Hippocampal atrophy and altered brain responses to pleasant tastes among obese compared with healthy weight children.

OBJECTIVE: The hippocampus is a key structure implicated in food motivation and intake. Research has shown that the hippocampus is vulnerable to the consumption of a western diet (i.e., high saturated fat and simple carbohydrates). Studies of patients with obesity (OB), compared with healthy weight (HW), show changes in hippocampal volume and response to food cues. Moreover, evidence suggests that OB children, relative to HW, have greater hippocampal response to taste. However, no study has examined the association of hippocampal volume with taste functioning in children. We hypothesized that OB children, relative to HW, would show a significant reduction in hippocampal volume and that decreased volume would be significantly associated with greater activation to taste. Finally, we explored whether hippocampal activation would be associated with measures on eating and eating habits. SUBJECTS: Twenty-five 8-12-year-old children (i.e., 13 HW, 12 OB) completed a magnetic resonance imaging scan while participating in a taste paradigm (i.e., 1 ml of 10% sucrose or ionic water delivered pseudorandomly every 20 s). RESULTS: Children with OB, relative to HW, showed reduced left hippocampal volume (t=1.994, P=0.03, 95% confidence interval (CI)=-40.23, 755.42), and greater response to taste in three clusters within the left hippocampus (z=3.3, P=0.001, 95% CI=-0.241, -0.041; z=3.3, P=0.001, 95% CI=-0.2711, -0.0469; z=2.7, P=0.007, 95% CI=-0.6032, -0.0268). Activation within the hippocampus was associated with eating in the absence of hunger (EAH%; t=2.408, P=0.025, 95% CI= 1.751708, 23.94109) and two subscales on a measure of eating behaviors (Food responsiveness, t=2.572, P=0.017, 95% CI= 0.9565195, 9.043440; Food enjoyment, t=2.298, P=0.032, 95% CI=0.2256749, 4.531298). CONCLUSION: As hypothesized, OB children, relative to HW, had significantly reduced hippocampal volume, and greater hippocampal activation to taste. Moreover, hippocampal activation was associated with measures of eating. These results contribute to research on the relationship between OB, overeating and cognitive impairment.

Increased brain response to appetitive tastes in the insula and amygdala in obese compared with healthy weight children when sated.

OBJECTIVE: There is evidence of altered neural taste response in female adolescents who are obese (OB), and in adolescents who are at risk for obesity. To further understand risk factors for the development of overeating and obesity, we investigated response to tastes of sucrose and water in 23 OB and healthy weight (HW) children. METHODS AND DESIGN: Thirteen HW and 10 OB 8-12-year-old children underwent functional magnetic resonance imaging while tasting sucrose and water. Additionally, children completed an eating in the absence of hunger paradigm and a sucrose-liking task. RESULTS: A region of interest analysis revealed an elevated BOLD response to taste (sucrose and water) within the bilateral insula and amygdala in OB children relative to HW children. Whole-brain analyses revealed a group by condition interaction within the paracingulate, medial frontal, middle frontal gyri and right amygdala: post hoc analyses suggested an increased response to sucrose for OB relative to HW children, whereas HW children responded more strongly to water relative to sucrose. In addition, OB children, relative to HW, tended to recruit the right putamen as well as medial and lateral frontal and temporal regions bilaterally. CONCLUSION: This study showed increased reactivity in the amygdala and insula in the OB compared with HW children, but no functional differentiation in the striatum, despite differences in the striatum previously seen in older samples. These findings support the concept of the association between increased neural processing of food reward in the development of obesity, and raise the possibility that emotional and interoceptive sensitivity could be an early vulnerability in obesity.

Neurocognitive correlates of obesity and obesity-related behaviors in children and adolescents.

Childhood obesity rates have risen dramatically over the past few decades. Although obesity has been linked to poorer neurocognitive functioning in adults, much less is known about this relationship in children and adolescents. Therefore, we conducted a systematic review to examine the relationship between obesity and obesity-related behaviors with neurocognitive functioning in youth. We reviewed articles from 1976 to 2013 using PsycInfo, PubMed, Medline and Google Scholar. Search terms included cognitive function, neurocognitive function/performance, executive function, impulsivity, self-regulation, effortful control, cognitive control, inhibition, delayed gratification, memory, attention, language, motor, visuo-spatial, academic achievement, obesity, overweight, body mass index, waist-hip ratio, adiposity and body fat. Articles were excluded if participants had health problems known to affect cognitive functioning, the study used imaging as the only outcome measure, they were non-peer-reviewed dissertations, theses, review papers, commentaries, or they were non-English articles. Sixty-seven studies met inclusion criteria for this review. Overall, we found data that support a negative relationship between obesity and various aspects of neurocognitive functioning, such as executive functioning, attention, visuo-spatial performance, and motor skill. The existing literature is mixed on the effects among obesity, general cognitive functioning, language, learning, memory, and academic achievement. Executive dysfunction is associated with obesity-related behaviors, such as increased intake, disinhibited eating, and less physical activity. Physical activity is positively linked with motor skill. More longitudinal research is needed to determine the directionality of such relationships, to point towards crucial intervention time periods in the development of children, and to inform effective treatment programs.

Targeting parents for the treatment of pediatric obesity in boys with Duchenne muscular dystrophy: a case series.

Obesity is a major public health concern in children. Obesity occurs frequently in boys with Duchenne muscular dystrophy (DMD), complicating treatment and impairing functioning. Parent-focused interventions to facilitate weight loss have been successful in other pediatric samples but have not been studied with this population. The current investigation examined the feasibility and potential efficacy of parent-focused treatment to improve healthy eating and physical activity of parents and eating and weight in their sons with DMD. Three families participated in this case series. Resulting changes in body weight among boys with DMD were an outcome variable. Findings indicate inconsistent changes in boys' weight, decreases in parent weight, increases in healthy foods available in the home, and increases in children's perceived quality of life. Participant ratings of treatment suitability and satisfaction were generally favorable. These preliminary findings support the use of parent-focused psychoeducation for the treatment of obesity in children with DMD.

A case series investigating acceptance and commitment therapy as a treatment for previously treated, unremitted patients with anorexia nervosa.

The aim of the present study was to evaluate the effectiveness of Acceptance and Commitment Therapy (ACT) for treatment of anorexia nervosa (AN) using a case series methodology among participants with a history of prior treatment for AN. Three participants enrolled; all completed the study. All participants had a history of 1-20 years of intensive eating disorder treatment prior to enrollment. Participants were seen for 17-19 twice-weekly sessions of manualized ACT. Symptoms were assessed at baseline, post-treatment and 1-year follow-up. All participants experienced clinically significant improvement on at least some measures; no participants worsened or lost weight even at 1-year follow-up. Simulation modelling analysis (SMA) revealed for some participants an increase in weight gain and a decrease in eating disorder symptoms during the treatment phase as compared to a baseline assessment phase. These data, although preliminary, suggest that ACT could be a promising treatment for subthreshold or clinical cases of AN, even with chronic participants or those with medical complications.

Temporal trends in energy intake in the United States: an ecologic perspective.

BACKGROUND: The causes of recent increases in the prevalence of overweight in the United States are perplexing because national survey data do not show clear patterns of change in energy intake or expenditure. OBJECTIVE: Ecologic data regarding the quantities and types of foods and nutrients available in the United States between 1970 and 1998 were reviewed to provide an alternative perspective on trends in energy intake. DESIGN: Literature searches in agriculture, business, and medical library databases were conducted to identify data regarding the quantities and types of foods and nutrients available in the United States between 1970 and 1998. RESULTS: Per capita energy availability estimates from the US Department of Agriculture, US Food Supply Series, indicate that energy availability increased by 15% between 1970 and 1994. Data regarding trends in food purchasing and preparation suggest that Americans are eating more meals outside the home, relying more heavily on convenience foods, and consuming larger food portions. Americans appear, in some cases, to be selecting lower-fat foods over higher-fat alternatives. In addition, availability and sales of reduced-energy and reduced-fat products have increased. CONCLUSION: Consistent with trends in overweight, most of the ecologic data reviewed suggest that energy intake has increased over the past several decades and is likely a major contributor to increases in average body weight.

How can obese weight controllers minimize weight gain during the high risk holiday season? By self-monitoring very consistently.

This study examined the efficacy of augmenting standard weekly cognitive-behavioral treatment for obesity with a self-monitoring intervention during the high risk holiday season. Fifty-seven participants in a long-term cognitive-behavioral treatment program were randomly assigned to self-monitoring intervention or comparison groups. During 2 holiday weeks (Christmas-New Years), the intervention group's treatment was supplemented with additional phone calls and daily mailings, all focused on self-monitoring. As hypothesized, the intervention group self-monitored more consistently and managed their weight better than the comparison group during the holidays. However, both groups struggled with weight management throughout the holidays. These findings support the critical role of self-monitoring in weight control and demonstrate the benefits of a low-cost intervention for assisting weight controllers during the holidays.

The use of exposure with response prevention in a male anorexic.

The present case study describes the use of exposure with response prevention (ERP) in a 24-yr-old male with anorexia nervosa. In this case, ERP offered an opportunity to address problematic cognitions and decrease the anxiety associated with consumption of high fat/high calorie foods. By the end of 34 treatment sessions, the client's distress decreased while eating high-fat/high-calorie foods and he integrated a greater variety of foods in his diet. Implication for conceptualizing anorexia nervosa within an anxiety reduction/avoidance cycle is discussed with reference to the recent literature.

Teasing, depression and unhealthy weight control behaviour in obese children.

BACKGROUND: Data were taken from 80 obese children (mean age = 10.03 years; mean body mass index = 27.37; %white = 29.37%; %female = 58.8%). Self-report surveys were used to collect data on rates of depressive symptoms, unhealthy weight control behaviours (UWCBs), teasing, sources of teasing and how much the teasing bothered the child. OBJECTIVES: This study aimed to evaluate relationships between weight-related teasing and UWCBs and depression in obese children. Teasing by peers and/or family, negative feelings due to teasing, frequency of teasing, and number of teasing sources reported and associations with UWCBs and depression were analysed. METHODS: Logistical and linear regressions were used to evaluate relationships between the teasing variables, depression and UWCBs, controlling for age and gender. RESULTS: Results indicated that children teased by other children have significantly higher levels of depression (B = 6.1 [SE = 2.3]) and are five times more likely to engage in UWCBs (OR = 5.1 [CI = 1.5-17.4]). Children who endorsed that teasing by peers bothered them had significantly higher levels of depression (B = 2.3 [SE = 0.8]). The frequency of weight-related teasing was significantly associated with depression (B = 2.5 [SE = 0.8]), as was the number of teasing sources (B = 4.6 [SE = 1.5]). No significant relationships were found between familial teasing and depression or UWCBs. CONCLUSIONS: Weight-related teasing, especially by other children, was associated with negative psychosocial measures in these obese children. Interventions are needed to reduce teasing, and longitudinal studies are recommended to understand the impact of teasing over time.

A pilot study evaluating a minimal contact telephone and mail weight management intervention for primary care patients.

OBJECTIVE: This study examined an 8-week telephone and mail weight management intervention for Veterans who are unable to attend frequent clinical visits. METHODS: A mail and phone based intervention was compared to a "usual care" intervention in a Hospital clinic. 26 participants (80% male; mean wt=246.2 lbs, BMI=34.7) completed the study. All participants received weight management counseling at weeks 1 and 8. Participants in the intervention group received phone calls and mailings during weeks 2-7. RESULTS: The intervention group lost more weight, although it was not statistically significant. Multivariate analyses showed stage of change was associated with weight loss and attendance. Treatment group and role limitations due to emotional problems were related to weight loss. The intervention group significantly increased their intake of fruits and vegetables. CONCLUSION: This pilot study suggests that minimal interventions may be a method to reach populations that do not have access to more intensive treatments for weight management.

Further support for consistent self-monitoring as a vital component of successful weight control.

OBJECTIVE: This study attempted to replicate that of Baker and Kirschenbaum by providing a descriptive analysis of the relationship between self-monitoring and weight control. PROCEDURES: Fifty-nine women and men in long-term cognitive-behavioral treatment for obesity participated over an 8-week period. Percentages of participants who self-monitored consistently and the relationship between the variability in self-monitoring and weight change were examined. RESULTS: As in the previous study, a substantial minority of the participants in this research (26.3%) self-monitored all foods eaten on less than half of the days evaluated. The assertion of Baker and Kirschenbaum that self-monitoring is most appropriately viewed as both a state and a trait was supported by finding that the most consistent self-monitors lost more weight than the least consistent self-monitors; however, regardless of overall self-monitoring consistency, participants lost much more weight during their two most consistent weeks compared with their two least consistent weeks. Again, as in the previous study, only the more consistent quartile of self-monitors lost a substantial amount during the course of this study. DISCUSSION: The results of both studies taken together suggests that a reasonable target for consistency for self-monitoring within the context of a professional cognitive-behavioral treatment program may be self-monitoring all foods eaten on at least 75% of the days. If participants generally self-monitor on less than half of the days during participation in such programs, they may be very unlikely to succeed at weight loss both during the program and afterward.

What is a binge? The influence of amount, duration, and loss of control criteria on judgments of binge eating.

OBJECTIVE: We investigated the influence of amount of food eaten, duration of eating episode, and loss of control in judgments of eating episodes as binges. METHOD: Participants rated the degree to which the eating behavior of a female actress qualified as a "binge" after observing eight videotaped vignettes in which the amount of food eaten, apparent duration of eating episode, and loss of control were varied. Binge ratings were stable across a test-retest interval of 3-4 weeks, there was minimal observer drift, and the experimental variables were independently perceived. RESULTS: A repeated measures analysis of variance (ANOVA) on binge ratings revealed significant main effects for quantity and loss of control, and a significant Quantity x Time interaction. DISCUSSION: The results are consistent with the definitional criteria of a binge, underscore the independence of loss of control, and highlight the importance of the violation of dietary standards in judgments of binges. Moreover, they illustrate the reliability and sensitivity of the methodology, and its potential for further investigations of binge eating.

Perceptions of the family mealtime environment and adolescent mealtime behavior: do adults and adolescents agree?

The family mealtime environment has great potential to affect the eating behaviors of youth in the family. It is difficult to determine the important elements of a healthy mealtime environment because a valid assessment of the family environment is so difficult to obtain.The objective of this study is to examine the level of agreement between adult and adolescent perceptions of the family mealtime environment and adolescent mealtime behavior.A telephone survey was used to query adult and adolescent family members about how they perceive the family mealtime environment and the adolescent's mealtime behavior. A convenience sample of 282 adult/adolescent pairs from four schools in the Minneapolis/St. Paul area completed the telephone surveys. Frequencies of responses and the associations between the adult and adolescent responses are presented. Pearson correlations and regression were used to examine the level of association between adult and adolescent responses. Mixed-model regression was used for the continuous variables, and mixed-model logistic regression was used for the dichotomous variables. This study showed very little concordance between adolescent and adult responses. Only one question regarding arguments about eating during mealtime showed concordance. Adults and adolescents living in the same household seem to have different perceptions of the family mealtime environment and adolescent eating patterns. Researchers need to be aware of and concerned with the validity of the use of self-report for descriptions of family mealtime. They also need to be aware of the difference in adult and adolescent perceptions and consider these differences when designing messages for the family.

Using signs, artwork, and music to promote stair use in a public building.

OBJECTIVES: This study assessed the impact on stair use of improving the attractiveness of a stairwell. METHODS: Observations of stair usage were made in a university building during baseline, 2 interventions, and follow-up. The first intervention involved signs; the second intervention added artwork and music in the stairwell. RESULTS: More participants used the stairs during the music and artwork intervention than at baseline or when signs alone were used. CONCLUSIONS: Improving the aesthetic qualities of a stairwell can increase rates of stair usage in a public building. Designs for buildings should take accessibility and aesthetic issues into consideration.

Associations between exercise and health behaviors in a community sample of working adults.

BACKGROUND: The present study examined the associations between leisure-time exercise and a range of health behaviors and reports of illness and injury in a sample of community working adults. METHODS: The study population included 4907 women and 4136 men who completed surveys in 24 worksites in the Minneapolis-St. Paul metropolitan area. RESULTS: Participants in the study were ranked by gender according to their exercise score and grouped into quartiles. Women and men in the highest activity quartiles were more highly educated and were younger. High-activity men were more likely to be unmarried. Higher levels of leisure-time exercise were positively associated with seat belt use and inversely related to smoking, dietary fat intake, reported stress, and obesity. In men only, leisure-time exercise was related to greater reports of injuries resulting in restriction of usual activities. In women only, leisure-time exercise was positively associated with daily alcohol use. Most of the significant associations were seen in the two highest quartiles of exercise. CONCLUSIONS: These findings suggest that associations between leisure-time exercise and health behaviors occur at the higher levels of exercise and interventions may need to promote this higher level of leisure-time exercise to impact overall public health.