Food Insecurity Predicts Magnitude of Early BMI Change in a Pediatric Weight Management Intervention.

OBJECTIVE: The aim of this study was to estimate the prevalence of food insecurity among children with overweight/obesity presenting for weight management treatment and examine whether food insecurity predicts early change in body mass index (BMI), expressed as a percentage of the 95th percentile (%BMIp95). METHOD: Children (N = 69; ages 3-18 years) presenting to a hospital-based pediatric weight management intervention and 1 parent/guardian per child (N = 69) were included. At the first appointment, parents/guardians completed the US Household Food Security Survey Module: Six-item Short Form and a demographics questionnaire. Height and weight of the children were measured at the first and third appointments to calculate %BMIp95. RESULTS: Among participating families, 29.0% reported experiencing food insecurity. Controlling for the ratio of income to poverty, 11.4% of the variance in %BMIp95 change from the first to third appointments was accounted for by food insecurity, ▵F (1, 66) = 8.46, p = 0.01. Children with greater food insecurity demonstrated a smaller magnitude of %BMIp95 decrease, representing a small-to-medium effect size within the context of the regression model (f2 = 0.13). CONCLUSION: A high proportion of families with children receiving weight management treatment reported experiencing food insecurity in comparison with US households with children. There may be unique characteristics of food insecurity, as opposed to household income alone, that explain the smaller magnitude of BMI decrease observed early in treatment. Future research should explore complex associations among food insecurity, income, BMI, and race over time.

A biobehavioral examination of emotional eating in adolescents: Evaluating the role of acute cortisol stress reactivity in the context of a multi-method assessment of eating in response to stress.

Stress is linked to emotional eating among adolescents, which in turn increases risk for overweight/obesity (OW/OB) development and continuation. There is a lack of research disentangling chronic and acute stress as predictors of adolescent emotional eating. Further, there is a corresponding need to understand the effects of acute physiological stress reactivity within the context of adolescent emotional eating. The primary aim of this study was to examine the impact of cortisol stress reactivity on emotional eating in adolescents, above and beyond the effects of perceived chronic stress. The impact of subjective stress reactivity was also explored. Adolescents' (N = 49) intake of highly palatable snack foods was measured on separate control and stress-induction (following the Trier Social Stress Test for Children) days. A multi-method approach was used to assess objective (caloric intake) and subjective (self-report) emotional eating. Results indicated that greater cortisol reactivity, but not subjective stress reactivity, predicted subjective emotional eating, beyond the impact of chronic stress. Neither chronic stress nor subjective or objective stress reactivity predicted objective emotional eating following stress-induction. Findings point to the role of chronic stress and cortisol reactivity as risks for greater perceived emotional eating among adolescents, while elucidating differences between perceived and objective emotional eating. Future research should explore how chronic versus acute stress differentially contribute to adolescent weight management.

Disinhibited Eating and Executive Functioning in Children and Adolescents: A Systematic Review and Meta-Analysis.

A growing body of research suggests disinhibited eating and weaker executive function (EF) are two risk factors for pediatric obesity. Emerging brain imaging and behavioral findings support the notion that EF skills impact eating regulation. However, a major gap in the current literature is a synthesis of the association between various EF skills and disinhibited eating patterns across child development. To address this gap, a systematic review and meta-analysis was conducted to examine the effect of EF skills on disinhibited eating behaviors among youth ages 3-18 years old. PubMed and PsychINFO databases were utilized and data from 15 studies with a total sample of 4909 youth were included. A random effects meta-analysis revealed a small negative effect of overall EF skills on disinhibited eating behavior, r = -0.14, p < 0.01. Analysis of individual EF skills found working memory had an overall medium negative effect on disinhibited eating behavior, r = -0.25, p < 0.05. Taken together, findings from this meta-analysis support an inverse relationship between EF abilities and disinhibited eating patterns in children and adolescents, such that poorer EF abilities are associated with higher levels of disinhibited eating. Given the effect on eating behavior, future research is needed to assess whether EF difficulties may be a barrier to effective weight management in youth. Specifically, research is needed to examine whether EF skills may be a key target to consider for effective obesity prevention and treatment in children and adolescents.