Ellen Moens

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.

Unfavourable family characteristics and their associations with childhood obesity: a cross-sectional study

OBJECTIVE This cross-sectional study explores the influence of multiple familial factors on childrens weight status and the interaction between parenting stress and unfavourable family characteristics. METHODS A total of 197 families with children between 6 and 14 years participated in this study. Of this group, 97 families had a child with normal weight and 100 families had a child with overweight. Parents reported on seven family factors (maternal BMI, number of children, family structure, socioeconomic position, life events, parental psychopathology and parenting stress). RESULTS Families with overweight children experience more parenting stress. A regression analysis revealed that familial factors explain 27% in the variance in childs weight status. The hypothesis that a combination of familial factors will be more able to explain childs adiposity could not be confirmed. CONCLUSIONS Familial factors have moderate ability to predict childrens weight status. There is a need to identify other familial mechanisms taking into account developmental and temporal evolutions over the past decade.

How is reward sensitivity related to bodyweight in children

Previous research assumes that there are two seemingly opposing hypotheses for the relation between reward sensitivity (RS) and bodyweight: hyper-responsiveness model and Reward Deficiency Syndrome (RDS), leading to the proposition of a feed forward process of weight gain. High RS may contribute to overeating and weight-gain among normal weight individuals. Over time the excessive food-intake may evolve in a down-regulation of dopamine (RDS), resulting in overeating as a form of self-medication and the progression to obesity. This process was evidenced in adults showing a curvi-linear relationship between self-reported RS and BMI. The aim of the current study was to investigate the association between self-reported RS and BMI in children (10-15 years). The results confirm the non-linear relationship between RS and bodyweight and support the suggestion of the same feed forward process in children. These findings imply that it is crucial to reduce the intake of high palatable foods in high RS children to prevent the decrease in RS and reduce the risk for future weight gain.

An 8-year follow-up of treated obese children: Children’s, process and parental predictors of successful outcome

OBJECTIVE This study presents an 8-year outcome of overweight children who were treated in an outpatient program and aims to identify child and familial variables associated with long-term weight regulation. METHODS A total of 90 children participated with a mean age of 10.1 years +/- 2.6 at baseline and a mean adjusted BMI (actual BMI/50th percentile of BMI for age and gender x 100) of 153.1 +/- 20.7% at baseline participated in the 8-year follow-up (retrieval rate 71%; response rate 89%). Childrens and parental factors, administered at baseline and at follow-up were related to the success of the treatment. RESULTS The children obtained a mean reduction of 8% in adjusted BMI at the 8-year follow-up. A total of 59 children (66%) were successful in obtaining weight control (i.e. maintaining their original % adjusted BMI); 40% even decreased their adjusted BMI by 10% or more. Analyses revealed that the childs age, the degree of overweight at baseline and the childs global self-worth were positive predictors of long-term weight loss 8 years after treatment, whereas psychopathology in the mother was a negative predictor. The total explained variance was R(2) = 35%. DISCUSSION Treatment of childhood obesity by means of a multidisciplinary cognitive-behavioural program enables the majority of children to control their weight in the long term. In order to predict the success of the treatment, it is recommended to take into account the childs age, its degree of overweight, its global self-worth and the occurrence of maternal psychopathology.

The association of parental characteristics and psychological problems in obese youngsters.

Objective:The aim of the present study was to examine to what extent parental psychological characteristics and parental behavior are related to psychological problems in obese youngsters.Research methods:Data were collected from 196 families having an overweight youngster (range 10–16 years old) (mean body mass index (BMI)=31.2; s.d.=5.3) seeking weight-loss treatment and compared with data from normal weight samples. Behavior problems were measured using the Child Behavior Checklist; the Child version of the Eating Disorder Examination was used to assess eating disorder psychopathology. Parental psychopathology was measured using the Symptom Checklist-90; parenting behavior was assessed with the Ghent Parental Behavior Scale.Results:Parental psychopathology was prevalent in 59.6% of mothers and 35.7% of fathers. Youngsters exceeding the cutoff for problem behavior ranged between 41.4 and 53.1%. Childrens problem behavior was most associated with psychopathology in the mother (r=0.40 for Internalizing and r=0.37 for Externalizing; both P<0.01). The research findings further revealed that the effects of maternal psychopathology were partly mediated by a specific form of parenting behavior, namely Inconsistent discipline, although the effect was stronger for Externalizing behavior (explained variance: 10%) than for Internalizing behavior (explained variance: 4%). No evidence was found for a mediator effect from parenting behavior on the eating disorder symptoms of the obese youngsters. However, several direct relations emerged, suggesting a negative association between a childs eating disorder symptoms and Positive parenting behavior by the mother (r=−0.20 for Eating concern; r=−0.18 for Restraint eating; r=−0.16 for Shape concern; all P<0.05) as well as by the father (r=−0.25 for Eating concern; r=−0.25 for Weight concern; both P<0.01; r=−0.21 for Shape concern; P<0.05).Discussion:Parental characteristics were associated with psychological problems in obese youngsters, not only in a direct way but also indirectly. The effects were partly mediated by a particular ineffective parenting style, namely inconsistent discipline on the part of the mother. Pediatric obesity treatments should focus more on parenting behaviors and parental characteristics.

Comprehending emotional eating in obese youngsters: the role of parental rejection and emotion regulation.

Objectives:The present study examined the role of emotion regulation in the relation between parental rejection and emotional eating of obese youngsters.Method:Participants were 110 obese youngsters between the ages of 10 and 16 years who were referred to a Belgian treatment centre for obesity. Participants completed questionnaires assessing maternal and paternal rejection, emotion regulation strategies and emotional eating during their intake at the treatment centre. Bootstrapping procedure was used to test if emotion regulation mediated the relationship between maternal and paternal rejection on the one hand and emotional eating of the youngster on the other hand.Results:Results revealed that the use of maladaptive emotion regulation strategies mediated the relation between maternal rejection and emotional eating. Paternal rejection was neither associated with the emotion regulation nor with the emotional eating of the youngster.Discussion:The findings highlight the importance of assessing the emotional bond between mother and child and the emotion regulation of the youngster in the treatment of pediatric obesity.

Training Parents of Overweight Children in Parenting Skills: A 12-Month Evaluation

BACKGROUND The origins of childhood obesity invariably need to be looked at within a family context and several reviews have concluded in favour of parental involvement in the treatment of paediatric obesity. However, there is little consensus on the format, and next to weight outcomes behavioural outcomes also merit more attention when assessing program effectiveness. METHOD In this pilot study, a total of 50 families with overweight children (aged 6-12) were randomly allocated to a parent-led intervention group (cognitive behavioural training) or to a waiting list control group (Study 1). Afterwards, the parents of the waitlist control group also followed the intervention. All children were included in a follow-up study and were compared with a reference group (Study 2). RESULTS The intervention group as well as the waitlist group (who had not yet received treatment) showed a decrease in adjusted BMI over a 6-month period, although the decrease was only significant for the intervention group (Study 1). All children showed a decrease of 7% in adjusted BMI from pre to one-year follow-up measurement (Study 2), while the reference group showed an increase in adjusted BMI over that period. Parents reported significant positive changes in childrens eating behaviour and a significant positive increase in familial health principles. CONCLUSIONS Weight and behavioural outcomes suggest potential for intervention effectiveness. Long-term follow-up is needed to reveal residual benefits of enhanced parenting skills on environmental lifestyle changes.

Subtyping children and adolescents who are overweight based on eating pathology and psychopathology

Children and adolescents who are overweight can differ on dimensions measuring dietary restraint and psychopathology. Classifying clinical obese children and adolescents based on these psychological characteristics is shown to be useful in making differential prognoses. The present study aimed to research the validity of subtyping children and adolescents with overweight (N = 138) in a non-clinical sample. Using cluster analysis, results revealed three subtypes: a dietary restraint/internalizing group (DR + IN; n = 41), a pure internalizing group (IN; n = 20) and a non-symptomatic group (NS; n = 77). The DR + IN group outscored both other groups on measures of eating pathology, whereas the IN group outscored both other groups on measures of negative offect. Interestingly, the three groups did not differ on degree of overweight. The results seem to suggest that different psychological mechanisms can be observed in subgroups of young overweight adolescents. Further research should explore how individual psychological characteristics can be helpful when stipulating weight loss treatment programmes.

Can we link emotional eating with the emotion regulation skills of adolescents

Objective: A recent cross-sectional study showed that maternal rejection is associated with emotional eating of obese youngsters seeking treatment, and that this relation is mediated by maladaptive emotion regulation (ER) of the youngsters. We wanted to build on this study and investigate the relation between parental rejection, maladaptive ER and emotional eating in a community sample using longitudinal data. Design: Participants were 81 youngsters between the ages of 10 and 16 years. Participants completed questionnaires assessing maternal and paternal rejection, ER strategies and emotional eating, at two time moments (M = 71 days between time moments). Latent change models were used to estimate level and change of each variable. Results: Results showed that the levels of maternal rejection, maladaptive ER and emotional eating were related. The indirect effect of the level of maternal rejection on the level of emotional eating through the level of maladaptive ER was marginally significant. On average, maternal rejection showed no change over time, whereas the other variables decreased. The changes in the variables were not related. Conclusion: The findings highlight the importance of assessing the emotional bond between mother and youngster and the ER of youngsters with an emotional eating style.

Food Approach and Food Avoidance in Young Children: Relation with Reward Sensitivity and Punishment Sensitivity.

It has recently been suggested that individual differences in Reward Sensitivity and Punishment Sensitivity may determine how children respond to food. These temperamental traits reflect activity in two basic brain systems that respond to rewarding and punishing stimuli, respectively, with approach and avoidance. Via parent-report questionnaires, we investigate the associations of the general motivational temperamental traits Reward Sensitivity and Punishment Sensitivity with Food Approach and Food Avoidance in 98 preschool children. Consistent with the conceptualization of Reward Sensitivity in terms of approach behavior and Punishment Sensitivity in terms of avoidance behavior, Reward Sensitivity was positively related to Food Approach, while Punishment Sensitivity was positively related to Food Avoidance. Future research should integrate these perspectives (i.e., general temperamental traits Reward Sensitivity and Punishment Sensitivity, and Food Approach and Avoidance) to get a better understanding of eating behavior and related body weight.