for YEDE-Q (0.78-0.95) and EDI-3RC (0.79-0.94). High levels of concurrent validity with the chEDE were seen with both tools. Preliminary evidence is provided for the validation of the YEDE-Q and EDI-3RC for use in adolescents with type 1 diabetes. The YEDE-Q also defines individual disturbed eating behaviours with frequency ratings which can be helpful for tailoring early intervention.

Children’s coping after psychological stress. Choices among food, physical activity, and television

Children’s stress-coping behaviors and their determinants have not been widely studied. Some children eat more after stress and dietary restraint moderates stress eating in youth, but eating has been studied in isolation of other coping behaviors. Children may not choose to eat when stressed if other behavioral alternatives are available. The purpose was to determine individual difference factors that moderate the duration of stress coping choices and to determine if stress-induced eating in youth persists when other stress coping behaviors are available. Thirty children (8–12years) completed a speech stressor on one day and read magazines on another day. They completed a free-choice period with access to food, TV, and physical activity on both days. Dietary restraint moderated changes in time spent eating and energy consumed from the control to stress day. Children high in restraint increased their energy intake on the stress day. Changes in the time spent watching TV were moderated by usual TV time, as children higher in usual TV increased their TV time after stress. Thus, dietary restrained children eat more when stressed when other common stress coping behaviors are freely available. These results extend the external validity of laboratory studies of stress-induced eating.

Subtyping children and adolescents with loss of control eating by negative affect and dietary restraint

Objective Research suggests that subtyping adults with binge eating disorders by dietary restraint and negative affect predicts comorbid psychopathology, binge eating severity, and treatment outcome. Little research has explored the validity and clinical utility of subtyping youth along these dimensions. Method Children (aged 8–18 years) reporting loss of control eating ( n=159) were characterized based upon measures of dietary restraint and negative affect using cluster analysis, and then compared regarding disordered eating attitudes and behaviors, and parent-reported behavior problems. Results Robust subtypes characterized by dietary restraint ( n=114; 71.7%) and dietary restraint/high negative affect ( n=45; 28.3%) emerged. Compared to the former group, the dietary restraint/high negative affect subtype evidenced increased shape and weight concerns, more frequent binge eating episodes, and higher rates of parent-reported problems (all ps<0.05). Conclusion Similar to findings from the adult literature, the presence of negative affect may mark a more severe variant of loss of control eating in youth. Future research should explore the impact of dietary restraint/negative affect subtypes on psychiatric functioning, body weight, and treatment outcome.

State of the Art Reviews: Using the Internet to Promote Physical Activity and Healthy Eating in Youth

The prevalence of overweight children and adolescents is increasing at alarming rates. Since 1980, the prevalence of overweight among children aged 6 to 11 years has more than doubled and more than tripled among adolescents aged 12 to 19. Innovative, effective weight loss strategies that effectively promote healthy eating and physical activity are needed to address this obesity epidemic. The Internet may prove to be an effective means of reaching youth to reduce overweight and, ideally, prevent weight gain. This article reviews the available literature of Internet-based interventions promoting healthy eating, physical activity, and/ or weight loss in school, home, camp, and medical settings. Findings show that few examples of well-designed trials exist in the youth literature. However, several studies show promise for the use of the Internet. It is recommended that future trials use adequate sample sizes, randomized designs, objective measures, boys and girls, health disparity youth, longer intervention periods (at least 16 weeks), long-term follow-up, theory-based skill building (eg, tracking of behavior, goal setting, feedback, increasing social support), the involvement of parents or caretakers, and improved means for sustaining interest and use in the site over time.

Assessment of binge eating in overweight youth using a questionnaire version of the child eating disorder examination with instructions

Existing self-report methods for assessing eating disorder (ED) symptoms in youth do not adequately measure binge eating and lack sufficient psychometric support. The Youth Eating Disorder Examination-Questionnaire (YEDE-Q), a self-report version of the Child Eating Disorder Examination (ChEDE), was designed to assess the spectrum of ED psychopathology in youth. The YEDE-Q was compared to the ChEDE and the Questionnaire for Eating and Weight Patterns-Adolescent version (QEWP-A) in a sample of 35 overweight adolescents aged 12-17. The YEDE-Q showed significant agreement (ps < .001) with the ChEDE on all four subscale scores, the global score, and measurement of objective bulimic episodes. The YEDE-Q and the QEWP-A showed significant agreement (ps < .001) on the measurement of shape and weight concerns. The YEDE-Q appears promising in the assessment of eating-related pathology in overweight adolescents, but remains in need of validation in children and ED populations.

Understanding gardening and dietary habits among youth garden program participants using the Theory of Planned Behavior

Sedentary lifestyles, along with diets low in fruits, vegetables, and complex carbohydrates, and high in fat and total energy are increasing among youth. These unhealthy behaviors contribute to an increase in childhood overweight, which is associated with type 2 diabetes, hypertension, and heart disease. Healthful dietary behaviors, such as eating a balanced and varied diet may be addressed in garden-based programs for youth. Therefore, this project assessed the influence of a garden program, with a newly developed nutrition curriculum, on youth's eating and gardening behavior using the Theory of Planned Behavior. The model included the constructs of attitude, subjective norm, and perceived behavioral control (PBC). Youth (age 8-15 years) involved in a garden program in Minneapolis/St. Paul, Minnesota completed a pre- (n=96) and a post-survey (n=66) assessing the theory's constructs with regard to eating and gardening behaviors. Fruit and vegetable consumption were assessed using survey questions and a 24-h recall. In addition to finding gender differences regarding associations between intention and behavior and the constructs correlated with behavior, results indicated that attitude was most predictive of intention at both pre- and post-survey for both boys and girls with behavior associated to PBC in girls, but not for boys. A high level of intention for boys pre-survey marginally predicted some behavioral change post-survey, but girls with high levels of intention at pre-survey did not show positive behavioral changes at post-survey. Additionally, the garden program positively impacted youth fruit and vegetable consumption, as determined from a mean computed from the responses to the fruit and vegetable behavior survey questions and the 24-h recall food group data. Because youth in the garden program consumed more fruit and vegetables at post-survey compared to pre-survey, we conclude that garden programs may be a viable way to assist youth in making healthy lifestyle changes.