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Pediatrics

Pathways to eating in children and adolescents with obesity

International Journal of Obesity volume 43, pages 1193–1201 (2019)Cite this article

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A Correction to this article was published on 19 February 2019

This article has been updated

Abstract

Background

Paediatric obesity management remains generalised to dietary and exercise modifications with an underappreciation for the contributions of eating behaviours and appetitive traits in the development of obesity.

Objectives

To determine whether treatment-seeking children and adolescents with obesity cluster into phenotypes based on known eating behaviours and appetitive traits (“eating correlates”) and how socio-demographic and clinical characteristics associate with different phenotypes.

Methods

A cross-sectional, multi-centre questionnaire was administered between November 2015 and March 2017 examining correlates of eating in children and adolescents attending weight-management programmes in Canada. Latent profile analysis was used to cluster participants based on seven eating correlate scores obtained from questionnaires. Analysis of variance (ANOVA) was used to determine phenotype differences on socio-demographic and clinical characteristics. Multinomial logistic regression models assessed relative risk of specific characteristics associating with a disordered eating phenotype.

Results

Participants were 247 children and adolescents (45.3% male, mean BMI z-score = 3.4 ± 1.0 kg/m2) from six paediatric weight management centres in Canada. Seven eating correlates clustered into three distinct phenotypes: (1) loss of control eating, emotional eating, external eating, hyperphagia, impulsivity (“Mixed-Severe”; n = 42, 17%), (2) loss of control eating, emotional eating, external eating, hyperphagia (“Mixed-Moderate”; n = 138, 55.9%), and (3) impulsivity (“Impulsive”; n = 67; 27.1%). Social functioning scores and body esteem were significantly different across groups, with the Mixed-Severe participants having the poorest social functioning and lowest body esteem. Low body esteem indicated a greater risk of being in a multi-correlate group compared to the Impulsive group, while poor social function had a greater risk of clustering in the Mixed-Severe than Impulsive phenotype.

Conclusions

Distinct eating phenotypes were found in treatment-seeking children and adolescents with obesity. Empirical evidence is needed, but these data suggest that tailored treatment approaches could be informed by these classifications to improve weight-management outcomes.

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Change history

  • 19 February 2019

    In the original version of this Article the following were listed as authors; however, they should have only been referred to in the Acknowledgments section and not listed in this way:

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Acknowledgements

Authors would like to acknowledge the CANPWR Investigators who provided input on various stages of this study: Geoff Ball11, Jean-Pierre Chanoine12, Josephine Ho13, Laurent Legault14, Pam Mackie5, Lehana Thabane15,5, Ian Zenlea16,17

Funding

This study was funded by a Canadian Institutes of Health Research Team Grant in Bariatric Care (Team to Address Bariatric Care in Canadian Children – Team ABC3; 2015-2020), which included partnership funding from the Ontario Ministry of Health and Long-Term Care, Canadian Obesity Network, and the Women and Children’s Health Research Institute (University of Alberta). This is a substudy of a larger study funded by an Open Operating Grant (MOP = 123505) from the Canadian Institutes of Health Research. Dr. Jill Hamilton is supported with unrestricted research funds by the University of Toronto Department of Paediatrics Mead Johnson Chair in Nutritional Science.

Author information

Authors and Affiliations

  1. Institute of Medical Science, University of Toronto, Toronto, Canada

    Hayyah Clairman, Debra K. Katzman & Jill Hamilton

  2. Department of Psychology, The Hospital for Sick Children, Toronto, Canada

    Elizabeth Dettmer

  3. Children’s Hospital of Eastern Ontario, Ottawa, Canada

    Annick Buchholz

  4. Department of Psychology, York University, Toronto, Canada

    Kristina Cordeiro

  5. Population Health Research Institute, McMaster University, Hamilton, Canada

    Quazi Ibrahim, Pam Mackie & Lehana Thabane

  6. School of Public Health, University of Alberta, Alberta, Canada

    Katerina Maximova

  7. Division of Adolescent Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada

    Alene Toulany & Debra K. Katzman

  8. Department of Psychiatry, Women’s College Hospital, Toronto, Canada

    Valerie H. Taylor

  9. Division of Endocrinology, Department of Pediatrics, McMaster Children’s Hospital, McMaster University, Hamilton, Canada

    Katherine M. Morrison

  10. Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada

    Jill Hamilton

  11. Department of Pediatrics, University of Alberta, Alberta, Canada

    Hayyah Clairman & Geoff Ball

  12. Department of Pediatrics, University of British Columbia, Vancouver, Canada

    Jean-Pierre Chanoine

  13. Department of Pediatrics, University of Calgary, Calgary, Canada

    Josephine Ho

  14. Department of Pediatrics, McGill University, Montreal, Canada

    Laurent Legault

  15. Department of Pediatrics, McMaster University, Hamilton, Canada

    Lehana Thabane

  16. Credit Valley Hospital, Toronto, ON, Canada

    Ian Zenlea

  17. Department of Pediatrics, University of Toronto, Toronto, ON, Canada

    Ian Zenlea

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  1. Hayyah Clairman
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  2. Elizabeth Dettmer
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  10. Katherine M. Morrison
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  11. Jill Hamilton
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  12. Geoff Ball
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  13. Jean-Pierre Chanoine
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  14. Josephine Ho
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  15. Laurent Legault
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  16. Pam Mackie
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  18. Ian Zenlea
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on behalf of the CANPWR Investigators

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Correspondence to Jill Hamilton.

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Clairman, H., Dettmer, E., Buchholz, A. et al. Pathways to eating in children and adolescents with obesity. Int J Obes 43, 1193–1201 (2019). https://doi.org/10.1038/s41366-018-0271-2

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