Subtyping youngsters with obesity: A theory-based cluster analysis.

Psychological mechanisms play a crucial role in explaining weight gain. Aim of the present study was to identify subtypes in youngsters with obesity in line with these mechanisms. Defining homogeneous clusters within this heterogeneous group provides relevant information for personalized treatments. Data were collected in N = 572 participants (51% boys, aged 7-19) with extreme obesity (%BMI M = 187.8; SD = 30.9) recruited in an inpatient treatment centre. Based on psychological models of overweight/obesity, the Affect Regulation Model, the Reward Deficiency Model and The Dual Pathway Model, cluster variables were selected assessing emotional eating, reward reactivity and regulative capacities. Youngsters reported on emotional eating (DEBQ Emotional Eating) and reward sensitivity (BAS), while parents reported on children's regulative Executive Functions (BRIEF). Characteristics of the different clusters were examined concerning weight variables (pre and post treatment) and variables indexing problematic eating (DEBQ External Eating, Ch-EDE), affect regulation (FEEL-KJ) and depressive symptoms (CDI). Hierarchical cluster analyses supported the presence of three clusters, further evaluated by K-means cluster analyses. The cluster solutions differed according to age and sex (boys 7-13, boys 14-19, girls 7-13, girls 14-19). In all four age and gender subsamples, an "Emotional Eating" cluster displaying a vulnerable profile (high depression, maladaptive emotion regulation, problematic eating) and a "Reward Deficiency" cluster displaying a more resilient profile were detected. In girls 7-13, a "Weak Executive Functioning" indicative of insufficient self-regulative capacities, showed moderate to high emotional problems and problematic eating. In the other subgroups, the "Mean Level Functioning" cluster also showed elevated emotional problems and problematic eating. Given that different clusters can be identified, and given that these clusters have different profiles on emotional problems and problematic eating, subtyping youngsters with severe obesity is indicated, setting the stage for personalized treatments.

Inflammation in obese children and adolescents: Association with psychosocial stress variables and effects of a lifestyle intervention.

Obesity in childhood and adolescence is a complex health issue that has detrimental effects on the physical and psychological health of the youngster, both in the short and long term. A characteristic of obesity is the associated chronic low-grade inflammation which can result in insulin resistance. Previous research suggested that biomarkers referring to such increased inflammation may help in understanding resistance to weight loss. Whether and how psychosocial factors are related with inflammation remains to be proven. The current study consisted of 594 children and adolescents (7-19 years), of whom 480 had follow-up data, who enrolled for a ten-month inpatient multidisciplinary obesity treatment consisting of healthy food routines, physical activities and psychological treatment. The purpose of the study was to explore (1) the relationship between inflammation and psychosocial stress variables (i.e., depressive symptoms, eating behavior, concerns about eating/shape/weight, insecure parent-child attachment) (correlational and multiple regression analysis), (2) whether a lifestyle intervention for obese youngsters results in decreased C-reactive protein (CRP) values (paired t-test) and (3) which psychosocial variables influence this CRP change as indication of treatment success (multiple regression analysis with change in BMI as control variable). Results showed that the psychosocial stress variables emotional eating, external eating and attachment anxiety are related to higher CRP values. Our data further suggested that a lifestyle intervention decreases the CRP values. This significant reduction in blood inflammatory marker was besides being influenced by weight loss also dependent on psychosocial variables, more specific on self-reported attachment avoidance, as this latter was related to less CRP decrease.

Is there stress eating in children and adolescents? A first validation of the Dutch version of the Salzburg Stress Eating Scale.

The recently developed Salzburg Stress Eating Scale (SSES) is the first to specifically address the relationship of stress experiences and coping failure on the one hand and increases or decreases in food intake on the other hand. The SSES demonstrated good psychometric properties in English and German speaking adult samples. However, it has not been applied to younger age groups, which may differ in their expression and reporting of stress related eating behavior. Therefore, the current study evaluated the psychometric properties and correlates of the SSES in a Dutch speaking community sample of adolescents (study 1; N = 244, 9-18 years, adjusted BMI range = 71-189%, M = 103%) and in an inpatient sample of adolescents with obesity (study 2; N = 100, 9-16 years, adjusted BMI range = 151-310%, M = 194.5%). Factor analysis confirmed the original one factor structure in both studies. Internal consistency was 0.85 in study 1 and 0.90 in study 2 (Cronbach's alpha). In both the obesity and community sample, SSES scores were positively correlated with other eating-related measures (e.g., emotional eating, external eating), and uncorrelated with non-eating-related wellbeing measures (e.g., perceived stress, depressive symptoms). Unexpectedly, however, no association with adjusted BMI was found in the community sample, obesity sample, or combined sample. The scores of the obesity sample were also compared to the community sample in an age and sex-matched subsample of study 1. Against our hypothesis, the obesity sample did not report higher SSES scores than the community sample. The good internal consistency and the evidence for convergent and discriminant validity indicate that the Dutch version of the SSES seems useful in examining this clinically important eating behavior in adolescents. However, validity with regard to stress eating and BMI remains to be further explored.

Using confidence interval-based estimation of relevance to explore bottom-up and top-down determinants of problematic eating behavior in children and adolescents with obesity from a dual pathway perspective.

Prevalence of overweight and obesity in children and adolescents is high, not only in Western countries but also in developing countries. Efforts to improve prevention and treatment programs are needed. Given their essential role in weight problems, knowledge of determinants of problematic eating behavior ('External Eating' and 'Emotional Eating') is crucial for intervention development. Inspired by Appelhans' Dual Process Theory of Eating Behavior, the present study evaluated the importance of top-down regulative capacities and bottom-up reactivity, using the CIBER approach. CIBER is an innovative statistical approach to test the importance of behavior determinants, based on confidence intervals, instead of significance testing of point estimates. Survey data on different aspects of executive functioning (as indices of regulative capacities: Inhibition, Cognitive Flexibility, Emotional Control, Initiation, Working Memory, Planning/Organizing, Organization of materials, and Monitoring) and reward sensitivity (as an index of reactivity) were collected in a large sample of children and adolescents (n = 572) with severe obesity (adjBMI > 180%). Results showed that Emotional Eating is determined by Emotional Control, while External Eating is determined by Reward Sensitivity. The finding that differential mechanisms underlie different aspects of problematic eating suggests the need for using tailored intervention techniques to address altered reactivity and weak regulative capacities.

Factors influencing the reinforcing value of fruit and unhealthy snacks.

OBJECTIVE: The present study investigated the reinforcing value of healthy and unhealthy snack food in adolescents (n = 108, aged 14-16 years). Moderation by access to different foods, sex and the personality trait reward sensitivity is tested. METHODS: In a computerized Food Reinforcement Task, adolescents could earn portions of a healthy and an unhealthy snack following an identical progressive reinforcement schedule for both food types. Reinforcing value of food was indexed by the number of button presses for each food type. Participants were allocated randomly to two-order condition: fruit-snack versus snack-fruit. Reward sensitivity was assessed with the Dutch age-downward version of Carver and White's BIS/BAS scale. RESULTS: Results showed that the reinforcing value of an unhealthy snack is higher than that of fruit, with participants making more button presses for unhealthy snacks, M = 1280.40, SD = 1203.53, than for fruit, M = 488.04, SD = 401.45, F(1,48) = 25.37, p < 0.001. This effect is stronger in boys (ß = -1367.67) than in girls (ß = -548.61). The effect is only present in the snack-fruit condition, not in the fruit-snack condition, indicating that access to food moderates the effect of food type. There is no evidence for moderation by reward sensitivity. CONCLUSIONS: Results point to the importance of simultaneously increasing barriers to obtain unhealthy food and promoting access to healthy food in order to facilitate healthy food choices.

Using a gamified monitoring app to change adolescents' snack intake: the development of the REWARD app and evaluation design.

BACKGROUND: As the snacking pattern of European adolescents is of great concern, effective interventions are necessary. Till now health promotion efforts in children and adolescents have had only limited success in changing adolescents' eating patterns and anthropometrics. Therefore, the present study proposes an innovative approach to influence dietary behaviors in youth based on new insights on effective behavior change strategies and attractive intervention channels to engage adolescents. This article describes the rationale, the development, and evaluation design of the 'Snack Track School' app. The aim of the app is to improve the snacking patterns of Flemish 14- to 16-year olds. METHODS: The development of the app was informed by the systematic, stepwise, iterative, and collaborative principles of the Intervention Mapping protocol. A four week mHealth intervention was developed based on the dual-system model with behavioral change strategies targeting both the reflective (i.e., active learning, advance organizers, mere exposure, goal-setting, monitoring, and feedback) and automatic processes (i.e., rewards and positive reinforcement). This intervention will be evaluated via a controlled pre-post design in Flemish schools among 1400 adolescents. DISCUSSION: When this intervention including strategies focused on both the reflective and automatic pathway proves to be effective, it will offer a new scientifically-based vision, guidelines and practical tools for public health and health promotion (i.e., incorporation of learning theories in intervention programs). TRIAL REGISTRATION: NCT02622165 registrated November 15, 2015 on clinicaltrials.gov.

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.

Comparing decision making in average and overweight children and adolescents.

OBJECTIVE: The current study investigates the aspects of self-regulation skills in overweight and normal-weight children, which may be related to their overeating problems. It is hypothesised that overweight children may show poor decision-making behaviour, and this may be because of two processes: hypersensitivity to reward or future insensitivity. SUBJECTS: Average weight children (n=66) and overweight children (n=64) between 11 and 16 years were tested with the developmentally appropriate analogue of the Iowa gambling task. RESULTS: The results reveal that overweight children show decision-making failure ensued from future insensitivity. CONCLUSION: These findings provide support for the reward deficiency hypothesis or the anhedonic route to obesity in children.

Ending prematurely a weight loss programme: the impact of child and family characteristics.

The present study evaluates the pre-treatment child and family characteristics as well as the parental motives and experienced barriers when ending prematurely a weight loss programme for their obese child, in accordance with the 'barriers-to-treatment model' and subsequent research on dimensions underlying treatment termination decision. Treatment seeking youngsters (n = 72) with a mean of 10.46 years (SD = 2.56) were followed over a 1-year period. Dropout, child and family characteristics were measured both during assessment and treatment. The 'barriers-to-treatment' data were collected at the 1-year follow-up via mail (response rate = 65%; n = 47). Results showed that dropout could be successfully predicted at intake by age, psychopathology in the child and motivation of the parents. Results indicated further that there are few differences in total barriers score between completers and non-completers. Item content analysis revealed two themes that were more often reported by non-completers (appointment arrangements and perceived relevance of treatment). The hypothesis that non-completers (compared to completers) experienced more barriers that burden their willingness to continue a weight loss programme could not be confirmed. Besides demographic characteristics, specifically motivation of the parents at intake seems an important area for future research.

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%. Children's 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 child's 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.

Psychological profile to become and to stay obese.

OBJECTIVE: The presentation will successively deal with the psychological models to explain for the onset or maintenance of child obesity. DESIGN: Five psychological perspectives on childhood obesity are selected. The boundary model of Herman and Polivy (1980) was brought forward as an explanation model for understanding the overeating behaviour in obese people. Others describe obese children as over-responsive to external cues and this over-responsiveness is seen as a personality trait. Learning theories put forward how (dysfunctional) learning mechanisms can explain also why obese people eat in front of food cues, without feeling hungry. Finally, obesity can be seen as an expression of a family pathology or an emotional problem. CONCLUSIONS: Psychological explanation models are still subject of discussion. Personality variables, eating behaviour, restraint attitudes, psychopathlogy and emotional factors, learning mechanisms as well as the role of the family are to be considered in an assessment process. It may help to better empathize with both parent and child. Furthermore, it can help to tailor the treatment program to the individual needs of an obese child. Further research is needed to find out whether already during the intake psychological indicators can be found that are predictors of negative therapy outcome.

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.

Engineering of a glycosidase Family 7 cellobiohydrolase to more alkaline pH optimum: the pH behaviour of Trichoderma reesei Cel7A and its E223S/ A224H/L225V/T226A/D262G mutant.

The crystal structures of Family 7 glycohydrolases suggest that a histidine residue near the acid/base catalyst could account for the higher pH optimum of the Humicola insolens endoglucanase Cel7B, than the corresponding Trichoderma reesei enzymes. Modelling studies indicated that introduction of histidine at the homologous position in T. reesei Cel7A (Ala(224)) required additional changes to accommodate the bulkier histidine side chain. X-ray crystallography of the catalytic domain of the E223S/A224H/L225V/T226A/D262G mutant reveals that major differences from the wild-type are confined to the mutations themselves. The introduced histidine residue is in plane with its counterpart in H. insolens Cel7B, but is 1.0 A (=0.1 nm) closer to the acid/base Glu(217) residue, with a 3.1 A contact between N(epsilon2) and O(epsilon1). The pH variation of k(cat)/K(m) for 3,4-dinitrophenyl lactoside hydrolysis was accurately bell-shaped for both wild-type and mutant, with pK(1) shifting from 2.22+/-0.03 in the wild-type to 3.19+/-0.03 in the mutant, and pK(2) shifting from 5.99+/-0.02 to 6.78+/-0.02. With this poor substrate, the ionizations probably represent those of the free enzyme. The relative k(cat) for 2-chloro-4-nitrophenyl lactoside showed similar behaviour. The shift in the mutant pH optimum was associated with lower k(cat)/K(m) values for both lactosides and cellobiosides, and a marginally lower stability. However, k(cat) values for cellobiosides are higher for the mutant. This we attribute to reduced non-productive binding in the +1 and +2 subsites; inhibition by cellobiose is certainly relieved in the mutant. The weaker binding of cellobiose is due to the loss of two water-mediated hydrogen bonds.

Glycosylated rat prolactin: isolation and structural characterization.

Isolation of glycosylated 26 kDa rat prolactin and subsequent proper carbohydrate characterization has so far not been reported. In the present work the hormone isoform was isolated to 95% homogeneity by preparative electrophoretic separation on Mini Prep Cell of rat pituitary homogenate. The isoform was then investigated by 2-mercaptoethanol gradient electrophoresis, Cleveland's sequential SDS-PAGE, digestion with endoproteinase Asp-N and N-glycanase. The glycosidic part of the isoform was examined in O-profiling and its monosaccharide composition obtained by FACE and HPAE-PAD analysis. The outcome of the experimental data is: 1) in contrast to unglycosylated 23 kDa rat prolactin, intra-chain S-S bridging is not affected in 26kDa rat prolactin, neither by transiting through a thiol gradient nor in sequential nonreducing/reducing SDS-PAGE; 2) the conformational availability of Asp residues involved in the endoproteinase Asp-N attack is the same in 23- and 26 kDa rat prolactin; the glycan moiety apparently does not cause steric hindrance at this level; 3) no glycosidic N-linkage could be detected, only O-linkage(s); 4) 26 kDa rat prolactin is no glycosyl-phosphaditylinositol-anchored protein; 5) in O-profiling an oligosaccharide chain of Mr +/- 1.4 kDa was recorded; 6) the monosaccharide composition obtained in FACE is peculiar in the sense that next to Fuc, Man, GalNac, GlcNac and NeuAc also Rib was determined; 7) HPAE-PAD analysis identified NeuAc subtypes; 8) in vitro, glycosylation of rat prolactin modulates immune recognition through steric hindrance of the access to the epitope sites.

Dietary restraint in normal weight and overweight children. A cross-sectional study.

OBJECTIVE: This study investigated the degree to which actual fatness and negative self-esteem might be linked to dietary restraint in childhood. METHOD: Subjects were 426 boys and 319 girls, aged 10.6 y (+/- 1 y). Forty-nine children were overweight (> 30%) and 149 subjects were in the category 'moderately overweight' (10-30% overweight). Measures of self-esteem and dietary restraint were used in the analyses. RESULTS: Dietary restraint was observable in all weight groups and significantly more in girls. Boys and girls with an existing fatness problem showed more dietary restraint. Weight status, not self-esteem, turned out to be the best predictor of dietary restraint. DISCUSSION: Because there were good reasons to expect side-effects of the observed dietary restraint in obese children in the long term, valuable alternatives like changes in the life-style and interventions that enhance body image and self-esteem were recommended.

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.

Follow-up results of different treatment programs for obese children.

OBJECTIVE: Many approaches have been tried in order to tackle the problem of obesity in children, but most of them have failed to achieve long-term weight loss. Cognitive behaviour therapy tends to predict good prospects. So far, no studies have investigated the surplus value of introducing a "healthy-eating" lifestyle program instead of a strict diet prescription, in combination with the principles of cognitive behaviour therapy. Therefore, a new program was designed. The second aim of the study was to evaluate the impact of different forms of therapeutic contact. SUBJECTS AND METHODS: The obese group consisted of 205 children seeking treatment, and a control group of 54 obese school children. The effects of the program were evaluated by means of a pre-test/post-test design with a 1-y follow-up. Subjects were assigned to different therapeutic conditions: group therapy, individual therapy, summer camp or "advice in one session". RESULTS: A progressive and significant loss of weight for all therapeutic conditions was noticeable. The reduction continued at least 6 months after completing therapy. The control group, however, showed weight evolution in the opposite sense. CONCLUSIONS: A replication of the positive effect of CBT was found in a broad sample of clinically obese children, even without strict diet prescription. Our hypothesis that group approach will result in a better outcome is borne out.

Psychological aspects of childhood obesity: a controlled study in a clinical and nonclinical sample.

Explored the relationship between obesity and psychosocial adjustment in a combined clinical and nonclinical sample of 139 obese children and 150 non-obese children (ages from 9 to 12 years and matched for age, socioeconomic status, and gender) who filled out the Perceived Competence Scale for Children; their parents completed the Child Behavior Checklist. All obese children, independent of their help-seeking status, reported more negative physical self-perceptions than their nonobese peers and they scored lower on general self-worth. According to their parents, the obese children of the clinical sample appeared to have more behavior problems. Findings suggest that psychopathology depends on a clinical obese status, and they provide evidence for a psychosocial at-risk profile for a subgroup of obese children.

Body size estimation in obese children: a controlled study with the video distortion method.

OBJECTIVE: To investigate the reliability of the video distortion method in obese children and compare their body image with the body perception of non-obese peers. DESIGN: A standardized series of body size estimations: cognitive (what subjects 'think' they look like), affective (what they 'feel' they look like), and optative (what they 'wish' to look like). SUBJECTS: Fourty-one obese children (16 boys and 25 girls, average 12 years old) and 42 age-matched control subjects. MEASUREMENTS: Comparison of percentages of deviation from the accurate body image. RESULTS: The method was shown to be sufficiently reliable in young subjects. Compared with controls, obese children were more accurate in estimating their real body width, but desired to reduce their body size by about 25%. CONCLUSION: The video distortion method can be used as a reliable instrument to assess body perception in obese children.