Validation of a Laboratory Craving Assessment and Evaluation of 4 Different Interventions on Cravings Among Adults with Overweight or Obesity.

Food cue reactivity (FCR) is an appetitive trait associated with overeating and weight gain. We developed a laboratory craving assessment to objectively evaluate cognitive aspects of FCR. This study examined the preliminary construct and criterion validity of this craving assessment and evaluated 4 different interventions, 2 of which incorporated cue-exposure treatment for food, on craving over treatment and follow-up. 271 treatment-seeking adults with overweight/obesity (body mass index=34.6[5.2]; age=46.5[11.8]; 81.2% female; 61.6% non-Latinx White) completed the Food Cue Responsivity Scale and the laboratory craving assessment, during which they alternated holding and smelling a highly craved food and provided craving ratings over 5 minutes. Participants were subsequently randomized to 26 treatment sessions over 12-months of ROC, Behavioral Weight Loss (BWL), a combined arm (ROC+) and an active comparator (AC), and repeated the craving assessment at post-treatment and 12-month follow-up. Linear mixed-effects models assessed associations between trial type (holding vs. smelling), trial number, pre-treatment FCR, treatment arm, assessment time point, and craving. Cravings were greater when smelling vs. holding food (b=0.31, p<0.001), and cravings decreased over time (b=-0.02, p<0.001). Participants with higher pre-treatment FCR reported elevated cravings (b=0.29, p<0.001). Longitudinally, we observed a significant 3-way interaction in which treatment arm modified the relationship between pre-treatment FCR and craving over time (F(17,5122)=6.88, p<0.001). An attenuated FCR-craving relationship was observed in ROC+ and BWL from baseline to post-treatment but was only sustained in BWL at follow-up. This attenuation was also observed in ROC and AC from post-treatment to follow-up. The preliminary validity of this laboratory craving assessment was supported; however, greater craving reductions over time in ROC/ROC+ compared to BWL and AC were not consistently observed, and thus do not appear to fully account for the moderating effect of FCR on weight losses observed in the trial.

Change in Weight Status Among Children Who Do and Do Not Participate in Intensive Health Behavior and Lifestyle Treatment for Obesity.

Background: Primary care providers (PCPs) are expected to provide weight management counseling despite having low confidence in their ability to be effective. This analysis examined change in weight status between children who received usual care from their PCP and those who received one of two structured weight management programs in a randomized control trial. Methods: Data from parent-child dyads who were referred to the Guided Self-Help Obesity Treatment in the Doctor's Office study, but did not participate, were examined to determine change in weight status compared with those who participated in the trial. Families were divided into four groups: Group 1, structured treatment with high attendance; Group 2, structured treatment with low attendance; Group 3, PCP/usual care with some weight management counseling; and Group 4, PCP/usual care with no counseling. Anthropometric data and PCP delivery of weight management counseling were abstracted from the electronic health record. Main outcomes were changes in child BMI z-scores, BMI as a percentage relative to the 95th percentile, and BMI as a difference relative to the 95th percentile at the end of treatment and 6-month follow-up for each group. Results: Groups 1 and 2 showed significant decreases in weight status over time, with Group 1 showing the greatest decrease. Groups 3 and 4 remained relatively stable. Changes in weight status in Groups 2, 3, and 4 were significantly different from Group 1 at post-treatment. Conclusions: While structured weight management programs have a significant impact on weight status, those who received some counseling by their PCP did not show significant increases in weight status and were relatively weight stable. Efforts should be broadened to support PCPs as they provide weight management counseling in the office.

Development and validation of the food cue responsivity scale.

Food cues are ubiquitous in today's environment; however, there is heterogeneity as to the extent to which these cues impact eating behavior among individuals. This study examines the validity and reliability of the Food Cue Responsivity Scale (FCRS) to assess responsivity to distinct types of food cues. Items gathered from existing measures were combined in the FCRS to reflect two subdomains, uncontrolled eating behavior and cognitive rumination. The criterion validity of the FCRS was established using a paradigm that assesses psychophysiological responsivity to a craved food among adults with overweight or obesity. Higher overall FCRS scores were associated with greater physiological responsivity to food exposures. These findings may help identify specific phenotypes of individuals with overweight or obesity with high responsivity to food cues, which could be used to understand overeating and response to weight-loss programs.

Psychometric properties of the Child Eating Behavior Questionnaire (CEBQ) in school age children with overweight and obesity: A proposed three-factor structure.

BACKGROUND: Obesity in youth is a significant public health concern, with eating behaviors being a major contributor. The Child Eating Behavior Questionnaire (CEBQ) was developed to evaluate the appetitive characteristics of young children, across a myriad of eating domains. Despite the breadth of its use, the psychometric properties of the measure in children with overweight/obesity (OW/OB), particularly treatment seeking youth, remains largely unexplored. METHODS: The psychometric properties of the CEBQ were examined in a sample of school age children (8-12) with OW/OB. Parent-child dyads (N = 148) completed assessments prior to beginning a family weight management program. Exploratory factor analysis (EFA) was performed utilizing polychoric correlations, and emerging subscales were assessed to ensure that the range of response scores demonstrated adequate variability. Indices of the number of factors to be retained included acceleration factor (2), optimal coordinates (4), Velicer's MAP (5) and parallel analysis (11). These indices were used in combination with clinical utility to determine the final factor structure. RESULTS: A three-factor structure emerged. The first factor combined many food responsiveness, enjoyment of food, satiety responsiveness and slowness in eating items, with the latter two domains loading negatively. The second factor retained the food fussiness subscale, and the third factor included items from the emotional over- and under-eating subscales. CONCLUSIONS: These results suggest that in children with OW/OB, eating behaviors may be optimally assessed using three domains: reward-based eating, emotional eating and picky eating. Future research should explore how this structure holds in non-treatment-seeking samples and across wider socio-demographic profiles.

Family-based treatment program contributors to child weight loss.

BACKGROUND: Multicomponent family-based behavioral treatment (FBT) program for pediatric obesity includes nutrition and physical activity education, as well as behavior therapy techniques. Studies suggest that parent weight loss is the best predictor of child weight loss in FBT. However, given the important role that parents play in the implementation of FBT for their child, isolating the effects of specific FBT treatment component requires consideration of parent influences over time. METHODS: The following treatment components were assessed: stimulus control (high/low-fat food items in home), nutrition knowledge, energy intake, physical activity, and parental monitoring, as well as weekly anthropometric measures. Adjusted models of interest using inverse probability weights were used to evaluate the effect of specific FBT components on time-varying child weight loss rate, adjusting for time-varying influence of parent weight loss. RESULTS: One hundred thirty-seven parent-child dyads (CHILD: mean BMI = 26.4 (3.7) and BMIz = 2.0 (0.3); mean age = 10.4 (1.3); 64.1% female; ADULT: mean BMI = 31.9 (6.3); mean age = 42.9 (6.5); 30.1% Hispanic parents; 87.1% female) participated in an FBT program. In traditional model, adult BMI change (b = 0.08; p < 0.01) was the most significant predictor of child weight loss rates and no other treatment components were significant (p's > 0.1). In models that accounted for potential influences from parental weight loss and differential attendance during treatment period, lower availability of high-fat items (b = 1.10, p < 0.02), higher availability of low-fat items (b = 3.73; p < 0.01), and higher scores on parental monitoring practices (b = 1.10, p < 0.01) were associated with greater rates of weight loss, respectively. CONCLUSION: Results suggest that outside of parent weight change, changes in stimulus control strategies at home and improved parental-monitoring practices are important FBT components for child weight loss.

Role of appetitive phenotype trajectory groups on child body weight during a family-based treatment for children with overweight or obesity.

OBJECTIVE: Emerging evidence suggests that individual appetitive traits may usefully explain patterns of weight loss in behavioral weight loss treatments for children. The objective of this study was to identify trajectories of child appetitive traits and the impact on child weight changes over time. METHODS: Secondary data analyses of a randomized noninferiority trial conducted between 2011 and 2015 evaluated children's appetitive traits and weight loss. Children with overweight and obesity (mean age = 10.4; mean BMI z = 2.0; 67% girls; 32% Hispanic) and their parent (mean age = 42.9; mean BMI = 31.9; 87% women; 31% Hispanic) participated in weight loss programs and completed assessments at baseline, 3, 6,12, and 24 months. Repeated assessments of child appetitive traits, including satiety responsiveness, food responsiveness and emotional eating, were used to identify parsimonious grouping of change trajectories. Linear mixed-effects models were used to identify the impact of group trajectory on child BMIz change over time. RESULTS: One hundred fifty children and their parent enrolled in the study. The three-group trajectory model was the most parsimonious and included a high satiety responsive group (HighSR; 47.4%), a high food responsive group (HighFR; 34.6%), and a high emotional eating group (HighEE; 18.0%). Children in all trajectories lost weight at approximately the same rate during treatment, however, only the HighSR group maintained their weight loss during follow-ups, while the HighFR and HighEE groups regained weight (adjusted p-value < 0.05). CONCLUSIONS: Distinct trajectories of child appetitive traits were associated with differential weight loss maintenance. Identified high-risk subgroups may suggest opportunities for targeted intervention and maintenance programs.

Evaluating psychometric properties of the Emotional Eating Scale Adapted for Children and Adolescents (EES-C) in a clinical sample of children seeking treatment for obesity: a case for the unidimensional model.

BACKGROUND: The Emotional Eating Scale - Adapted for Children and Adolescents (EES-C) assesses children's urge to eat in response to experiences of negative affect. Prior psychometric studies have demonstrated the high reliability, concurrent validity, and test-retest reliability of theoretically defined subconstructs among non-clinical samples of children and adolescents who were primarily healthy weight; however, no psychometric studies exist investigating the EES-C among clinical samples of children with overweight/obesity (OW/OB). Furthermore, studies conducted in different contexts have suggested a discordant number of subconstructs of emotions related to eating. The purpose of this study was to evaluate the validity of the EES-C in a clinical sample of children seeking weight-loss treatment. METHOD: Using a hierarchical bi-factor approach, we evaluated the validity of the EES-C to measure a single general construct, a set of two separate correlated subconstructs, or a hierarchical arrangement of two constructs, and determined reliability in a clinical sample of treatment-seeking children with OW/OB aged 8-12 years (N = 147, mean age = 10.4 years.; mean BMI z = 2.0; female = 66%; Hispanic = 32%, White and other = 68%). RESULTS: Comparison of factor-extraction methods suggested a single primary construct underlying EES-C in this clinical sample. The bi-factor indices provided clear evidence that most of the reliable variance in the total score (90.8 for bi-factor model with three grouping factors and 95.2 for bi-factor model with five grouping factors) was attributed to the general construct. After adjusting for relationships with the primary construct, remaining correlations among sets of items did not suggest additional reliable constructs. CONCLUSION: Results suggest that the primary interpretive emphasis of the EES-C among treatment-seeking children with overweight or obesity should be placed on a single general construct, not on the 3- or 5- subconstructs as was previously suggested.

Do christian denominations exhibit higher rates of alcohol consumption? A study of Korean American women in California.

Although Korean American women show high levels of involvement in religious practices and high prevalence of alcohol consumption, no studies have assessed the association between religious denomination and alcohol intake among this group of women. This cross-sectional study examined the associations of religious denomination and religious commitment to alcohol consumption among Korean American women in California. Polychotomous regression models were used to provide estimates of the associations between religious denomination and religious commitment to alcohol consumption. Catholic Korean American women (OR 5.61 P < 0.01) and Independent Christian women (OR 4.87 P < 0.01) showed stronger associations to heavy alcohol consumption when compared to Conservative Christian Korean American women. Path analysis suggested that specific denominations had both direct and indirect effects on the outcome of interest, and that religious commitment and drinking models served as moderators for this phenomenon.

Does church participation facilitate tobacco control? A report on Korean immigrants.

BACKGROUND: This study explores hypotheses linking church attendance to smoking prevalence, cessation, exposure to environmental tobacco smoke (ETS), and household smoking bans among Korean immigrants in California. METHODS: Data were drawn from telephone interviews with Korean adults (N = 2085) based on a probability sample during 2005-2006 in which 86% of those contacted completed interviews. RESULTS: Koreans who reported that they had attended church were less likely to be current smokers and to be exposed to ETS, and more likely to have quit smoking and to have a complete smoking ban than non-attenders after statistical controls for behavioral covariates. DISCUSSION: Whether or not participants reported attending church was associated with increased tobacco control practices. Public health interventions may profit by seeking to expand cooperation with religious congregations to facilitate efforts to promote healthy lifestyles among immigrant populations beyond the influences of church attendance.