Problematic Eating Research Articles

Understanding problematic eating in out-of-home care: The role of attachment and emotion regulation

Children living in Out-of-Home Care (OoHC) are thought to be especially vulnerable to developing problematic eating behaviours due to their likelihood of having insecure attachment styles and emotion regulation deficits. Despite this increased risk, our understanding of problematic eating among children in OoHC is limited. Therefore, this study aimed to; (1) Explore the rate of problematic eating behaviours among children living in OoHC, specifically residential and foster care; (2) Investigate how carers manage problematic eating and (3) Understand carers' perceptions of the role of attachment and emotion regulation in relation to problematic eating in OoHC. Semi-structured interviews, focus groups, and surveys were conducted with residential care staff (n = 36) and foster carers (n = 8) in Victoria, Australia. Interviews were recorded, transcribed, and analysed for themes, and frequency data from the survey were generated. Residential and foster carers reported that approximately 38% of the children in their care displayed problematic eating behaviours at a clinical level. Both residential and foster carers commonly understood these behaviours as a function of the child's experiences of food deprivation and limited access to healthy foods prior to entering care which, they believe, has contributed to problems with regulating food intake and/or willingness to try new foods. Carers also commonly reported that the children in their care struggle to form attachments or regulate their emotions, which impacts carers ability to manage problematic eating. It is recommended that future interventions prioritise educating community service organisations (CSOs), responsible for delivering OoHC, to better recognise and address problematic eating behaviours. This will enable CSOs to train their residential and foster carers about how best to respond to and manage problematic eating behaviours.

Food-related behaviours among individuals with overweight/obesity and normal body weight

BackgroundEmotional eating is a factor associated with a negative body image and other problematic eating behaviours. In this context little is known about differences between individuals with overweight and obesity and those with normal body weight. The main aim of the study was to evaluate the role of emotional eating in the relationship between the desire to consume chocolate and the wish to avoid social situations related to food and body exposures. For this purpose, we tested the direct, indirect and buffer effects. In addition, we used moderated mediation by introducing snacking into the model.MethodsThe study included 123 outpatients with excessive body weight and 123 individuals with normal weight. The mean of body mass index (BMI) in the first group was 30.19 kg/m2 (SD = 4.37) and, in the second, it was 23.02 kg/m2 (SD = 1.20). The Three-Factor Eating Questionnaire, the Attitudes to Chocolate Questionnaire and the Body Image Avoidance Questionnaire were used.ResultsResults show that in all individuals, the greater emotional eating is, the greater the desire for chocolate consumption and avoidance of social situations related to food and body exposures are. In addition, the desire for chocolate consumption are positively associated with avoidance of social situations related to food and body exposures in both group. Among individuals with excessive and normal body weight, emotional eating is a significant mediator in the relationship between desire for chocolate consumption and avoidance of social situations related to food and body exposures. However, it does not moderate the relationship between these variables. Outcomes show that there is a significant model of moderated mediation of the link between social situation–avoidance related to food and body exposure and the desire to consume chocolate through emotional eating, moderated by snacking among individuals with normal body weight. A similar effect has not been discovered in the group with excessive body weight.ConclusionThe presented results show that among people with varied BMI categories, emotional eating is connected to craving chocolate and avoidance of social situations related to food and body exposure that plays only the role of mediation. In addition, snacking is crucial for this relationship among the group with normal body weight.

Association between eating frequency and eating behaviours related to appetite from 4 to 7 years of age: Findings from the population-based birth cohort generation XXI

The examination of specific characteristics of eating habits in childhood and its influence on eating behaviours is needed to better understand the establishment of appetite-related eating behaviours. This study aimed to assess the association between eating frequency (EF) (main meals vs. snacks) at 4 and 7y and problematic eating behaviours and appetite-related eating behaviours at 7y. The analysis included 1359 children from the birth cohort Generation XXI who provided 3-day food diaries, at both ages, and complete information on the Child Eating Behaviour Questionnaire, at 7y. Problematic eating behaviours were assessed using parental perception of child's poor eating (including not eating enough, eating too slow or overeating) at both ages. A time-of-day approach was used to distinguish main meals from snacks. A cross-lagged analysis was performed to check the direction of the association between EF and parental concerns regarding problematic eating behaviours. Associations between EF and appetite-related eating behaviours were evaluated through linear regression models. Between 4 and 7y a moderate tracking of EF was described as well as a strong tracking of parental concerns. We found a bidirectional relationship between EF and parental concerns. Prospectively, a higher frequency of snacks at 4y was independently associated with higher scores in ‘Desire to Drink’ at 7y (β = 0.051, 95%CI:0.009; 0.093). At 7y, a higher EF had a positive association with ‘Satiety Responsiveness’ but an inverse association with ‘Enjoyment of Food’. A higher number of main meals had a positive association with ‘Enjoyment of Food’ and ‘Food Responsiveness’. In conclusion, children who had more eating occasions seem to have more food-avoidance behaviours, traits that might protect these children from gaining excessive weight.

Changes in Symptoms of Problematic Eating Over 6 Months in Infants and Young Children

The purpose of this article is to describe changes in problematic eating symptoms across 6 months in children seen in an outpatient feeding clinic and explore child characteristics associated with symptom changes. Participants were 58 parents of children aged 6 months to 7 years of age who were seen in an outpatient feeding clinic. Parents completed an online survey at 3 time points: enrollment and 3 and 6 months later. The survey consisted of the Pediatric Eating Assessment Tool (PediEAT) and a set of questions assessing demographic information, child's medical and feeding history, medical diagnoses, gastrointestinal function, and medications. Linear mixed modeling was used to examine changes in PediEAT total and subscale scores over time and explore associated child characteristics. The PediEAT total score significantly decreased over time with the greatest change in the Physiologic Symptoms subscale. Several child characteristics were associated with more severe symptoms of problematic feeding: older child age, more symptoms of constipation, and diagnoses of speech–language delay, developmental delay, food allergy, and/or genetic disorder. Parent report of child symptoms of problematic eating decreased across 6 months. Associations with child characteristics highlight the complexity of pediatric eating problems and the need for more research on potential factors influencing symptoms of eating problems.

Relationship between Problematic Pediatric Feeding Behavior and Nutritional Intake in Young Children

Upon completion, participants will be able to identify the relationships between nutrient intake and scores from the Behavioral Pediatric Feeding Assessment Scale among children with feeding difficulties.

Eating disorders and associated risk factors among Imam Abdulrahman bin Faisal university preparatory year female students in Kingdom of Saudi Arabia.

Objectives:To estimate the prevalence of eating disorders among Imam Abdulrahman bin Faisal University (IAU) in Dammam, Kingdom of Saudi Arabia, female students and to investigate the associated factors.Methods:A cross-sectional study was conducted at IAU, Dammam, Kingdom of Saudi Arabia, in 2016 with 670 participants. Data was collected by self-administered questionnaires, including the Eating attitude test 26 (EAT-26) and the sociocultural attitudes toward appearance questionnaire (SATAQ-4). Eating behavior questions were asked to determine whether the respondents should seek evaluation for an eating disorder (ED) from a professional.Results:Eating attitude test 26 results showed that 29.4% of participants were categorized at a high level of concern for an ED, and 45.5% were categorized as at risk of having problematic feeding behaviors. Of the participants who scored above 20 on the EAT-26, 60.7% demonstrated high-risk feeding behavior attitudes, and approximately 11.5% who scored a body mass index (BMI) classified as underweight or very underweight required referral to a psychologist. A significant relationship was found between family stress to lose weight and EAT-26 scores above 20. The media was also found to represent external influence to lose weight.Conclusion:This study concluded that early detection of EDs or problematic feeding behaviors and attitude is vital to minimize the risks to physical health and well-being of the sufferers’ experiences.

Decision Making Deficits in Relation to Food Cues Influence Obesity: A Triadic Neural Model of Problematic Eating.

In this review article we propose a model of the brain systems, the deficiency of which may underlie problematic eating. This integrative model is based on studies that have focused on discrete brain components involved in problematic eating, combined with insights from studies on the neurocognitive basis of other addictive and problematic behaviors. The model includes: (a) a hyper-functioning reward anticipation and processing system (amygdala-striatum dependent) in response to food-related cues; (b) a hypo-functioning reflective and inhibitory control system (prefrontal cortex dependent), that fails to anticipate and properly weigh future outcomes; and (c) an altered interoceptive awareness system (insular cortex dependent) that translates homeostatic violation signals into a strong consumption desire that hijacks the inhibitory system and excites the reward system. We posit that when the abovementioned systems are imbalanced in such a way that the dopamine axis is hyperactive in relation to food cues and the inhibitory system is weak, and this is further aggravated by an altered interoceptive awareness system, people may experience loss of control or inability to resist tempting/rewarding foods. This loss of control over food consumption can explain, at least in part, the development of excess weight and contribute to the obesity epidemic.

Age-based norm-reference values for the Pediatric Eating Assessment Tool.

Differentiating problematic feeding from variations of typical behavior is a challenge for pediatric providers. The Pediatric Eating Assessment Tool (PediEAT) is a parent-report measure of symptoms of problematic feeding in children 6 months to 7 years old with evidence of reliability and validity. This study aimed to determine age-based, norm-referenced values for the PediEAT. Parents of children between 6 months and 7 years old (n = 1110) completed the PediEAT. Descriptive statistics were calculated for subscale and total scores of the PediEAT within 11 age groups. The PediEAT total scores followed a general downward trajectory with increasing age. Physiologic Symptoms were relatively steady from 6 to 15 months, and then rapidly declined in 15-18 month olds and continued to decline thereafter. Problematic Mealtime Behaviors increased from 6 to 9 months to a peak in 24-30 month olds and then declined with increasing age. Selective/Restrictive Eating increased from 6 to 9 months to a peak at 12-15 months and then decreased over time thereafter. Symptoms of difficulty with Oral Processing were highest in 6-9 month olds and decreased with age. The PediEAT now has age-based norm-reference values to guide score interpretation and clinical decision-making.

Problematic eating behaviors and psychopathology in patients undergoing bariatric surgery: The mediating role of loss of control eating.

This study compares different problematic eating behaviors (PEBs; objective [OBE]/subjective [SBE] binge-eating and compulsive [CG]/noncompulsive [NCG] grazing) in relation to the severity of loss of control (LOC) and psychopathology. We also investigate LOC as a mediator between PEBs and psychopathology. This cross-sectional study assessed a group of patients before bariatric surgery (n = 163), and a group of bariatric patients 12 months or more after surgery (n = 131). Face-to-face assessment: Eating Disorders Examination for binge-eating episodes; Rep(eat) for grazing. LOC was measured by five questions answered in a 5-point Likert scale. Self-report measures: disordered eating, grazing, negative urgency, depression, anxiety, and stress. OBEs were reported by 26(8.8%), SBE by 29(9.8%), CG by 35(11.9%), and NCG by 36(12.2%) of patients. The different PEBs differed significantly in the severity of LOC (F(3,120)= 25.81, p < .001). Patients reporting OBEs scored higher and patients with NCG scored lower in most measures than patients with other PEBs. Patients with any PEBs scored higher in all self-report measures than those not reporting any PEBs, with statistical significance reached for uncontrolled eating (F(4,288)= 20.21, p < .001), emotional eating (F(4,288)= 23.10, p < .001), repetitive eating F(4,288)= 18.34, p < .001), and compulsive grazing (F(4,288)= 27.14, p < .001). LOC was found to be a full mediator between PEBs and psychopathology. There is no evidence that the different PEBs differ in the psychopathology severity, independently of the experience of LOC eating during the eating episodes. We show evidence for the conceptualization of different PEB, including grazing, on a continuous scale of LOC and psychopathology.

Troubles alimentaires, fonctionnement émotionnel et activité physique au sein d’une population étudiante spécifique

IntroductionThe students represent a high-risk population for Feeding and Eating Disorders, including problematic eating behaviors, also called Unspecified Feeding and Eating Disorders. These latters usually begin during this period, especially in the first years of study. This study aims to better understand disordered eating by focusing on exercise dependence, emotional sensitivity and openness among a student population. The literature has shown that eating disorders are linked to an operative psychic functioning. The latter is characterized by a poverty of symbolization, associated with problematic emotions treatment modalities’ and with addicted to physical activity that account for the tendency of the subject to focus on the field of reality. We consider it important to study the link between emotions and physical activity in a non-clinical population in order to bring elements of understanding of problematic eating behaviors. Our aim is to assess, firstly, the emotional functioning of students with problematic eating behaviors; on the other, to assess the links that may exist between problematic eating behaviors and dependence to physical activity. We also aim to assess how emotional intensity, emotional openness and dependence to physical activity are explanatory factors of problematic eating behaviors. MethodsThis work was conducted with 113 female enrolled in a first year nursing program. We used the Eating Attitudes Test, the Exercise Dependence Scale, the Affect Intensity Measure and the Emotional Openness Inventory. ResultsAmong the 113 female enrolled in a first year nursing program, 21% of them have problematic eating behaviors. The results showed (1) a positive relationship between problematic eating behaviors and the perception of body internal and external emotional indicators; (2) women with problematic eating behaviors were more aware of body internal indicators of affectivity than none problematic eating disturbance, they also had an exercise dependence score higher than the others students; (3) the awareness of external indicators of affectivity and tolerance were explanatory factors from problematic eating behaviors. ConclusionThe research aim was to determine the specificity of exercise dependence, affect intensity and emotional openness within eating disturbances. Results indicated that the exercise dependence and the processing mode of emotions highlight a concrete operating mode among student with a problematic eating disturbance. The apprehension of emotions is done on a concrete and operative side. The subject would practice a sport in order to turn away from emotional experiences that he cannot develop psychically, but also reduce the sense of body dissatisfaction. Problematic eating behaviors would an alternative allowing regaining control over his body and would a support in the regulation of emotions.

Psychological, behavioral, and weight-related aspects of patients undergoing reoperative bariatric surgery after gastric band: comparison with primary surgery patients

BackgroundPatients experiencing insufficient weight loss or weight regain in their first bariatric surgery may represent a high-risk group with greater problematic eating and general psychopathology levels, which may compromise the success of a reoperative procedure. ObjectivesThis study seeks to describe and compare disordered eating-related psychological and behavioral features of primary and reoperative surgery candidates after gastric band. SettingHospital center and university in Portugal. MethodsThe baseline (preoperative) data from a longitudinal observational study are presented. Patients were interviewed by trained psychologists to identify binge-eating episodes and grazing and responded to a set of self-report measures: disordered eating, grazing, negative urgency, depression, anxiety, and stress. ResultsTwo hundred twenty-five patients were undergoing primary surgery, and 166 were undergoing reoperative (REOP group) surgery. The groups did not differ in body mass index preoperatively, but the REOP group had greater weight suppression (t387 = −5.35, P = .001), higher highest (t387 = −3.40, P = .001) and lower lowest body mass index (t381 = 2.22, P = .03). The main reasons for reoperative surgery were weight regain/poor weight loss (42.8%) or medical complications (32.5%). REOP patients with objective binge eating reported a higher frequency of these episodes (t47 = 2.15, P = .04). No significant difference was found for the self-report measures assessed (only shape concern was higher for REOP group, F1,216 = 8.30, P<.001). ConclusionsDespite the preoperative similarities between patients undergoing reoperative or primary surgeries, the differences in binge eating and weight-related variables may associate with postoperative difficulties. The link between binge eating, weight suppression, and weight gain found in other samples suggests that patients undergoing reoperative surgery may be at increased risk for poor weight outcomes.

Problematic Eating Behaviors Predict Outcomes After Bariatric Surgery.

There are no clear psychosocial predictors of weight loss following bariatric surgery. The purpose of this study was to investigate whether preoperative problematic eating behaviors predict weight loss outcomes following bariatric surgery. Clinical records were utilized to examine outcomes of 101 patients who completed a pre-surgical psychosocial evaluation and underwent gastric bypass or sleeve gastrectomy. Information analyzed included binge eating history and scores from the Hospital Anxiety and Depression Scale, Yale Food Addiction Scale, and Emotional Eating Scale. Measures of weight loss 1year post-surgery were compared to pre-surgical assessments. One-year follow-up data were available for 60 patients. Patients with higher levels of eating in response to anger/frustration (p = .02), anxiety (p = .01), or depression (p = .05) were more likely to miss the 1-year follow-up appointment. Eating in response to anger/frustration and depression were related to poorer weight loss outcomes. There was a trend for binge eating to predict greater %EWL (p = .06). A higher number of food addiction symptoms increased the likelihood that patients would experience less weight loss (p = .01). Psychiatric symptoms were not related to weight loss outcomes. Patients who endorsed higher levels of pre-surgical emotional eating and food addiction symptoms had poorer weight loss 1year post-surgery. Providers should consider screening patients for these behaviors during the pre-surgical psychosocial evaluation which would allow opportunities for psychotherapy and potential improvement in weight loss outcomes. Future research should examine which interventions are successful at improving problematic eating behaviors.

“It's a Long-Term Process”: Description of Daily Family Life When a Child Has a Feeding Disorder

Pediatric feeding problems occur in 25% of the general pediatric population and up to 80% of those who have developmental delays. When feeding problems place the child at nutritional risk, families are typically encouraged to increase their child's intake. Family mealtime can become a battle, which further reinforces problematic feeding behaviors from the child and intensifies well-intentioned but unguided parental mealtime efforts. Family has an essential influence on feeding; however, studies to date neglect to address the family context of feeding difficulty. In this study we describe, in the context of everyday life, family management of feeding when a child had a significant feeding problem. Parents of children with feeding problems were interviewed with the Family Management Style Framework components as a guide. Twelve parents participated, representing nine families of children with feeding disorder. Description of family management of feeding provides a foundation for development of family feeding interventions.

The association of addictive-like eating with food intake in children

ObjectivesThe potential role of an addictive process in problematic eating is a growing area of interest and debate. Children are more vulnerable to the negative effects of addictive substances than adults and may be at increased risk for addictive-like eating behavior. No prior study has evaluated the association of addictive-like eating with objectively measured eating behavior in adults or children. We examined the association between “food addiction” and observed food consumption among children and whether age moderated this association. MethodSeventy children participated in an observed dinner meal, completed a dietary recall interview, and answered the Yale Food Addiction Scale for Children (YFAS-C), a questionnaire assessing symptoms of “food addiction”. Children's total calories ordered, calories consumed at dinner, calories consumed post-dinner, and a total of calories consumed at dinner and post-dinner were calculated along with their BMI percentile. We used generalized estimated equation models to investigate the relationship between the YFAS-C and food consumption. ResultsElevated “food addiction” symptoms, but not BMI percentile, were positively associated with an increased amount of calories consumed at dinner and post-dinner. Age significantly moderated the relationship between YFAS-C and caloric intake, with only younger children exhibiting this association. ConclusionsAs the first study of objectively measured eating behavior, we found addictive-like eating scores in children were positively associated with the total amount of calories consumed. Among younger children, “food addiction” was more strongly associated with the total calories consumed than BMI percentile, highlighting the importance of assessing behavioral phenotypes when evaluating caloric intake. This association between addictive-like eating and caloric intake among younger, but not older children may be due to differences in inhibitory control and dietary restraint.

Future Directions in “Food Addiction”: Next Steps and Treatment Implications

The purposes of this study were to examine future directions regarding food addiction and to discuss potential treatment implications. Foods likely differ in their ability to trigger addictive-like eating, with highly processed foods being the most closely associated with addictive processes. Harm reduction approaches may be relevant to the treatment of addictive-like eating. Food addiction is more closely associated with wanting for food, rather than liking the taste of food. Exposure to food cues increases wanting for food and increasing strategies to cope with cravings may be an important treatment approach. Negative affect likely increases vulnerability to overeating. Increasing emotion regulation capabilities may be important in reducing signs of food addiction. The role of addictive mechanisms in problematic eating requires additional research, but an addiction perspective may also have important treatment implications.

Modification of the medical exclusion criterion in DSM-5 social anxiety disorder: Comorbid obesity as an example

BackgroundThe DSM 5 modified the medical exclusion criterion from DSM-IV, which now allows for a diagnosis of social anxiety disorder (SAD) to be given if the fears are related only to the medical condition (e.g., obesity) yet cause significant impairment or distress. MethodsTo examine this modification, the current study compared bariatric surgery candidates with DSM-IV SAD (n=135), modified SAD (clinically significant social fears related to obesity only; n=40), and no history of Axis I disorders (n=616) on variables related to pre-surgical problematic eating behaviors, body image dissatisfaction, functional impairment, and other characteristics related to bariatric surgery. Participants were referred by their surgeon for a psychiatric evaluation as part of the clearance process, and completed a comprehensive, semi-structured diagnostic interview and self-report measures. ResultsThere were several differences between those with DSM-IV SAD and modified SAD compared to those with no disorder (e.g., on binge and emotional eating), but the two SAD groups did not differ from each other on any of the comparisons. LimitationsResults may not generalize to individuals suffering from obesity in the general population or those seeking other types of weight loss treatment. Because they were seeking psychiatric clearance, they also may have underreported symptoms/problems for fear that they would not get cleared. ConclusionsOverall, the modified SAD group more closely resembled the DSM-IV SAD group rather than the no disorder group, providing further support for diagnosing SAD even when the social fears are related to obesity only.

The Neonatal Eating Assessment Tool: Development and Content Validation.

To develop and content validate the Neonatal Eating Assessment Tool (NeoEAT), a parent-report measure of infant feeding. The NeoEAT was developed in three phases. Phase 1: Items were generated from a literature review, available assessment tools, and parents' descriptions of problematic feeding in infants.Phase 2: Professionals rated items for relevance and clarity. Content validity indices were calculated. Phase 3: Parent understanding was explored through cognitive interviews. Phase 1: Descriptions of infant feeding were obtained from 12 parents of children with diagnosed feeding problems and 29 parents of infants younger than seven months. Phase 2: Nine professionals rated items. Phase 3: Sixteen parents of infants younger than seven months completed the cognitive interview. Content validity of the NeoEAT. Three versions were developed: NeoEAT Breastfeeding (72 items), NeoEAT Bottle Feeding (74 items), and NeoEAT Breastfeeding and Bottle Feeding (89 items).

Stability of problematic eating behaviors and weight loss trajectories after bariatric surgery: a longitudinal observational study

BackgroundThe literature is rather mixed regarding the stability and the role of pre- and postoperative problematic eating behaviors (PEBs) on weight outcomes after bariatric surgery. ObjectivesTo investigate the stability of loss of control (LOC) eating and picking and/or nibbling from pre- to postoperative assessments, and to investigate whether pre- and postoperative PEBs are predictors of different weight loss trajectories. SettingCentral Hospital, University, Portugal. MethodsThis longitudinal study assessed LOC eating and picking and/or nibbling before and approximately 2 years after laparoscopic adjustable gastric banding or Roux-en-Y gastric bypass through face-to-face interviews and 2 self-report measures. Weight across follow-up time was retrieved from hospital charts. Of the 130 patients invited to participate in the study, 100 were assessed preoperatively, and of these, 61 were also assessed postoperatively. ResultsFrequency of PEBs is similar pre- and postoperatively (37.7% and 45.9%, respectively) (McNemar χ2P = .832). Yet, about 40% ceased preoperative PEBs. Those with LOC preoperatively were more likely to develop picking and/or nibbling postoperatively (McNemar χ2P<.05). About 39.5% developed PEBs de novo after surgery. The presence of PEBs postoperatively was a significant predictor of different weight loss trajectories after both laparoscopic adjustable gastric banding and Roux-en-Y gastric bypass. Worse weight loss outcomes were found particularly at 17–20 months postsurgery. Preoperative PEBs were not a significant predictor. ConclusionsOur data do not support the stability of all PEBs across time, highlighting that the absence of preoperative PEBs does not preclude an unfavorable weight loss outcome after surgery. Postoperative but not preoperative PEBs are predictors of poorer weight loss trajectories after surgery.

Wanting and liking: Separable components in problematic eating behavior?

Some individuals may have an addictive-like response to certain foods, possibly contributing to problematic eating. Highly processed foods, with added fats and/or refined carbohydrates, are suggested to be most associated with addictive-like eating. The incentive sensitization theory suggests that wanting (e.g. craving) may drive compulsive drug use rather than liking (e.g. enjoyment), but it is unknown whether highly processed foods elicit similar wanting and liking patterns as drugs of abuse, or whether individual differences exist. The current study examines the association of highly processed foods with craving and liking, and whether these relationships differ by food addiction symptomology, cognitive restraint, or body mass index (BMI). Participants (n = 216) reported craving and liking for 35 foods and completed the Yale Food Addiction Scale (YFAS) and Three Factor Eating Questionnaire (TFEQ). Highly processed foods were craved more overall. Craving of highly processed foods was predicted negatively by restraint and positively by YFAS score. Liking of highly processed foods was predicted negatively by restraint and positively by BMI. In conclusion, craving and liking appear distinct with respect to highly processed foods, and may be influenced by addictive-like eating, cognitive restraint, and BMI. This suggests that the incentive sensitization framework may also be relevant for problematic food consumption, especially for individuals reporting food addiction symptoms.

Feeding problems in infancy and early childhood: evolutionary concept analysis.

The aim of this study was to report an analysis of the concept of pediatric feeding problems. Reviews of the literature on pediatric feeding problems and disorders repeatedly reference the lack of a shared conceptualization of feeding problems. It is difficult to track aetiology, prevalence and incidence of a phenomenon when available definitions and diagnoses lack practical utility. An evolutionary concept analysis. A search was conducted in October 2014 of Google Scholar, CINAHL, PubMed and Web of Science databases, with MeSH terms and key words including: failure to thrive, feeding disorder/difficulty/problems, infantile anorexia, oral aversion, mealtime behaviour and dysphagia. Inclusion criteria were: subject of feeding problems, index children 0-10years of age, English language and full text. The articles (n=266) were sorted into disciplines of authorship, including Psychology, Medicine, Nursing, Nutrition, Occupational Therapy, Speech Language Pathology or Other. The sample was divided into a historical sample (n=42) for pre-2000 articles and current for those published post-2000. The current sample was later reduced to 100 and coded for surrogate terms, related concepts, attributes, antecedents and consequences. The historical view of pediatric feeding problems shows a tradition of mother blame or parental culpability, both direct and indirect. Currently, there exist many different definitions and typologies, but none have sound validity or generalizability. Areas of attribute consensus across disciplines are problematic feeding behaviours and selective or restrictive intake. A spectrum conceptualization of feeding problems is suggested for further development, with attributes that would be critical to have a feeding problem.