Sandra Verbeken

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.

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.

Problem Behavior, Parental Stress and Enuresis

PURPOSE We determined maternal and paternal ratings of problem behavior in 5 to 13-year-old children with (non)monosymptomatic enuresis and investigated parental stress and the association between parental ratings of child behavior and parental stress. MATERIALS AND METHODS We compared problem behavior in 78 children with (non)monosymptomatic enuresis vs that in 110 without enuresis using the Child Behavior Checklist and the Disruptive Behavior Disorders Rating Scale. Parental stress was measured using the Parenting Stress Index. RESULTS Maternal results replicated previous findings of significantly higher Child Behavior Checklist scores for externalizing and total problems compared with those in the control group, whereas no significant differences were found for paternal ratings. Mothers and fathers of enuretic children reported significantly higher scores on the Disruptive Behavior Disorders Rating Scale inattention, hyperactivity/impulsivity and oppositional defiant disorder subscales than parents of children without enuresis. The Parenting Stress Index revealed significantly higher overall stress in mothers and fathers of children with (non)monosymptomatic enuresis compared with that in parents of controls. Especially parental stress related to child characteristics was associated with a greater report of child behavior problems. CONCLUSIONS Each parent but especially mothers reported more problem behavior in children with (non)monosymptomatic enuresis than in controls. They also reported more stress, which correlates highly with parental ratings of problem behavior in children with (non)monosymptomatic enuresis.

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.

Long‐term outcome of pediatric eating pathology and predictors for the onset of loss of control over eating following weight‐loss treatment

OBJECTIVE To investigate the stability of eating pathology over a 6-year period and predictors for the onset of loss of control (LC) over eating among overweight youngsters having undergone weight-loss treatment. METHOD Structured clinical interviews and self-report questionnaires were administered to a sample of 56 overweight youngsters (M age = 13 years) who were at the start of weight-loss treatment in 2000 and again 6 years later. RESULTS Mean levels of eating concerns, drive for thinness, bulimic symptoms, and body dissatisfaction decreased over the 6-year period. Dietary restraint, weight, and shape concerns were stable over time. Also, in 50% of those reporting objective binge eating at baseline, binge-eating episodes remained stable. Youngsters characterized by symptoms of depression in early adolescence were at a higher risk for developing new episodes of LC 6 years later. Neither concerns about eating, shape, and weight nor dietary restraint independently predicted LC. DISCUSSION Six years after following structured weight-loss treatment, some eating pathology variables still remain stable. Especially youngsters who already report LC at young ages appear to develop a more stable pattern of disordered eating behavior.

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.

Computer training of attention and inhibition for youngsters with obesity: A pilot study

Obesity is a widespread problem that starts from an early age. Previous studies suggest that obese youngsters have an attentional bias and an automatic approach tendency towards high-calorie food and display difficulties inhibiting impulses, which may result in a higher intake of (high-calorie) food. An interesting idea for improvement of the current obesity treatment is adding a program that enables to train their difficulties. Subjects were 36 youngsters aged 9-15 years old from an inpatient treatment program for obesity, randomized over a training group and an active control group. The training consisted of six training sessions with cognitive tasks aimed at enhancing inhibition towards unhealthy food items (with a go/no-go task), as well as decreasing a food approach bias (using an approach/avoidance task) and a food attentional bias (using a dot-probe task). The current study evaluated the feasibility, acceptability and initial effectiveness of the training and explores if these characteristics helps obese youngsters to maintain weight-loss once they return home at the end of their inpatient treatment program. Results on the cognitive performances were investigated during two measurement sessions, spread over 5 weeks while weight evolution was followed over 13 weeks. Results showed that the training program was feasible and acceptable to the majority of participants and clinicians. Furthermore, the preliminary findings suggest that the training tasks used were ineffective in this group of obese children. Lessons learned and suggestions for future research are discussed.

Reward sensitivity and body weight: the intervening role of food responsive behavior and external eating

BACKGROUND During the last three decades, the prevalence of childhood overweight and obesity has increased worldwide. It is well established that different child-related factors such as food approach behaviors (i.e. eating behaviors that imply movements towards food) contribute to the development of overweight. However, research is lacking on the underlying mechanisms leading to food approach behaviors, which in turn lead to overweight. SUBJECT/METHODS Via parent-report questionnaires, we investigated the relation between the personality trait reward sensitivity and body weight in a convenience sample of 211 children aged 2.5-9 years. We further investigated the intervening role of food approach behaviors in the association between reward sensitivity and body weight. RESULTS Unexpectedly, there was no direct association between reward sensitivity and body weight. Despite the absence of a direct effect, a significant indirect association was found between reward sensitivity and body weight through the intervening food approach variables (i.e. food responsive behavior and external eating). CONCLUSIONS These results highlight the importance of the focus on eating behaviors as well as trait characteristics in prevention programs for overweight.

Fat tissue accretion in children and adolescents : interplay between food responsiveness, gender, and the home availability of snacks

The appetitive trait “food responsiveness” is assumed to be a risk factor for adiposity gain primarily in obesogenic environments. So far, the reported results are inconsistent in school-aged children, possibly because these studies did not take into account important moderators such as gender and the food-environment. In order to better inform caregivers, clinicians and the developers of targeted obesity-prevention interventions on the conditions in which food responsiveness precedes adiposity gain, the current study investigated if this relationship is stronger in girls and in children exposed to a higher home availability of energy-dense snacks. Age- and sex-independent Fat and Lean Mass Index z-scores were computed based on air-displacement plethysmography at baseline and after 2 years in a community sample of 129 children (48.8% boys) aged 7.5–14 years at baseline. Parents reported at baseline on childrens food responsiveness and the home availability of energy-dense snacks. Food responsiveness was a significant predictor of increases in Fat Mass Index z-scores over 2 years in girls but not boys. The home availability of energy-dense snacks did not significantly moderate the relation of food responsiveness with Fat Mass Index z-score changes. The results suggest that food responsiveness precedes accelerated fat tissue accretion in girls, and may inform targeted obesity-prevention interventions. Further, future research should investigate to which food-environmental parameters children high in food responsiveness mainly respond.

How do I feel right now? Emotional awareness, emotion regulation, and depressive symptoms in youth

Decreased emotional awareness contributes to the risk of internalizing disorders, such as depression. Although emotional awareness may be especially important during adolescence, a developmental period in which emotional arousal is high and the risk of depression rises dramatically, little research has examined the mechanisms linking emotional awareness to depression. Starting from affect regulation models, the current study proposes emotion regulation (ER) as a key underlying mechanism in the emotional awareness—depression relationship. The current study investigated whether maladaptive and adaptive ER strategies mediate the relationship between emotional awareness and depressive symptoms among youth using a cross-sectional design. Participants were 220 youth (65% girls;