Problematic Eating Research Articles

“In China, I live to eat. Here, I eat to live”

The population of international students in Canadian post-secondary institutions, including in dietetic programs, is growing. In addition to academic stress, international students must cope with culture change and acculturative stress, which has been found to increase the prevalence of problematic eating and body image concerns among this population. Research indicates that problematic eating and body image concerns may also be relatively high among dietetic students due, in part, to the emphasis on body weight management and the narrow representations of healthy eating, and the disciplinary processes of professional socialization that are characteristic of dietetic education. For international dietetic students, vulnerability to problematic eating and body image concerns may be particularly acute, given their position as both dietetic and international students. However, little is known about the experiences of this population, and if, how and to what extent being an international dietetic student may impact on eating and body image concerns, or what efforts may be needed to prevent and support those experiencing these concerns. This research used the EAT-26 questionnaire and one-on- one, semi-structured interviews to explore how culture change impacts eating and body image among Mandarin-speaking, Chinese international dietetic students. Results indicate that culture change has a significant impact on the relationships to food and on eating and body image among the study population. Further research is needed to elucidate the impacts of culture change, and how dietetic educators may best support international dietetic students.

Binge Eating in a Slovenian Population-based Sample of Adults.

Binge eating is the most common form of disordered eating associated with obesity, reduced quality of life, and medical and psychological comorbidities. It therefore affects the well-being of individuals. This underscores the fact that it is a serious public health problem. The study aimed to investigate binge eating and anxiety across gender, age and body mass index in a large population sample of adults in Slovenia. A total of 3,310 adult volunteers participated in this cross-sectional study. Questionnaires, including a binge eating and anxiety scale and an eating behaviour questionnaire, were completed by 1,487 subjects (90.9% female, ages 18 to 69). The frequency of reported binge eating was 29.9%, with 9.8% of participants reporting severe binge eating, and the presence of overweight and obesity was high (41.8%). BMI was associated with this problematic eating, and explained 5.4% of the variation in binge eating. Importantly, anxiety was the most important factor related to binge eating, with younger participants and women reporting significantly more anxiety. The high presence of binge eating, obesity and anxiety in the Slovenian population-based sample is worrying. Anxiety is clearly an important factor in understanding the relationship between negative affect and binge eating, as it accounts for a greater proportion of the variance in binge eating symptoms than BMI. Particularly concerning was the fact that the youngest participants showed the greatest anxiety. Targeting anxious adolescents and females is important from a health perspective because it can impact the physical and mental health of the population in the long term.

Rationale and design of the SenseWhy project: A passive sensing and ecological momentary assessment study on characteristics of overeating episodes.

Overeating interventions and research often focus on single determinants and use subjective or nonpersonalized measures. We aim to (1) identify automatically detectable features that predict overeating and (2) build clusters of eating episodes that identify theoretically meaningful and clinically known problematic overeating behaviors (e.g., stress eating), as well as new phenotypes based on social and psychological features. Up to 60 adults with obesity in the Chicagoland area will be recruited for a 14-day free-living observational study. Participants will complete ecological momentary assessments and wear 3 sensors designed to capture features of overeating episodes (e.g., chews) that can be visually confirmed. Participants will also complete daily dietitian-administered 24-hour recalls of all food and beverages consumed. Overeating is defined as caloric consumption exceeding 1 standard deviation of an individual's mean consumption per eating episode. To identify features that predict overeating, we will apply 2 complementary machine learning methods: correlation-based feature selection and wrapper-based feature selection. We will then generate clusters of overeating types and assess how they align with clinically meaningful overeating phenotypes. This study will be the first to assess characteristics of eating episodes in situ over a multiweek period with visual confirmation of eating behaviors. An additional strength of this study is the assessment of predictors of problematic eating during periods when individuals are not on a structured diet and/or engaged in a weight loss intervention. Our assessment of overeating episodes in real-world settings is likely to yield new insights regarding determinants of overeating that may translate into novel interventions.

Parents’ Perceived Challenges and Best Practices in Encountering Food Neophobia Among Preschool Children

Introduction: Three objectives of this study were (1) to determine the prevalence of FN; (2) to determine the parents' perceived challenges in having food neophobic children (FN); and (3) to determine the parents' perceived best practices for food neophilic children (FA). Methods: This study adopted a mixed-method approach with a survey questionnaire among 126 parents of 4 to 6 years-old children; and purposive phone interviews to the 6 selected participants. The questionnaire consists of two sections, quantitative and qualitative which are comprised of demographic information, children’s height and weight, Food Neophobia Scales (FNS), and an open-ended questionnaire on parents’ challenges and best practices in FN. Results: The quantitative results reported prevalence of FN was 38.1% in which higher in 5 years, girls and normal-weight children. Qualitative analysis of open-ended questionnaire and interviews outlined three major challenges in FN and three major best practices in FA. Among the reported challenges of FN parents were related to problematic feeding behavior and preferences (37.3%); negative beliefs and perception about new foods (34.5%); and lack of practical skills, ideas and meal strategies (28.2%). Food skills activities with children (38.4%), role modelling (15.8%), and creativity in food design (13.5%) were the best practices reported by FA parents. Conclusion: These results suggest parents require greater knowledge and skills on how to improve children’s eating behaviors. Feeding interventions such as food skills education should focus on providing parents, teachers and health practitioners with practical, emotional, and informational feeding supports to manage FN.

Feeding at 6-12 months in infants with CHD.

Feeding difficulty is common in infants with CHD. The purpose of this study was to describe the feeding skills and behaviours of infants with CHD at 6-12 months of age and explore relationships between feeding, gastrointestinal distress, and gastroesophageal reflux. Parents of 30 infants with CHD completed online surveys when their infant was 6, 8, 10, and 12 months old. Surveys included parent-report measures of feeding skills (Child Oral and Motor Proficiency Scale), feeding behaviours (Pediatric Eating Assessment Tool), symptoms of gastrointestinal distress (Infant Gastrointestinal Symptoms Questionnaire), and gastroesophageal reflux (Infant Gastroesophageal Reflux Questionnaire-Revised). We found that 95, 32, 67, and 30% of infants were delayed in their feeding skill development at 6, 8, 10, and 12 months, respectively. Symptoms of problematic feeding behaviours were similarly high, with 90, 62, 29, and 38% of infants meeting criteria for problematic feeding at 6, 8, 10, and 12 months, respectively. Feeding skills and behaviours were related but unique contributors. Feeding behaviours were related to both gastrointestinal distress and gastroesophageal reflux, but feeding skills were rarely related to either. Delayed acquisition of feeding skills and problematic feeding were common in infants with CHD. Infants with more gastrointestinal and gastroesophageal reflux symptoms had more symptoms of problematic feeding behaviours. Comprehensive assessment, targeted interventions, and early involvement of feeding specialists are important to support feeding in infants with CHD through at least the first year of life.

How does the increase in eating difficulties according to the Development and Well-Being Assessment screening items relate to the population prevalence of eating disorders? An analysis of the 2017 Mental Health in Children and Young People survey.

We examine the test accuracy of the Development and Well-Being Assessment (DAWBA) eating disorder screening items to explore whether the increased eating difficulties detected in the English National Mental Health of Children and Young People (MHCYP) Surveys 2021 reflect an increased population prevalence. Study 1 calculated sensitivity, specificity, and positive and negative predictive values from responses to the DAWBA screening items from 4057 11-19-year-olds and their parents, in the 2017 MHCYP survey. Study 2 applied the positive predictive value to data from 1844 11-19-year-olds responding to the 2021 follow-up to estimate the prevalence of eating disorders in England compared to 2017 prevalence. Parental report most accurately predicted an eating disorder (93.6%, 95% confidence interval: 92.7-94.5). Sensitivity increased when parent and child answers were combined, and with a higher threshold (of two) for children. The prevalence of eating disorders in 2021 was 1% in 17-19-year-olds, and .6% in 11-16-year-olds-similar to the prevalence reported in 2017 (.8% and .6%, respectively). However, estimates for boys (.2%-.4%) and young men (.0%-.4%) increased. We found tentative evidence of increased population prevalence of eating disorders, particularly among young men. Despite this, the DAWBA screening items are useful for ruling out eating disorders, particularly when parents or carers screen negative, but are relatively poor at predicting who will have a disorder. Data from both parents and children and applying a higher cut point improves accuracy but at the expense of more missed cases. The prevalence of eating disorders did not markedly change from 2017 to 2021, but we found tentative evidence of an increase, particularly among young men. This is despite larger increases in problematic eating, which need further investigation. The DAWBA screen is best suited to ruling out eating disorders which limits its clinical applications as it would provide many false positives requiring further assessment.

Looking at me, looking at you: The mediating roles of body surveillance and social comparison in the relationship between fit ideal internalisation and body dissatisfaction

Understanding the mechanisms through which internalisation of societal body standards lead to negative outcomes for women is important to inform prevention and treatment strategies targeting female body image issues and problematic eating and exercise behaviours. This study investigated the mediating roles of body surveillance and social comparison on the relationship between fit-ideal internalisation and a range of negative eating and body image related outcomes. Participants were 448 females, aged 16–25 years who completed self-report measures of fit-ideal internalisation, body surveillance, social comparison, body dissatisfaction, dieting, bulimic behaviours and compulsive exercise. Consistent with hypotheses, the results of parallel mediation analyses suggested that both body surveillance and social comparison mediated the relationship between fit-ideal internalisation and body dissatisfaction, dieting and bulimic behaviours. However, only social comparison was found to mediate the relationship between fit-ideal internalisation and compulsive exercise. The results suggest both body surveillance and social comparison are mechanisms by which fit internalisation detriments women's body image, making them potentially useful treatment targets for future research.

Translation, Cultural Adaption, and Validation of the Persian Version of the Pediatric Eating Assessment Tool

Introduction: The Pediatric Eating Assessment Tool (PediEAT) is a parent-report tool to assess feeding problems in children aged 6 months to 7 years. This study aimed to translate and adapt the PediEAT to Persian and determine its psychometric properties. Methods: The PediEAT was translated and culturally adapted the following guidelines for health-related instruments. Face and content validity was assessed using an expert panel. This study also aimed to evaluate psychometric properties using a sample of 160 children without feeding problems and 43 children with diagnosed feeding problems. Known-groups validation was used to compare PediEAT scores between children with and without feeding problems. In criterion validity, pediatricians’ opinions were used as a criterion. To calculate internal consistency, Cronbach’s alpha was used. After 2 weeks, temporal stability was assessed with 40 parents who repeated the PediEAT. Results: Face and content validity showed that all tool items had CVI and kappa coefficients higher than 0.8. Known-group validity showed that the total and subscale scores significantly differed between children with and without feeding problems (p < 0.001). Criterion validity showed that criterion measurements correlated with questionnaire measurements. All four subscales and the total scale showed acceptable internal consistency reliability (Cronbach’s alpha > 0.74). Test-retest reliability was acceptable (ICC = 0.987, p < 0.001). Conclusions: The PediEAT-Persian version is a valid and reliable tool for assessing symptoms of problematic feeding in Persian children aged 6 months to 7 years.

Parent-Child Interaction Therapy Supports Healthy Eating Behavior in Child Welfare-Involved Children.

Objective: We tested the efficacy of standard Parent–Child Interaction Therapy (PCIT), a live-coached, behavioral parent-training program, for modifying problematic eating behaviors in a larger effectiveness trial of PCIT for children involved in the child welfare system. Method: Children ages 3–7 years and their parents were randomly assigned to PCIT intervention (n = 120) or services as the usual control (SAU; n = 84) groups in a randomized clinical trial. Children’s eating behaviors were assessed pre- and post-intervention via the Child Eating Behaviors Questionnaire (CEBQ). Intention-to-treat analyses were conducted, followed by per-protocol analyses, on treatment-engaging families only. Results: PCIT led to reductions in child welfare-involved children’s food responsiveness, speed of food consumption, and tendency to engage in emotional overeating relative to children in the services-as-usual control condition. Standard PCIT may be an effective intervention to promote healthy child eating behaviors in families involved with child welfare, even when food-related behaviors are not directly targeted by the intervention. Public Health Significance: This clinical trial provides evidence that child welfare-involved children who received PCIT experienced significant reductions in maladaptive eating-related behaviors, namely food responsiveness, emotional overeating, and speed of eating. These findings were observed in relation to children in a comparison control group who had access to child welfare services-as-usual.

Food Addiction, Weight Perception, Dieting, and Maladaptive Eating Behaviors in U.S. Young Adults: An Observational, Prospective, Nationally Representative Cohort Study

ObjectivesThis study examines relations of food addiction with weight-related and maladaptive eating behaviors in a nationally representative sample of U.S. young adults. MethodsData come from the final annual assessment of the NEXT Generation Health Study, which followed a cohort of U.S. emerging adults from 2010–2017 (year 7 n = 2323, age 22.6 ± 0.5 years, 81% retention). Food addiction was assessed using the modified Yale Food Addiction Scale. Participants self-reported height, weight, weight perception (underweight, about right, overweight), currently attempting weight loss (vs. not), and 10 maladaptive eating behaviors (e.g., self-induced vomiting, laxative use, diet pills). Logistic (rare outcomes) and log-binomial (common outcomes) regression analyses accounting for the complex survey design estimated relations of food addiction with dieting, perceived overweight, and maladaptive eating behaviors. ResultsThe prevalence of food addiction was 4.7% (95% CI: 3.6% –6.2%). Forty-seven percent of young adults (95% CI: 46.9%, 52.1%) reported attempting weight loss; 45.6% reported perceived overweight (95% CI: 40.9%, 50.3%) and 7.1% (95% CI: 4.5%, 11.0%) reported any maladaptive eating behavior. In bivariate regressions, females had greater odds of food addiction, maladaptive eating behaviors, perceived overweight, and attempting weight loss; outcomes were not associated with other sociodemographics. Attempting weight loss (RR = 3.4, 95% CI: 1.7, 7.1, p = .002), perceived overweight (RR = 6.3, 95% CI: 2.9, 13.6, p < .001), and maladaptive eating behaviors (OR = 3.3, 95% CI: 1.7, 6.5, p = .001) were positively associated with food addiction adjusted for sex and weight status. ConclusionsFindings indicate considerable overlap between food addiction, perceived overweight, weight loss attempt, and subclinical maladaptive eating behaviors. Food addiction may be an important consideration in the treatment and management of young adults with multiple aspects of problematic eating. Funding SourcesFunding was provided by the NICHD Intramural Research Program, NIAAA, MCHB of HRSA, and NIDA.

Exploring the association between self-compassion, mindfulness and mindful eating with eating behaviours amongst patients with obesity.

Background: People who have obesity often experience problematic eating behaviours, contributing towards their excessive weight gain. Aims: Understanding problematic eating behaviours and their association to self-compassion, mindfulness and mindful eating is important for the development of future interventions that improve weight-loss and weight-regulation. Methods: One hundred and one participants attending their first session of a 6-session dietetic programme within a Tier 3 medical weight management service in the West Midlands, UK were recruited to complete questionnaires on self-compassion, mindfulness, mindful eating and eating behaviours, such as, emotional, restrained, external, fat and sugar consumption and grazing. Results: The findings suggested all three constructs, self-compassion, mindfulness and mindful eating were significantly and negatively associated with grazing and emotional eating, but mindful eating was the only construct that also displayed a significant and negative association with other eating behaviours that are often barriers to successful weight regulation, such as external eating and fat consumption. Further investigation suggested mindful eating had an indirect effect on fat consumption and grazing via external eating. Conclusion: Whilst, self-compassion, mindfulness and mindful eating displayed a negative relationship with grazing and emotional eating, mindful eating also displayed a negative relationship with fat consumption and external eating. Possible explanations and directions for future work are discussed with an emphasis on the need for more empirical work.

Feeding/Eating Problems in Children Who Refrained From Treatment in the Past: Who Did (Not) Recover?

BackgroundYoung children with disordered feeding may be at increased risk for problematic eating in the future. This retrospective study attempts to identify predictors of later feeding problems.ObjectivesChildren (N = 236) with disordered feeding, who refrained from behavioral treatment after consultation at a tertiary treatment center for feeding and eating problems were followed-up after, on average, 6 years and 3 months (timepoint 2).MethodLogistic regressions were carried out with characteristics taken at intake (timepoint 1)—sex, pre/dysmaturity, gastro-intestinal disease, history of age-adequate feeding, syndrome/developmental impairment, autism spectrum disorder, comorbidity, age, and several variables of a restrictive- and selective food intake—and duration between timepoint 1 and 2, as predictor variables, and age-appropriate food intake at t2 as the dependent variable.ResultsDespite improvement over time, 63% did not reach an age-adequate food intake at t2. Predictors of age-inadequate food intake were: (a) older age; (b) sex (male), (c) longer duration between timepoint 1 and timepoint 2; (d) autism spectrum disorder; (e) selective texture choices and (f) lack of varied nutritional intake.ConclusionThis study shows that most untreated young children's feeding problems do not improve over years. Besides the advice to seek help at an early age, it seems especially recommended to treat (male) children with autism spectrum disorder and selective feeding patterns.

Psychosocial predictors of problematic eating in young adults who underwent adolescent bariatric surgery.

IntroductionThis study examined problematic eating and eating‐related psychopathology among young adults who underwent adolescent bariatric surgery including concurrent and prospective associations with psychosocial factors and weight change.MethodsVIEW point is a 6‐year follow‐up study within a prospective observational study series observing adolescents with severe obesity who had bariatric surgery (n = 139) or who presented to nonsurgical lifestyle modification programs (n = 83). Participants completed height/weight measurements, questionnaires, and diagnostic interviews. Regression analyses compared problematic eating across groups and examined Year 6 correlates (i.e., psychosocial factors and weight change) and baseline predictors (i.e., psychosocial factors) of eating‐related psychopathology.ResultsCompared to the nonsurgical group, the surgical group reported lower eating‐related psychopathology, objective binge eating, and grazing at Year 6. While chewing/spitting out and vomiting for weight/shape‐related reasons were very infrequent for the surgical group, self‐induced vomiting for other reasons (e.g., avoid plugging) was more common. For the surgical group, lower self‐worth, greater internalizing symptoms, and higher weight‐related teasing in adolescence predicted increased eating‐related psychopathology in young adulthood. Year 6 eating‐related psychopathology was concurrently associated with lower percent weight loss for the surgical group and greater percent weight gain for the nonsurgical group.ConclusionUndergoing adolescent bariatric surgery appears to afford benefit for problematic eating and eating‐related psychopathology. Current findings suggest that the clinical intervention related to problematic eating and associated psychosocial concerns may be needed for young adults with obesity, regardless of surgical status.

Effect of Frenotomy on Maternal Breastfeeding Symptoms and the Relationship Between Maternal Symptoms and Problematic Infant Feeding.

The relationship between maternal symptoms and problematic infant feeding in the context of tongue-tie is unknown. In a sample of infants with tongue-tie undergoing frenotomy and their mothers, the aims of this study were to: (1) describe changes in maternal symptoms pre- and post-frenotomy, and (2) evaluate the relationships between maternal symptoms and symptoms of problematic feeding pre- and post-frenotomy. Mother-infant dyads were recruited from 1 pediatric dental office between July and November 2020. The sample included 102 mother-infant dyads; 84 completed the follow-up survey. Maternal symptoms of painful and difficult latch, creased/cracked nipples, bleeding, or abraded nipples, chewing of the nipple, and feelings of depression were significantly less common after tongue-tie revision. Poor latch onto the breast was associated with feeding difficulties at both time points. Frenotomy resulted in a decrease of symptoms in breastfeeding mothers. Maternal symptoms and feeding problems persisting post-frenotomy warrant further evaluation.

Parent-reported feeding characteristics in children with ASD vs. children who are typically developing

BackgroundParents of children with autism spectrum disorders (ASDs) often report that their children have multiple dietary behavior problems than parents of typically developing (TD) children do. This may affect proper nutrition and subsequently adequate growth and development in children with ASD. The current study aimed to assess the feeding behavior in recently diagnosed children with autism spectrum disorders (ASD) ranged in age from 2 to 4 years and compare it with typically developing (TD) children and to explore the relationship between feeding behaviors and autism severity using the Montreal Children’s Hospital Feeding Scale (MCH) and Childhood Autism Rating Scale (CARS), respectively. Parents of 35 preschool children (2–4 years) with ASD completed reports of physical measurements, feeding interview, Childhood Autism Rating Scale (CARS), and Montreal Children’s Hospital Feeding Scale (MCH Feeding-Scale). The collected data from parents of children with ASD were analyzed and compared with 70 typically developed children matched with age and sex.ResultsASD children showed statistically significantly more problematic feeding behaviors in most of the assessed eating characters compared with TD children, e.g., food neophobia, eating non-food items instead of food, requiring assistance during eating, and feeding avoidance to particular textures and taste. The mean total score of the MCH feeding scale differed significantly between children with ASD and TD children. No correlation was found between the mean total score of the MCH feeding scale and CARS scores.ConclusionOur findings revealed a high rate of behavioral feeding problems in children with ASD. Future work will be needed to follow up the feeding behaviors and to develop practical feeding approaches for ASD children to maintain nutritional adequacy.

Eater profile and associated factors in pediatric patients of the PEDIANUT cohort

Appetite traits have multifactorial origins. In association with environmental and genetic factors, they could become problematic and lead to Feeding or Eating Disorders (FED). As the DSM-5 classification is not suitable for pediatric FED, another way to describe eating behavior is to distinguish the clinical profiles of "small eater" and "big eater". The aim of this study was to identify socio-demographic and medical factors associated with these profiles, and to compare problematic and non-problematic profiles. From the Pedianut study, we analyzed socio-demographic, medical and family history data among 401 children according to 4 age groups (<1 year n = 101, 1–6 years n = 99, 6–12 years n = 100, 12–18 years n = 101). The information collected on eating behavior made it possible to define small eater profile (SEP) and big eater profile (BEP) using predefined grids. BEP was more frequent in adolescents (35.6%), and SEP was more frequent in children aged 1–6 years (34.3%). BEP was associated with having separated parents, being male and the oldest sibling (p < 0.05). Problematic BEP was associated with eating while watching television, being a girl, and having sensory disorders (p < 0.05). SEP was associated, whatever age, with non-breastfeeding, chronic illness, psychological history, sensory disorders, language delays (in the 1–6 year age group), and family history of FED (in the adolescent group) (p < 0.05). This analysis of factors associated with eater profile opens new perspectives for research on risk factors associated with eating traits, which warrants further study in larger populations to delineate transition from healthy to problematic eating.

A pilot study of non-nutritive suck measures immediately pre- and post-frenotomy in full term infants with problematic feeding

IntroductionThe purpose of this study was to describe symptoms of problematic feeding in infants with tongue-tie, evaluate changes in non-nutritive suck measures before and after frenotomy, and examine tongue-tie severity with changes in non-nutritive suck patterning. MethodParents completed the Neonatal Eating Assessment Tool about infant feeding before frenotomy. Non-nutritive suck data were collected for 5 min before and after frenotomy. We used paired t-tests to compare non-nutritive suck measures pre- and post-frenotomy and linear regression evaluated the effect of tongue-tie severity and infant behavioral state on change in non-nutritive suck mechanics. ResultsTwenty-one infants had scores that met criteria for problematic feeding. The infant's non-nutritive suck amplitude (cmH2O) (p = .02) and non-nutritive burst duration (sec) (p = .03) decreased post-frenotomy. DiscussionThis study supports the need for additional research to better understand feeding problems and changes in non-nutritive suck amplitude and duration in infants with tongue-tie.

Adverse experiences as predictors of maladaptive and adaptive eating: Findings from EAT 2018

Adverse experiences, such as childhood abuse and other violence victimization, are associated with problematic eating. However, whether different types of adversity relate to both maladaptive and adaptive eating behaviors is unclear. This study examined the associations of different adverse experiences with maladaptive (i.e., overeating and binge eating) and adaptive (i.e., intuitive eating and mindful eating) eating by gender. Data were derived from the EAT-2018 (Eating and Activity over Time) study (N = 1411, aged 18–30 years in 2017–2018). Modified Poisson regressions were used to examine the associations between adverse experiences and the prevalence of maladaptive eating. Linear regressions were used to examine the associations between adverse experiences and adaptive eating scores.Each adverse experience was associated with greater prevalence of maladaptive eating and lower adaptive eating scores. Among women, intimate partner sexual violence was strongly associated with more overeating (PR = 2.1 [95% CI = 1.4–3.1]) and binge eating (PR = 2.4 [95% CI = 1.5–3.9]), and less mindful eating (β = −0.6, [95% CI = −0.8, −0.3]); being attacked, beaten, or mugged was most associated with less intuitive eating (β = −0.5, [95% CI = −0.8, −0.2]). Among men, being attacked, beaten, or mugged was strongly associated with more overeating (PR = 2.1 [95% CI = 1.2–3.5]) and binge eating (PR = 3.2 [95% CI = 1.6–6.5]); intimate partner physical violence was strongly associated with less intuitive eating (β = −0.6, [95% CI = −0.9, −0.2]); childhood emotional abuse was strongly associated with less mindful eating (β = −0.8, [95% CI = −1.0, −0.5]). To improve eating behaviors, adverse life experiences and the potential impact on maladaptive and adaptive eating should be considered.

Subtyping youngsters with obesity: A theory-based cluster analysis

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.

Predictors of Problematic Feeding in Preterm Infants after Neonatal Intensive Care

Infants born preterm frequently experience difficulty with oral feeding during hospitalization. The purpose of this study was to describe the prevalence of problematic feeding in a sample of preterm infants at 1, 3, and 6 months corrected gestational age (CGA) as well as to identify factors known at the time of neonatal discharge that are related to later problematic feeding.