Caroline Braet

Assessment of emotional, externally induced and restrained eating behaviour in nine to twelve-year-old obese and non-obese children

Are there differences in eating behaviour between obese and non-obese children? Using the parent version of the Dutch Eating Behaviour Questionnaire (DEBQ-parent version), the results of the present study suggest an affirmative answer to this question. The scores for obese children were significantly higher on the scales for emotional, external and restrained eating behaviour. Relationships were found between emotional eating and negative feelings of physical competence; between external eating and negative feelings of self-worth; and between both eating styles and various aspects of problem behaviour. No relationship was found between external eating and locus of control. Higher scores on both scales were associated with greater caloric intake. These findings suggest that DEBQ can be used as a screening instrument for assessing eating styles of obese children.

Assessing Depression in Youth: Relation Between the Children's Depression Inventory and a Structured Interview

This study examined the utility of the Childrens Depression Inventory (CDI) for predicting a diagnosis of a depressive disorder derived from the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV], American Psychiatric Association, 1994) Child Edition (KID-SCID). The participants were 80 referred children and adolescents with a mean age of 12.21 years (range = 8 to 18 years). A categorical approach by means of a receiver-operating characteristics (ROC) analysis was used to examine the adequacy of cutoff scores for screening purposes. The results indicated that for the suggested cutoff scores of 13 and 19, the CDI has satisfactory ROCs. A cutoff score of 16 showed an optimal relation between sensitivity and specificity. The results from logistic regression indicated that the CDI total score is predictive of a depressive disorder. The CDI also differentiated a depressive disorder from an anxiety disorder and a disruptive behavior disorder. Those results provide support for the usefulness of the CDI as a screening tool for detecting depressive disorders in children and adolescents.

Loss of control over eating in overweight youngsters: the role of anxiety, depression and emotional eating.

The current study investigated loss of control (LC) over eating and the role of anxiety, depression and emotional eating in a sample of both treatment seeking (N = 115) and non-treatment seeking (N = 73) overweight youngsters (aged 8-18) using a semi-structured clinical interview and self-report questionnaires. It was found that treatment seekers reported twice as much LC (40%) compared to non-treatment seekers (21%). Cross-sectional prediction models indicated that increased anxiety was associated with emotional eating and LC. Emotional eating tended to mediate the relationship between anxiety and LC. Increased depression was associated with emotional eating but not with LC. Especially overweight treatment seekers turn out to be at risk for LC. Because LC may develop as a result of inadequate coping with negative emotions like anxiety, obesity treatment should focus on teaching more effective coping strategies. Longitudinal research is recommended to further elaborate affect regulation and LC.

Prevalence of binge-eating disorder in obese children and adolescents seeking weight-loss treatment

OBJECTIVE: The aim of the present study was to examine the extent to which a population of obese children and adolescents developed binge-eating disorder (BED).METHOD: A sample of 196 obese children and adolescents (aged 10–16 y) seeking weight-loss treatment at two treatment facilities (inpatient and outpatient treatment) was screened using the eating disorder examination.RESULTS: Only 1% of the subjects met the criteria for BED and 9% were found to have objective bulimic episodes (OBEs, overeating with loss of control), but did not endorse all of the other DSM-criteria that are required for a diagnosis of BED. OBEs were more common in girls than in boys. Episodic overeating was more common than binge eating. Compared to children without OBEs, children engaging in OBEs were more overweight and showed a greater eating-related psychopathology. The age of the first OBE was 10.88 y (s.d.=2.60). It appears that overweight precedes binge eating.DISCUSSION: A subgroup of girls and boys seeking treatment for obesity shows considerable eating difficulties. The results highlight the importance of considering binge-eating symptoms when devising treatment programmes for children and adolescents suffering from obesity.

Child Personality and Parental Behavior as Moderators of Problem Behavior: Variable- and Person-Centered Approaches

Parenting x Child Personality interactions in predicting child externalizing and internalizing behavior were investigated in a variable-centered study and a person-centered study. The variable-centered study used data from a 3-year longitudinal study of 600 children 7 to 15 years old at Time 1 and 512 children 10 to 18 years old at Time 2. Parents rated child personality (five factor model), negative control, positive parenting, and child problem behavior, whereas children rated parental behavior. Hierarchical moderated regression analyses showed significant Parenting x Child Personality (benevolence and conscientiousness) interactions, principally for externalizing behavior. The interactions were largely replicable across informants and across time. The person-centered study, which classified participants into 3 types, showed that negative parental control was more related to externalizing behavior for undercontrollers than for resilients. Negative parental control enhanced internalizing behavior for overcontrollers.

Differences in eating style between overweight and normal-weight youngsters.

Differences in eating styles between overweight and normal-weight youngsters were investigated with a child version of the Dutch Eating Behavior Questionnaire (DEBQ). Subjects were children (n = 1458; M: 10.1; SD = 1.3) and adolescents (n = 1016; M: 14.9; SD =1.5). Overweight adolescent girls scored high on emotional eating while overweight adolescent boys displayed more external eating. In overweight children, already 10.5 per cent displayed emotional eating and 38.4 per cent reported external eating. All overweight youngsters reported restrained attitudes. Eating styles were positively associated with indicators of eating pathology. The results suggest the use of appropriate norms that take into account the childs age, gender and overweight status.

Patient characteristics as predictors of weight loss after an obesity treatment for children

Objective: To examine pretreatment patient characteristics as predictors of treatment outcome 2 years after completion of an inpatient treatment for children with obesity.

Cognitive interference due to food cues in childhood obesity.

Investigated specific information-processing biases for food-relevant stimuli in 34 children, Mage = 13 years, SD = 2 years, M = 177% of ideal weight, SD = 24%, who were completing a residential cognitive-behavioral treatment program for severe obesity and 40 matched control children who were not obese, Mage = 13 years, SD = 2 years, M = 103% of ideal weight, SD = 13%. Participants completed a computerized modified Stroop task, which included food words, negative-emotion words, and control words. Results indicated that children in the obesity group displayed a specific interference effect for food words. It is hypothesized that the observed bias in information processing reflects hypersensitivity for food cues, which can initiate or maintain dysfunctional eating behavior.

Long-term follow-up of a cognitive behavioral treatment program for obese children

This study presents a 4.6-year follow-up of children treated for obesity. The primary goal of the treatment program was to prevent further weight gain. In setting this modest goal, we wanted to avoid the type of dietary restraint that has been linked to the development of eating disorders. A cognitive-behavior modification (CBM) program was designed to help the child change his or her lifestyle, to enhance self-regulation skills and specific problem-solving skills in different eating situations. Three active CBM treatment interventions were compared (group therapy, individual therapy, and summer camp) to an advice in one session. At pretest, the mean age was 11 years. Mean percentage overweight was 55%); all subjects were at least 20% overweight. Data from 109 children were available at the 4.6-year follow-up, representing 80.1% of the original sample. At follow-up, 72 subjects (71.6%) showed no further increase in percentage overweight. This does not mean that these obese youngsters had become thin. In this study 18% of the obese children were no longer obese and 29% of the subjects had become moderately obese. The obese youngsters showed a mean reduction of their overweight of -11%; the mean overweight was still 42%. Eating behavior was evaluated in a subgroup of the obese childrenand a stabilization of abnormal eating behavior was noted within the subscales of the Dutch Eating Behavior Questionnaire. Using the Eating Disorder Inventory, 5 adolescents (9%) had an at-risk score on the bulimia subscale. Taking into account the pessimistic prognosis for obese adults, the trends found here are more optimistic, at least for half of the obese children.

Executive function training with game elements for obese children: A novel treatment to enhance self-regulatory abilities for weight-control

For obese children behavioral treatment results in only small changes in relative weight and frequent relapse. The current study investigated the effects of an Executive Functioning (EF) training with game-elements on weight loss maintenance in obese children, over and above the care as usual in an inpatient treatment program. Forty-four children (aged 8-14 years) who were in the final months of a 10-months inpatient treatment program in a medical paediatric centre were randomized to either the 6 week EF-training condition or to a care as usual only control group. The EF-training consisted of a 25-session training of inhibition and working memory. Treatment outcomes were child performances on cognitive tasks of inhibition and working memory and childcare worker ratings on EF-symptoms as well as weight loss maintenance after leaving the clinic. Children in the EF-training condition showed significantly more improvement than the children in the care as usual only group on the working memory task as well as on the childcare worker reports of working memory and meta-cognition. They were also more capable to maintain their weight loss until 8 weeks post-training. This study shows promising evidence for the efficacy of an EF-training as weight stabilization intervention in obese children.