Grazing in children: associations with child's characteristics and parental feeding practices.

PURPOSE: Grazing is a problematic eating behavior linked with poor weight loss outcomes, disordered eating psychopathology, and psychological distress in the adult population. However, no study assessed this behavior in children. Childhood is an important time frame for the development and maintenance of healthy eating habits, which can be influenced by children's psychological state, eating habits, and parental practices. This study investigates the associations between grazing behavior in children and children's psychological variables (anxiety, depression and withdrawn symptoms, body image dissatisfaction), children eating habits, and parental feeding practices. METHODS: In this cross-sectional study, 330 primary school students (6-10 years old) and their parents completed measures assessing children's grazing, anxiety/depression and withdrawn symptoms, body image dissatisfaction, children eating habits and style, and parental feeding practices. RESULTS: The path analysis tested showed that more restrictive parental feeding practices, inappropriate children eating habits, children's anxiety/depression symptoms, and body image dissatisfaction were associated with increased grazing scores (CMIN = 12.679; DF = 11; p = 0.315; RMSEA = 0.025; CFI = 0.990; NFI = 0.935; TLI = 0.982; IFI = 0.991; SRMR = 0.045). CONCLUSION: Grazing tends to occur in a context of children's psychological distress, inappropriate children eating habits, and restrictive parental feeding practices. These variables should be addressed for the improvement of healthy eating habits and in weight-loss interventions for children. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

Does weight change relate to psychological variables and eating behaviours in combat sports?

PURPOSE: Athletes who perform combat sports tend to engage in weight-management strategies to fit in a specific weight class that are characterized by disordered eating behaviours. This study aimed to (1) characterize eating behaviours and adaptation to stress regarding an unwanted weight change before a competition; (2) evaluate the differences between athletes who consider unwanted weight changes as a challenge or as a threat in regard to emotions, coping strategies and eating behaviours; and (3) evaluate whether some of these variables related to the unwanted weight change (e.g., emotions, cognitive appraisal of the situation) are predictors of disordered eating behaviours in combat sports. METHODS: A total of 166 combat sports athletes (75.3% male), aged between 14 and 56 years (M = 22.73; SD = 8.03), filled out a set of questionnaires that evaluated personal variables, cognitive appraisal (threat/challenge), coping, emotions, and eating behaviours related to an unwanted weight change before a competition. RESULTS: Most of the athletes (57.3%) reported high levels of stress related to the experience of an unwanted weight change before a competition. Athletes who perceived this experience as more of a threat had significantly more eating concerns, anxiety, dejection, anger, active confrontation and emotional support. Athletes who perceived it as more of a challenge experienced more excitement and happiness. Athletes who perceived a high threat and low challenge experienced significantly increased anxiety levels and athletes who perceived this experience as a low threat and the low challenge had decreased anxiety. The desire to weigh less, the perception of a threat regarding weight changes, the ability to cope with denial, and anxiety emerged as predictors of disordered eating behaviours. CONCLUSION: To prevent or reduce disordered eating behaviours, it is important to promote adequate strategies to deal with weight changes before a competition and, consequently, positive emotions among sports combat athletes. LEVEL OF EVIDENCE: Level III, case-control analytic study.

A preliminary study on the psychosocial impact of COVID-19 lockdown in post-bariatric surgery women: the importance of eating behavior, health care access, and social support.

This study aims to characterize the psychosocial impact of COVID-19 lockdown for post-bariatric surgery (≥ 36 months) women and its association with disordered eating and psychological distress. The medium to long-time follow up is a period of increased susceptibility for poorer weight outcomes which might be triggered by the lockdown. Twenty-four participants responded to an online questionnaire and a telephone interview. About half (n = 14; 58.3%) reported perceived weight gain during the lockdown, 13 (54.1%) limited access to social support, and 12 (50%) limited access to medical care. Co-habiting with a higher number of persons during lockdown was associated with fewer difficulties in dealing with emotionally activating situations, less fear of gaining weight, less fear of losing control over eating, and less disordered eating. The global perceived psychosocial impact of lockdown was significantly correlated with difficulties in dealing with emotionally activating situations and stress symptoms. Results highlight the need to monitor post-bariatric patients, facilitate health care access, and promote social support during the lockdown period. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12144-021-01529-6.

Psychometric Properties of the Dimensional Yale Food Addiction Scale for Children 2.0 among Portuguese Adolescents.

The dimensional Yale Food Addiction Scale for Children 2.0 (dYFAS-C 2.0) was developed to provide a reliable psychometric measure for assessing food addiction in adolescents, in accordance with the updated addiction criteria proposed in the fifth edition of the Diagnostic and Statistical Manual (DSM-5). The present study aimed to evaluate the psychometric properties of the dYFAS-C 2.0 among Portuguese adolescents and pre-adolescents and to explore the relationship between food addiction and other eating behaviors such as grazing and intuitive eating. The participants were 131 Portuguese adolescents and pre-adolescents (53.4% female and 46.6% male) aged between 10 and 15 years (Mage = 11.8) and with a BMI between 11.3 and 35.3 (MBMI z-score = 0.42). Confirmatory Factor Analysis demonstrated an adequate fit for the original one-factor model (χ2 (104) = 182; p < 0.001; CFI = 0.97; TLI = 0.97; NFI = 0.94; SRMR = 0.101; RMSEA = 0.074; 95% CI [0.056; 0.091]). Food addiction was positively correlated with higher grazing (r = 0.69, p < 0.001) and negatively correlated with lower reliance on hunger/satiety cues (r = -0.22, p = 0.015). No significant association was found between food addiction and BMI z-score, or between food addiction and age. The results support the use of dYFAS-C 2.0 as a valid and reliable measure for assessing food addiction in Portuguese adolescents and pre-adolescents. Furthermore, the findings highlight that food addiction may be part of a spectrum of disordered eating behaviors associated with control impairment. Future research with a larger sample size could further elucidate the associations between food addiction and other variables, such as psychological distress and multi-impulsive spectrum behaviors.

Food Addiction and Grazing-The Role of Difficulties in Emotion Regulation and Negative Urgency in University Students.

University students are a vulnerable population to the development of disordered eating, such as food addiction (FA) and grazing. FA is an emerging concept characterized by an intense desire to eat hyper-palatable foods. Grazing is characterized by the repetitive and unplanned ingestion of food throughout a period of time. Both FA and grazing have been associated with increased scores of negative urgency (NU) and difficulties in emotion regulation (ER). This study aims to evaluate the frequency of FA and grazing in a university population and to test the direct, total, and indirect effects-via FA-of ER and NU on repetitive eating and compulsive grazing. A total of 338 participants responded to a set of psychological measures assessing these variables. Thirty-six (10.7%) participants met the criteria for FA diagnosis and 184 (54.4%) presented grazing. Confirmatory factor analysis showed acceptable fit indexes for the model tested (χ2(1695) = 3167.575; p < 0.001; CFI = 0.955; NFI = 0.908; TLI = 0.953; SRMR = 0.085; RMSEA = 0.051; CI 90% (0.048; 0.053); P[RMSEA ≤ 0.05] = 0.318) and suggested that FA partially mediated the effect of difficulties in ER and NU on grazing, specifically on compulsive grazing. The results indicate that individuals with difficulties in ER and impulse control under negative emotions are more likely to engage in grazing if food addiction scores are higher. These results highlight the importance of assessing these variables, particularly in at-risk populations such as university students.

Intuitive eating Scale-2: Factor structure and associations with disordered eating, impulsivity and quality of life in adolescents with overweight/obesity.

OBJECTIVE: The Intuitive Eating Scale-2 (IES-2) has been shown to be a valid tool to assess the capability of eating in reaction to natural hunger/satiety cues. However, its factor structure seems to differ in function of cultural/socioeconomic backgrounds, and its psychometric properties among the adolescents with overweight/obesity (BMI-for-age percentile >85th) have not been examined yet. Thus, this study aims to 1) investigating the factorial structure/psychometric properties of IES-2 in adolescents with overweight/obesity; and 2) exploring the associations between impulsivity, quality of life disordered and intuitive eating. METHODS: A total of 202 Portuguese adolescents (124 girls; 78 boys; 12-19 years) under weight-loss treatment with a mean BMI z-score of 2.41 (SD = 0.75) participated in this study. The IES-2 factor structure was explored by confirmatory factor analysis and bifactor models. Test-retest reliability analyses were performed over 6 months (n = 41) and associations between the variables under study were explored. RESULTS: Confirmatory factor analyses with posthoc modifications resulted in a bifactor model with acceptable fit supporting one general factor (intuitive eating) and three specific factors (IES-2 subscales). The "Unconditional Permission to Eat" subscale could not be replicated in this sample. Test-retest reliability analyses suggested good temporal stability. Intuitive eating scores were negatively associated with grazing eating behavior and impulsivity (negative urgency) and positively linked to quality of life. CONCLUSIONS: An adjusted version of IES-2 can be an appropriate measure for assessing intuitive eating levels in adolescents with overweight/obesity. Research on intuitive eating has the potential to enhance pediatric weight-loss interventions.

Food Addiction Problems in College Students: The Relationship between Weight-Related Variables, Eating Habits, and Food Choices.

The concept of food addiction, characterized by a strong urge to overeat highly palatable foods, has gained increased research attention over the last decade. College students are a recognized risk group for manifesting an eating pathology and weight gain due to the changes in eating habits experienced during this period. However, there is a gap in the literature connecting food addiction with eating and weight variables in this population. Thus, the present study aims to characterize food addiction in a sample of college students and enlighten the relationship between food addiction, weight-variables, eating habits, and food choices in this population. A sample of 194 college students (89.2% females) aged between 18 and 32 years old (M = 20.85, SD = 2.78) completed a set of self-reported online questionnaires on Google Forms. Namely, a Sociodemographic and Anthropometric Questionnaire, a questionnaire on Food Choices Characterization, the Eating Habits Scale, and the Portuguese Yale Food Addiction Scale 2.0. Thirty (22.2%) participants presented food addiction problems. The logistic regression models utilized suggest that participants in the group with food addiction problems are more likely to seek clinical help to control weight, to consider that they should eat less food high in sugar, and to report lower food adequacy. In sum, this finding highlighted a connection between food addiction, weight dissatisfaction, eating habits, and food choices in college students, a population at risk for developing and retaining eating pathologies. Further research is essential to evaluate and implement interventions regarding food addiction, weight dissatisfaction, eating habits, and food choices in college students.

Experiences of parent-adolescent dyads regarding a Facebook-based intervention to improve overweight/obesity treatment in adolescents: A qualitative study.

APOLO-Teens is a Facebook-based psychological intervention aiming to optimize hospital treatment for adolescents with overweight/obesity. The present qualitative study aims to explore (1) how adolescents experienced participation in APOLO-Teens and (2) how parents perceived adolescents' participation. Sixteen adolescent-parent dyads were interviewed by telephone using semistructured guides. An inductive approach of thematic analysis was used to analyze data by two independent codifiers. The consensus was used to resolve differences in coding/themes, and two independent auditors reviewed the codes and the themes proposed. We identified four themes from adolescents' interviews, namely, expectations, perception of outcomes, participation in the intervention, and sharing of acquired knowledge. From parents' interviews, we identified five themes: expectations for son/daughter participation, perception of adolescents' outcomes, son/daughter participation, parental role, and use of social networks in intervention programs for adolescents. Both elements of the dyad indicated that adolescents' participation in APOLO-Teens contributed to favorable outcomes, further highlighting the use of online interventions to complement the hospital treatment of adolescents with overweight/obesity. Future studies should address the viewpoints of adolescents and parents in the design of Facebook-based interventions, namely, to implement tailored, shorter, less time-demanding interventions that favor engagement between participants and parental involvement.

Eating behaviors and weight outcomes in bariatric surgery patients amidst COVID-19.

BACKGROUND: Recent studies suggest that eating habits are an area particularly affected by the lockdown imposed by many countries to curb the COVID-19 epidemic. Individuals that received bariatric surgery may represent a particularly susceptible population to the adverse effects of lockdown for its potential impact on eating, psychological, and weight loss outcomes. OBJECTIVES: This study seeks to investigate the incremental impact of COVID-19 lockdown on treatment outcomes of postbariatric patients in the risk period for weight regain. SETTING: Main hospital center. METHODS: This work uses data from an ongoing longitudinal study of bariatric patients assessed before surgery (T0), 1.5 years after sugery (T1), and 3 years after surgery (T2). Two independent groups were compared: the COVID-19_Group (n = 35) where T0 and T1 assessments were conducted before the pandemic started and T2 assessment was conducted at the end of the mandatory COVID-19 lockdown; and the NonCOVID-19_Group (n = 66), covering patients who completed T0, T1, and T2 assessments before the epidemic began. Assessment included self-report measures for disordered eating, negative urgency, depression, anxiety, stress, and weight outcomes. RESULTS: General linear models for repeated measures showed that the COVID-19_Group presented significantly higher weight concern (F = 8.403, P = .005, ƞ2p = .094), grazing behavior (F = 7.166, P = .009, ƞ2p = .076), and negative urgency (F = 4.522, P = .036, ƞ2p = .05) than the NonCOVID-19_Group. The COVID-19_Group also showed less total weight loss (F = 4.029, P = .05, ƞ2p = .04) and larger weight regain at T2, with more COVID-19_Group participants experiencing excessive weight regain (20% versus 4.5%). CONCLUSION: These results show evidence for the impact of the coronavirus outbreak on eating-related psychopathology and weight outcomes in postbariatric surgery patients.

Weight loss expectations and weight loss after surgery: the mediating role of body image and weight concerns.

BACKGROUND: Preliminary evidence suggests bariatric patients' unrealistic expectations regarding weight loss after bariatric surgery are related to worse weight outcomes. OBJECTIVES: This study aimed to examine preoperative weight loss expectations and their association with weight loss, body image, eating behavior, and depressive symptoms. SETTING: Hospital Centers, Portugal. METHODS: This longitudinal study assessed 64 bariatric patients. Participants were asked about their desired postoperative weight and responded to the following set of self-report measures before and 2 years after surgery: Eating Disorder Examination Questionnaire, Beck Depression Inventory, and Body Shape Questionnaire. RESULTS: The majority of participants (81.1%) did not reach the desired weight, 10 (13.5%) lost more weight than initially expected, and only 4 (5.4%) obtained the desired weight. More discrepant expectations were associated with more dissatisfaction with the body image and higher scores concerning eating psychopathology after surgery but not presurgery. Postsurgery body dissatisfaction and weight concerns were significant mediators in the relationship between discrepant expectations and poorer weight loss. CONCLUSIONS: This study shows bariatric patients hold preoperative unrealistic expectations about their weight loss, and that they sustain those expectations in the postoperative time. Our findings bring evidence for an interplay between preoperative and postoperative factors to explain weight loss. Educating about flexible weight loss goals before surgery may be a simple strategy to optimize psychological functioning and weight loss after surgery.

Maternal Eating Behavior and Problematic Eating Behaviors of Children Undergoing Weight Loss Treatment: A Cluster Analysis.

Background: Research on the interplay between mothers' and children's eating behaviors is needed to better inform sensitive and tailored interventions for treatment-seeking children with overweight/obesity. The present study aimed to identify mothers' eating behavior phenotypes, investigating their associations with problematic eating behaviors of children undergoing weight loss treatment in two central hospitals. Methods: This is a cross-sectional study evaluating 136 mother-child dyads (Mothers: age 39.58 ± 5.40 years; Children: n = 75 female; age 10.13 ± 1.37 years). Mothers' eating behavior (restraint, emotional, and uncontrolled eating) and depression/anxiety, and children's problematic eating attitudes/behaviors were assessed. A cluster analysis (K-means) was performed using mothers' eating behavior dimensions. Multivariate Analysis of Covariance investigated differences between clusters on mothers' and children's sociodemographic, anthropometric, psychological, and eating-related variables. Results: Three clusters emerged: The Disordered Eating group (n = 39) of mothers with the highest scores on emotional eating and uncontrolled eating dimensions, the Restraint Eating group (n = 48), including mothers scoring high in cognitive restraint, and the Low Disordered Eating (n = 49) group where mothers scored low in all eating behavior dimensions. Children of mothers in the Disordered Eating cluster had significantly higher emotional overeating relative to children of mothers in the other two clusters. Conclusions: Distinctive eating behavior profiles of mothers, instead of the presence of single eating behaviors, seem to be associated with specific problematic eating behaviors of children undergoing weight loss treatment. Prospective studies are essential to determine whether these profiles can predict differential weight change trajectories in pediatric obesity treatment.

Percepções sobre uma intervenção on-line para adolescentes com excesso de peso/obesidade: estudo preliminar / Perceptions on online intervention for overweight/obese adolescents: a preliminary study

Este estudo teve como objetivo analisar as percepções de satisfação dos participantes sobre o APOLO-Teens e fatores comportamentais/psicológicos associados. O APOLO-Teens é um programa psicoeducacional, implementado no Facebook®, durante seis meses, como complemento ao tratamento hospitalar convencional para adolescentes com excesso de peso/obesidade. Participaram 52 adolescentes (71,2% do sexo feminino; M = 14,98 anos, DP = 1,63) que foram alvo do programa APOLO-Teens. Foram avaliados com recurso a medidas de autorrelato quanto à sintomatologia depressiva, qualidade de vida e comportamento alimentar no início, no meio (3 meses) e final da intervenção (6 meses) e preencheram o questionário que avaliou as percepções sobre a participação no programa de intervenção aos 6 meses. Em geral, os participantes revelaram percepções positivas e satisfação com o programa. As sessões de chat tiveram baixa adesão e a maioria dos participantes preferia uma intervenção mais curta. O tema preferido foi "atividade física" e o preterido "alimentação saudável". Verificou-se uma correlação negativa entre satisfação com os resultados e sintomatologia depressiva e comportamento alimentar disfuncional. Como conclusões vale ressaltar alguns aspectos importantes: 1) reconsiderar a duração do programa e tornar as sessões de chat e o tema "alimentação saudável" mais atraentes; 2) priorizar a sintomatologia depressiva e os comportamentos alimentares disfuncionais como forma de otimizar a adesão a estas intervenções.

Satisfaction perception of participants with regard to APOLO-teens and associated behavior and psychological factors are investigated. APOLO-teens is a psycho-educational program implemented by Facebook®, during six months, supplementary to conventional hospital treatment for obese/overweight adolescents. Fifty-two adolescents (71.2% females; M = 14.98 years, DP = 1.63) participated and evaluated by self-reported measures with regard to depression symptoms, life quality and feeding behavior at the start, in the middle (three months) and at the end (six months) of the intervention. A questionnaire was filled with their perceptions on the intervention program after 6 months. As a rule, positive perceptions were given. Chat sessions had low adhesion and post participants preferred a shorter intervention. Preferred theme comprised physical activity, whilst the less appreciated theme was health food. There was a negative co-relationship between satisfaction with results and depression and dysfunctional food behavior. It is important (1) to reconsider duration and make chat and health food more attractive; (2) give priority to depression symptoms and dysfunctional food behavior for better adhesion to intervention.