Perceptions of tableware size in households of children and adolescents with obesity.

PURPOSE: Portion size influences energy intake and is an important factor when developing weight management strategies. The effect of tableware on food intake is less clear, especially in children. To date, the relationship between the body weight of individuals and the tableware used in their households has not been investigated. The aim of this study was to analyze the sizes of tableware in households of children and adolescents with obesity (OBE) in comparison to participants with normal-weight matched for age and gender (NW). METHODS: 60 OBE (32 female, 26 male) and 27 NW (12 female, 15 male) aged between 9 and 17 years participated in a structured interview on the tableware used at home. Responses were standardized based on the selection of different sizes of tableware and everyday objects presented to the children. RESULTS: In households of NW, larger plates and bowls were used during meals and desserts compared to OBE. OBE drank out of larger bottles. Shapes and sizes of drinkware, the number of children drinking out of bottles and the cutlery used during dessert did not differ between the groups. CONCLUSIONS: Drinking out of large bottles may be an unfavourable habit of OBE if they contain sugar-rich liquids. The use of smaller plates and bowls of OBE may result in multiple helpings being consumed and so contribute to an overall increased portion size. LEVEL OF EVIDENCE: Level V, Descriptive study.

Changes in Gustatory Function and Taste Preference Following Weight Loss.

OBJECTIVE: To investigate taste changes of obese children during an inpatient weight reduction treatment in comparison with normal weight children. STUDY DESIGN: Obese (n = 60) and normal weight (n = 27) children aged 9-17 years were assessed for gustatory functions using taste strips (taste identification test for the taste qualities sour, salty, sweet, and bitter), taste preferences, and experienced taste sensitivity. Obese children were examined upon admission (T1) and before discharge (T2). Normal weight children served as the control group. RESULTS: Irrespective of taste quality, obese children exhibited a lower ability to identify taste (total taste score) than normal weight children (P < .01); this overall score remained stable during inpatient treatment in obese children. Group and treatment effects were seen when evaluating individual taste qualities. In comparison with normal weight children, obese children exhibited poorer sour taste identification performance (P < .01). Obese children showed improvement in sour taste identification (P < .001) and deterioration in sweet taste identification (P < .001) following treatment. Subjective reports revealed a lower preference for sour taste in obese children compared with normal weight children (P < .05). The sweet and bitter taste ability at T1 predicted the body mass index z score at T2 (R2 = .23, P < .01). CONCLUSIONS: We identified differences in the ability to discriminate tastes and in subjective taste perception between groups. Our findings of increased sour and reduced sweet taste discrimination after the intervention in obese children are indicative of an exposure-related effect on taste performance, possibly mediated by increased acid and reduced sugar consumption during the intervention. Because the sweet and bitter taste ability at T1 predicted weight loss, addressing gustatory function could be relevant in individualized obesity treatment approaches. TRIAL REGISTRATION: Germanctr.de: DRKS00005122.

Parent reported inattention and hyperactivity/impulsivity as predictor of long-term weight loss after inpatient treatment in obese adolescents.

OBJECTIVE: The long-term success of treatment for pediatric obesity is often unsatisfactory and variable. We aim to elucidate the influence of inattention and hyperactivity/impulsivity on weight loss after inpatient treatment for adolescent obesity. METHOD: We included 13-17 year old obese participants treated in three inpatient multidisciplinary treatment centers. At the beginning and end of treatment and at one year follow-up weight and height were measured. Inattention and hyperactivity/impulsivity was assessed with the hyperactivity/inattention (HI) subscale of the parent-rated Strengths and Difficulties Questionnaire. General linear models were used with the standard deviation scores of the body mass index (BMI-SDS) as dependent variable. RESULTS: Totally, 253 participants were included (65% female, age: 15.3 ± 1.4 years, baseline BMI-SDS: 3.13 ± 0.38 kg/m(2)). HI scores were associated with long-term (p < .001) but not short term (ns) weight loss. DISCUSSION: This indicates that inattention and hyperactivity/impulsivity is associated with reduced long-term weight loss success in adolescent inpatients.

Effect of a weight reduction program on baseline and stress-induced heart rate variability in children with obesity.

OBJECTIVE: Autonomic dysregulation is a well-established feature in adults with obesity but not in children. Since this dysregulation could contribute to weight dynamics, this study aimed to compare autonomic regulation in children with obesity and normal-weight peers and to track autonomic status during weight reduction. METHODS: Sixty children with obesity and 27 age- and sex-matched normal-weight healthy participants were included. Heart rate variability (HRV) was assessed at baseline and during a mental stress test and a subsequent recovery period. Children with obesity were investigated both upon admission and discharge. RESULTS: Upon admission, no significant differences in HRV parameters were found for normal-weight participants and those with obesity. Inpatient treatment led to significant changes in HRV with increase in general variability (standard deviation of the normal-to-normal interval (SDNN), P < 0.001) as well as of parasympathetic regulation (root mean square successive difference (RMSSD) and high frequency power (logHF), P < 0.01). Children with obesity had sympathetic activation similar to normal-weight controls during mental stress with subsequent return to baseline values, and weight loss did not affect this profile. CONCLUSIONS: A weight reduction program induced a change in autonomic activity in children with obesity toward parasympathetic dominance but had no influence on autonomic nervous system reactivity during stress conditions.

Multimodal Body Representation of Obese Children and Adolescents before and after Weight-Loss Treatment in Comparison to Normal-Weight Children.

OBJECTIVE: The aim of the study was to investigate whether obese children and adolescents have a disturbed body representation as compared to normal-weight participants matched for age and gender and whether their body representation changes in the course of an inpatient weight-reduction program. METHODS: Sixty obese (OBE) and 27 normal-weight (NW) children and adolescents (age: 9-17) were assessed for body representation using a multi-method approach. Therefore, we assessed body size estimation, tactile size estimation, heartbeat detection accuracy, and attitudes towards one's own body. OBE were examined upon admission and before discharge of an inpatient weight-reduction program. NW served as cross-sectional control group. RESULTS: Body size estimation and heartbeat detection accuracy were similar in OBE and NW. OBE overestimated sizes in tactile size estimation and were more dissatisfied with their body as compared to NW. In OBE but not in NW, several measures of body size estimation correlated with negative body evaluation. After weight-loss treatment, OBE had improved in heartbeat detection accuracy and were less dissatisfied with their body. None of the assessed variables predicted weight-loss success. CONCLUSIONS: Although OBE children and adolescents generally perceived their body size and internal status of the body accurately, weight reduction improved their heartbeat detection accuracy and body dissatisfaction.

Obese children and adolescents need increased gastric volumes in order to perceive satiety.

OBJECTIVE: In order to develop effective weight management strategies, it is important to identify factors that influence energy intake. Portion size has been discussed as one such factor. To date, most studies focusing on the relationship between portion size, energy intake, and weight have analyzed questionnaire data and 24-h records. In this study, we assessed the onset of satiety using the water-load test in normal-weight and obese children and adolescents. METHODS: 60 obese and 27 normal-weight children and adolescents aged between 9 and 17 years participated in the water load test which involved drinking water for 3 min or until feeling full. The amount of water consumed was recorded. RESULTS: Obese children and adolescents drank 20% more water until the onset of satiety when compared with normal-weight participants (478 ± 222 ml vs. 385 ± 115 ml, P < 0.05). CONCLUSIONS: Obese children and adolescents need to ingest greater volumes to feel full which may predispose toward the consumption of larger portion sizes. This may easily lead to overeating if predominantly energy-dense foods are consumed. A reduction in energy-dense foods in the diet of obese children and adolescents appears to be a necessary strategy for managing body weight.

PreDictor Research in Obesity during Medical care - weight Loss in children and adolescents during an INpatient rehabilitation: rationale and design of the DROMLIN study.

BACKGROUND: Obesity in adults and children is increasing worldwide at alarming rates. Obese children and adolescents are likely to become obese adults with increased risk of a number of comorbidities. In addition to preventing the development of obesity at young age, it is necessary to individualize the therapy of already obese children and adolescents in order to increase the likelihood of weight loss and maintenance. Therefore, the aim of this study is to identify predictors which play a significant role in successful weight loss and weight loss maintenance in children and adolescents. METHODS/DESIGN: Over a one year period, 60 obese children and adolescents between 9 to 17 years of age shall be recruited at an inpatient children rehabilitation facility in Germany. They will be investigated twice within a few days following admission and prior to discharge. The study will be an integrated component of an established inpatient weight-loss and in part psychosomatic therapy. The collected data can be grouped into four clusters: 1) demographic, sociometric and psychometric data, 2) objective and subjective parameters of body condition, 3) autonomic nervous system regulated functions and 4) objective and subjective parameters for eating behavior. Primary outcome is the change of the body mass index standard deviation score (BMI-SDS). In order to evaluate the data appropriately, all examinations will be also conducted in a normal-weight reference group, matched for age and gender. DISCUSSION: For some of the collected parameters the time span between measures may be too short. Therefore, a 6 months, 1 year and 2 year follow-up will be performed for evaluating the different predictors and their influence in regard to a successful intervention. Further middle- and long-term follow-up studies are planned. TRIAL REGISTRATION: The study protocol was approved by the Ethics Committee of the University Hospital Tübingen, Germany. This study is registered at the German Clinical Trials Register (DRKS) with the clinical trial number DRKS00005122.