Arianna D. McClain

Psychosocial correlates of eating behavior in children and adolescents: a review

BackgroundUnderstanding the correlates of dietary intake is necessary in order to effectively promote healthy dietary behavior among children and adolescents. A literature review was conducted on the correlates of the following categories of dietary intake in children and adolescents: Fruit, Juice and Vegetable Consumption, Fat in Diet, Total Energy Intake, Sugar Snacking, Sweetened Beverage Consumption, Dietary Fiber, Other Healthy Dietary Consumption, and Other Less Healthy Dietary Consumption in children and adolescents.MethodsCross-sectional and prospective studies were identified from PubMed, PsycINFO and PsycArticles by using a combination of search terms. Quantitative research examining determinants of dietary intake among children and adolescents aged 3–18 years were included. The selection and review process yielded information on country, study design, population, instrument used for measuring intake, and quality of research study.ResultsSeventy-seven articles were included. Many potential correlates have been studied among children and adolescents. However, for many hypothesized correlates substantial evidence is lacking due to a dearth of research. The correlates best supported by the literature are: perceived modeling, dietary intentions, norms, liking and preferences. Perceived modeling and dietary intentions have the most consistent and positive associations with eating behavior. Norms, liking, and preferences were also consistently and positively related to eating behavior in children and adolescents. Availability, knowledge, outcome expectations, self-efficacy and social support did not show consistent relationships across dietary outcomes.ConclusionThis review examined the correlates of various dietary intake; Fruit, Juice and Vegetable Consumption, Fat in Diet, Total Energy Intake, Sugar Snacking, Sweetened Beverage Consumption, Dietary Fiber, Other Healthy Dietary Consumption, and Other Less Healthy Dietary Consumption in cross-sectional and prospective studies for children and adolescents. The correlates most consistently supported by evidence were perceived modeling, dietary intentions, norms, liking and preferences. More prospective studies on the psychosocial determinants of eating behavior using broader theoretical perspectives should be examined in future research.

Reduction in Risk Factors for Type 2 Diabetes Mellitus in Response to a Low-Sugar, High-Fiber Dietary Intervention in Overweight Latino Adolescents

OBJECTIVE To examine if reductions in added sugar intake or increases in fiber intake in response to a 16-week intervention were related to improvements in metabolic outcomes related to type 2 diabetes mellitus risk. DESIGN Secondary analysis of a randomized control trial. SETTING Intervention classes at a lifestyle laboratory and metabolic measures at the General Clinical Research Center. PARTICIPANTS Fifty-four overweight Latino adolescents (mean [SD] age, 15.5 [1] years). Intervention Sixteen-week study with 3 groups: control, nutrition, or nutrition plus strength training. MAIN OUTCOME MEASURES Body composition by dual-energy x-ray absorptiometry; visceral adipose tissue by magnetic resonance imaging; glucose and insulin incremental area under the curve by oral glucose tolerance test; insulin sensitivity, acute insulin response, and disposition index by intravenous glucose tolerance test; and dietary intake by 3-day records. RESULTS Fifty-five percent of all participants decreased added sugar intake (mean decrease, 47 g/d) and 59% increased fiber intake (mean increase, 5 g/d), and percentages were similar in all intervention groups, including controls. Those who decreased added sugar intake had an improvement in glucose incremental area under the curve (-15% vs +3%; P = .049) and insulin incremental area under the curve (-33% vs -9%; P = .02). Those who increased fiber intake had an improvement in body mass index (-2% vs +2%; P = .01) and visceral adipose tissue (-10% vs no change; P = .03). CONCLUSIONS Individuals who reduced added sugar intake by the equivalent of 1 can of soda per day or increased fiber intake by the equivalent of a cup of beans showed improvements in key risk factors for type 2 diabetes, specifically in insulin secretion and visceral fat. Improvements occurred independent of group assignment and were equally likely to occur in control group participants.

Physical activity, sedentary behavior, and the metabolic syndrome in minority youth.

PURPOSE This study aimed to determine the associations among physical activity, sedentary behavior, and the metabolic syndrome (MetS) in Latino and African American youth using both subjective and objective measures of activity levels. METHODS Cross-sectional data from 105 participants from three pediatric obesity studies that share a core set of methods and measures (Latino 74%, female 75%, mean age = 13 ± 3 yr) were used. Measures included moderate-to-vigorous physical activity and sedentary behavior by accelerometry and 3-Day Physical Activity Recall (3DPAR), fat and lean tissue mass by BodPod™, fasting glucose, lipids, blood pressure, and waist circumference. Associations between physical activity, sedentary behavior, and MetS were examined using ANCOVA, Pearson correlations, partial correlations, and logistic regressions with adjustments for age, sex, ethnicity, fat and lean mass, and pubertal Tanner stage. RESULTS Accelerometry data showed that greater time engaging in moderate-to-vigorous physical activity was related to lower odds of the MetS (odds ratio = 0.49, 95% confidence interval = 0.25-0.98), independent of sedentary behavior and covariates, and inversely correlated with fasting glucose (r = -0.21, P = 0.03) and systolic blood pressure (r = -0.25, P = 0.01), adjusting for covariates. Data from the 3DPAR showed that higher levels of sedentary behavior were related to higher odds of the MetS (odds ratio = 4.44, 95% confidence interval = 1.33-14.79), independent of moderate-to-vigorous physical activity and covariates, negatively correlated with HDL-cholesterol (r = -0.21, P = 0.04) and positively correlated systolic blood pressure (r = 0.26, P = 0.009), adjusting for covariates. CONCLUSIONS Future interventions aiming to improve metabolic health in youth should target both the promotion of physical activity and the reduction of sedentary behavior. Subjective and objective measures should be used in conjunction to better capture activity behaviors.

Visual illusions and plate design: the effects of plate rim widths and rim coloring on perceived food portion size

Objective:The Delboeuf Illusion affects perceptions of the relative sizes of concentric shapes. This study was designed to extend research on the application of the Delboeuf illusion to food on a plate by testing whether a plate’s rim width and coloring influence perceptual bias to affect perceived food portion size.Design and methods:Within-subjects experimental design. Experiment 1 tested the effect of rim width on perceived food portion size. Experiment 2 tested the effect of rim coloring on perceived food portion size. In both experiments, participants observed a series of photographic images of paired, side-by-side plates varying in designs and amounts of food. From each pair, participants were asked to select the plate that contained more food. Multilevel logistic regression examined the effects of rim width and coloring on perceived food portion size.Results:Experiment 1: participants overestimated the diameter of food portions by 5% and the visual area of food portions by 10% on plates with wider rims compared with plates with very thin rims (P<0.0001). The effect of rim width was greater with larger food portion sizes. Experiment 2: participants overestimated the diameter of food portions by 1.5% and the visual area of food portions by 3% on plates with rim coloring compared with plates with no coloring (P=0.01). The effect of rim coloring was greater with smaller food portion sizes.Conclusion:The Delboeuf illusion applies to food on a plate. Participants overestimated food portion size on plates with wider and colored rims. These findings may help design plates to influence perceptions of food portion sizes.

Family, community and clinic collaboration to treat overweight and obese children: Stanford GOALS—A randomized controlled trial of a three-year, multi-component, multi-level, multi-setting intervention

OBJECTIVE To test the effects of a three-year, community-based, multi-component, multi-level, multi-setting (MMM) approach for treating overweight and obese children. DESIGN Two-arm, parallel group, randomized controlled trial with measures at baseline, 12, 24, and 36 months after randomization. PARTICIPANTS Seven through eleven year old, overweight and obese children (BMI ≥ 85th percentile) and their parents/caregivers recruited from community locations in low-income, primarily Latino neighborhoods in Northern California. INTERVENTIONS Families are randomized to the MMM intervention versus a community health education active-placebo comparison intervention. Interventions last for three years for each participant. The MMM intervention includes a community-based after school team sports program designed specifically for overweight and obese children, a home-based family intervention to reduce screen time, alter the home food/eating environment, and promote self-regulatory skills for eating and activity behavior change, and a primary care behavioral counseling intervention linked to the community and home interventions. The active-placebo comparison intervention includes semi-annual health education home visits, monthly health education newsletters for children and for parents/guardians, and a series of community-based health education events for families. MAIN OUTCOME MEASURE Body mass index trajectory over the three-year study. Secondary outcome measures include waist circumference, triceps skinfold thickness, accelerometer-measured physical activity, 24-hour dietary recalls, screen time and other sedentary behaviors, blood pressure, fasting lipids, glucose, insulin, hemoglobin A1c, C-reactive protein, alanine aminotransferase, and psychosocial measures. CONCLUSIONS The Stanford GOALS trial is testing the efficacy of a novel community-based multi-component, multi-level, multi-setting treatment for childhood overweight and obesity in low-income, Latino families.

Anxiety mediates the relationship between sleep onset latency and emotional eating in minority children.

This study examined associations between sleep onset latency and emotional eating in a minority sample of children. A cross-sectional school-based study of sleep, psychological constructs, diet and physical activity was conducted in 6 public and private schools in Los Angeles County. An ethnically diverse sample of 356 third through fifth graders completed confidential self-report surveys. Multilevel regression (MLM) analyses were conducted to study associations while controlling for gender, ethnicity, and the random effect of school. Girls made up 57% of the total sample, which was predominantly Latino (42.6%), followed by African Americans (21.6%) and Asians (19.2%). MLM revealed that there were significant associations between sleep onset latency and emotional eating (p=.030), depressive symptomology (p<.0001) and trait anxiety (p<.0001). Sobels test for mediation showed that trait anxiety (p=.011) but not depressive symptomology (p=.141) was a mediator of the relationship between sleep onset latency and emotional eating. Thereby providing a mechanism through which sleep onset latency is related to emotional eating. These findings suggest that sleep onset latency is associated with increased anxiety, depressive symptoms, and emotional eating. Although causal inferences cannot be drawn from this cross-sectional data, future studies should examine the possibility that problems falling asleep could lead to emotional dysregulation that in turn leads to emotional eating. Emotional eating may be one avenue by which sleep disturbances lead to overweight and obesity.

CRP Is Related to Higher Leptin Levels in Minority Peripubertal Females Regardless of Adiposity Levels

Overweight is related to higher levels of C‐reactive protein (CRP) and leptin, which have been independently associated with increased risk for diabetes, cardiovascular disease, and the metabolic syndrome. Elevated CRP may trigger leptin resistance by inhibiting the binding of leptin to its receptors. We cross‐sectionally examined the relationship between CRP, leptin, BMI z‐score, percent body fat (%BF) assessed by air plethysmography (BodPod), and insulin sensitivity (SI) and acute insulin response (AIRg) measured by intravenous glucose tolerance test in 51 Latina and African‐American females (77% Latina), mean age 9.2 (±0.9) years, at either Tanner Pubertal Stage (TPS) 1 (n = 25) or TPS 2 (n = 26). Females at TPS 2 had higher BMI z‐scores, %BF (23% ± 10.1 vs. 30% ± 10.0, P = 0.02), AIRg (976.7 ± 735.2 vs. 1555.3 ± 1,223 µIU/ml, P = 0.05), fasting insulin (11.0 ± 10.8 vs. 17.2 ± 13.6 µlU/ml, P = 0.00) and leptin levels (11.0 ± 7.1 vs. 19.6 ± 10.9 ng/ml, P < 0.001) than those at TPS 1. There were no ethnic differences in any of the measured variables. CRP was positively correlated with BMI z‐score (P = 0.001), %BF (P = 0.006), fasting insulin and AIRg (P = 0.02), and fasting leptin (P = 0.00), and negatively correlated with SI (P = 0.05). A linear regression model showed that CRP independently explained 10% (P = 0.00) of the variance in leptin after adjusting %BF, TPS, ethnicity, habitual physical activity and SI. Hence, low‐grade inflammation may contribute to prolonged leptin exposure and leptin resistance, even in healthy children.

Adherence to a low-fat vs. low-carbohydrate diet differs by insulin resistance status.

Previous research shows diminished weight loss success in insulin‐resistant (IR) women assigned to a low‐fat (LF) diet compared to those assigned to a low‐carbohydrate (LC) diet. These secondary analyses examined the relationship between insulin‐resistance status and dietary adherence to either a LF‐diet or LC‐diet among 81 free‐living, overweight/obese women [age = 41.9 ± 5.7 years; body mass index (BMI) = 32.6 ± 3.6 kg/m2]. This study found differential adherence by insulin‐resistance status only to a LF‐diet, not a LC‐diet. IR participants were less likely to adhere and lose weight on a LF‐diet compared to insulin‐sensitive (IS) participants assigned to the same diet. There were no significant differences between IR and IS participants assigned to LC‐diet in relative adherence or weight loss. These results suggest that insulin resistance status may affect dietary adherence to weight loss diets, resulting in higher recidivism and diminished weight loss success of IR participants advised to follow LF‐diets for weight loss.

The influence of worries on emotional eating, weight concerns, and body mass index in Latina female youth.

PURPOSE To investigate the effect of worries on weight concerns, emotional eating, and body mass index (BMI) percentile in an ethnically diverse sample of female youth. METHODS This study used baseline and follow-up data from a brief school-based physical activity intervention trial involving minority female youth. Partial correlations adjusted for intervention status, age, and ethnicity were used to assess the relationships between emotional eating, weight concerns, and BMI percentile at follow-up. Multilevel modeling was used to analyze the relationships between baseline worries and follow-up emotional eating, weight concerns, and BMI percentile. Additional analysis assessed whether emotional eating mediated and/or moderated the relationship between baseline worries and follow-up BMI. Data were analyzed using SAS version 9.1. RESULTS The sample consisted of 404 minority females (67.1% Latina; mean age = 12.5 ± .6; 60.6% were of normal weight). Weight concerns were positively correlated with emotional eating and BMI percentile (p < .001 for both). At follow-up, baseline worries significantly predicted emotional eating (p = .027) and weight concerns (p < .001) but not BMI percentile (p = .183). Emotional eating did not mediate the relationship between baseline worries and follow-up BMI percentile; however, it did moderate the relationship between baseline worries and follow-up BMI percentile (p = .003). CONCLUSIONS In this sample, worries were associated with psychosocial variables but not with BMI percentile. Reducing worries in those with high emotional eating scores may influence future weight gain among Latina females.

Incorporating Prototyping and Iteration into Intervention Development: A Case Study of a Dining Hall-Based Intervention.

Abstract Background: Previous research from the fields of computer science and engineering highlight the importance of an iterative design process (IDP) to create more creative and effective solutions. Objective: This study describes IDP as a new method for developing health behavior interventions and evaluates the effectiveness of a dining hall–based intervention developed using IDP on college students’ eating behavior and values. Participants: participants were 458 students (52.6% female, age = 19.6 ± 1.5 years [M ± SD]). Methods: The intervention was developed via an IDP parallel process. A cluster-randomized controlled study compared differences in eating behavior among students in 4 university dining halls (2 intervention, 2 control). Results: The final intervention was a multicomponent, point-of-selection marketing campaign. Students in the intervention dining halls consumed significantly less junk food and high-fat meat and increased their perceived importance of eating a healthful diet relative to the control group. Conclusion: IDP may be valuable for the development of behavior change interventions.