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Pediatrics

Pediatric weight management interventions improve prevalence of overeating behaviors

International Journal of Obesity volume 46, pages 630–636 (2022)Cite this article

Subjects

Abstract

Objective

To examine changes in prevalence of overeating behaviors in a comparative effectiveness study of two pediatric weight management interventions.

Methods

Four-hundred and seven children, ages 6–12 years, with a BMI ≥ 85th percentile were enrolled in a comparative effectiveness trial of two pediatric weight management interventions. Prevalence of “sneaking, hiding or hoarding food”, and ‘eating in the absence of hunger’ was evaluated at baseline and 12 months. Statistical methods included McNemar’s test and longitudinal logistic regression.

Results

Prevalence of “sneak, hide, or hoard food” significantly decreased in all participants from 29.1% to 20.7% at 12 months. The prevalence of “eating in the absence of hunger” decreased in all participants from 46.7% to 22.4% at 12 months. Use of SNAP benefits, free/reduced meals at school, parental stress, housing, and food insecurity at baseline were associated with an increased likelihood of endorsing overeating behaviors at 12 months. Conversely, those who engaged in at least one session of the pediatric weight management intervention were significantly less likely to endorse “eating in the absence of hunger” at 12 months.

Conclusions

Participation in pediatric weight management interventions improves the prevalence of overeating behaviors and is associated with participant engagement and social determinants of health, specifically food security status. Efforts to engage populations impacted by food insecurity and other social determinants of health risk factors will be critical for success of weight management interventions.

Clinical trial registration

This trial has been registered at ClinicalTrials.gov (identifier: NCT03012126).

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References

  1. US Preventive Services Task F, Grossman DC, Bibbins-Domingo K, Curry SJ, Barry MJ, Davidson KW, et al. Screening for obesity in children and adolescents. JAMA. 2017;317:2417–26. https://doi.org/10.1001/jama.2017.6803

    Article  Google Scholar 

  2. US Preventive Services Task Force. Screening for obesity in children and adolescents: recommendation statement. JAMA. 2017;317:2417–26. https://doi.org/10.1001/jama.2017.6803

  3. Kumar S, Kelly AS. Review of childhood obesity: from epidemiology, etiology, and comorbidities to clinical assessment and treatment. Mayo Clin Proc. 2017;92:251–65. https://doi.org/10.1016/j.mayocp.2016.09.017

    Article  PubMed  Google Scholar 

  4. Skelton JA, Palakshappa D, Moore JB, Irby MB, Montez K, Rhodes SD. Community engagement and pediatric obesity: Incorporating social determinants of health into treatment. J Clin Transl Sci. 2019;4:279–85. https://doi.org/10.1017/cts.2019.447

    Article  PubMed  PubMed Central  Google Scholar 

  5. Graham H, White PCL. Social determinants and lifestyles: integrating environmental and public health perspectives. Public Health. 2016;141:270–8. https://doi.org/10.1016/j.puhe.2016.09.019

    Article  CAS  PubMed  Google Scholar 

  6. Hanson KL, Connor LM. Food insecurity and dietary quality in US adults and children: a systematic review. Am J Clin Nutr. 2014;100:684–92. https://doi.org/10.3945/ajcn.114.084525

    Article  CAS  PubMed  Google Scholar 

  7. Leung CW, Epel ES, Ritchie LD, Crawford PB, Laraia BA. Food insecurity is inversely associated with diet quality of lower-income adults. J Acad Nutr Diet. 2014;114:1943–e2. https://doi.org/10.1016/j.jand.2014.06.353

    Article  PubMed  Google Scholar 

  8. Bruening M, MacLehose R, Loth K, Story M, Neumark-Sztainer D. Feeding a family in a recession: food insecurity among Minnesota parents. Am J Public Health. 2012;102:520–6. https://doi.org/10.2105/AJPH.2011.300390

    Article  PubMed  PubMed Central  Google Scholar 

  9. Seligman HK, Berkowitz SA. Aligning programs and policies to support food security and public health goals in the United States. Annu Rev Public Health. 2019;40:319–37. https://doi.org/10.1146/annurev-publhealth-040218-4132

    Article  PubMed  Google Scholar 

  10. Tester JM, Lang TC, Laraia BA. Disordered eating behaviors and food insecurity: a qualitative study about children with obesity in low-income households. Obes Res Clin Pract. 2016;10:544–52. https://doi.org/10.1016/j.orcp.2015.11.007

    Article  PubMed  Google Scholar 

  11. Hooper L, Telke S, Larson N, Mason SM, Neumark-Sztainer D. Household food insecurity: associations with disordered eating behaviours and overweight in a population-based sample of adolescents. Public Health Nutr. 2020;23:3126–35. https://doi.org/10.1017/S1368980020000464

    Article  PubMed  PubMed Central  Google Scholar 

  12. Fiechtner L, Perkins M, Biggs V, Langhans N, Sharifi M, O'connor G, et al. Rationale and design of the clinic and community approaches to healthy weight randomized trial. Contemp Clin Trials. 2018;67:16–22. https://doi.org/10.1016/j.cct.2018.01.002

    Article  PubMed  PubMed Central  Google Scholar 

  13. Giuse NB, Koonce TY, Kusnoor SV, Prather AA, Gottlieb LM, Huang LC, et al. Institute of medicine measures of social and behavioral determinants of health: a feasibility study. Am J Prev Med. 2017;52:199–206. https://doi.org/10.1016/j.amepre.2016.07.033

    Article  PubMed  Google Scholar 

  14. Elo AL, Leppänen A, Jahkola A. Validity of a single-item measure of stress symptoms. Scand J Work Environ Health. 2003;29:444–51. https://doi.org/10.5271/sjweh.752

    Article  PubMed  Google Scholar 

  15. Atkins M, Castro I, Sharifi M, Perkins M, O'connor G, Sandel M, et al. Unmet social needs and adherence to pediatric weight management interventions: Massachusetts, 2017–-9. Am J Public Health. 2020;110:S251–S257. https://doi.org/10.2105/AJPH.2020.305772

    Article  PubMed  PubMed Central  Google Scholar 

  16. Urban Institute and Child Trends. National Survey of America’s Familities (NASF); 2002

  17. Hager ER, Quigg AM, Black MM, Coleman SM, Heeren T, Rose-Jacobs R, et al. Development and validity of a 2-item screen to identify families at risk for food insecurity. Pediatrics. 2010;126:e26–e32

    Article  PubMed  Google Scholar 

  18. Nobles JD, Perez A, Skelton JA, Spence ND, Ball GD. The engagement pathway: a conceptual framework of engagement-related terms in weight management. Obes Res Clin Pract. 2018;12:133–8. https://doi.org/10.1016/j.orcp.2017.12.005

    Article  PubMed  Google Scholar 

  19. Khanal S, Choi L, Innes-Hughes C, Rissel C. Dose response relationship between program attendance and children’s outcomes in a community based weight management program for children and their families. BMC Public Health. 2019;19:716 https://doi.org/10.1186/s12889-019-7094-5

    Article  PubMed  PubMed Central  Google Scholar 

  20. Sonneville KR, Horton NJ, Micali N, Crosby RD, Swanson SA, Solmi F, et al. Longitudinal associations between binge eating and overeating and adverse outcomes among adolescents and young adults: does loss of control matter? JAMA Pediatr. 2013;167:149–55. https://doi.org/10.1001/2013.jamapediatrics.12

    Article  PubMed  PubMed Central  Google Scholar 

  21. Russell H, Oliver C. The assessment of food-related problems in individuals with Prader-Willi syndrome. Br J Clin Psychol. 2003;42:379–92. https://doi.org/10.1348/014466503322528928

    Article  PubMed  Google Scholar 

  22. Yanovski SZ, Marcus MD, Wadden TA, Walsh BT. The Questionnaire on Eating and Weight Patterns-5: an updated screening instrument for binge eating disorder. Int J Eat Disord. 2015;48:259–61. https://doi.org/10.1002/eat.22372

    Article  PubMed  Google Scholar 

  23. Johnson WG, Grieve FG, Adams CD, Sandy J. Measuring binge eating in adolescents: adolescent and parent versions of the questionnaire of eating and weight patterns. Int J Eat Disord. 1999;26:301–14. 10.1002/(sici)1098-108x(199911)26:3<301::aid-eat8>3.0.co;2-m

    Article  CAS  PubMed  Google Scholar 

  24. Fairburn CG. Overcoming binge eating, Second Edition: The proven program to learn why you binge and how you can stop. Guilford Publications; 2013

  25. Rasmusson G, Lydecker JA, Coffino JA, White MA, Grilo CM. Household food insecurity is associated with binge-eating disorder and obesity. Int J Eat Disord. 2019;52:28–35. https://doi.org/10.1002/eat.22990

    Article  Google Scholar 

  26. West CE, Goldschmidt AB, Mason SM, Neumark‐Sztainer D. Differences in risk factors for binge eating by socioeconomic status in a community‐based sample of adolescents: findings from Project EAT. Int J Eat Disord. 2019;52:659–68

    PubMed  PubMed Central  Google Scholar 

  27. Leung CW, Stewart AL, Portela-Parra ET, Adler NE, Laraia BA, Epel ES. Understanding the psychological distress of food insecurity: a qualitative study of children’s experiences and related coping strategies. J Acad Nutr Diet. 2020;120:395–403. https://doi.org/10.1016/j.jand.2019.10.012

    Article  PubMed  PubMed Central  Google Scholar 

  28. West CE, Goldschmidt AB, Mason SM, Neumark‐Sztainer D. Differences in risk factors for binge eating by socioeconomic status in a community‐based sample of adolescents: Findings from Project EAT. Int J Eat Disord. 2019;52:659–68

    PubMed  PubMed Central  Google Scholar 

  29. Fram MS, Frongillo EA, Jones SJ, Williams RC, Burke MP, DeLoach KP, et al. Children are aware of food insecurity and take responsibility for managing food resources. J Nutr. 2011;141:1114–9. https://doi.org/10.3945/jn.110.135988

    Article  CAS  PubMed  Google Scholar 

  30. Brown AGM, Esposito LE, Fisher RA, Nicastro HL, Tabor DC, Walker JR. Food insecurity and obesity: research gaps, opportunities, and challenges. Transl Behav Med. 2019;9:980–7. https://doi.org/10.1093/tbm/ibz117

    Article  PubMed  PubMed Central  Google Scholar 

  31. Berger AT, Widome R, Erickson DJ, Laska MN, Harnack LJ. Changes in association between school foods and child and adolescent dietary quality during implementation of the Healthy, Hunger-Free Kids Act of 2010. Ann Epidemiol. 2020;47:30–36. https://doi.org/10.1016/j.annepidem.2020.05.013

    Article  PubMed  Google Scholar 

  32. Tester JM, Leung CW, Crawford PB, Revised WIC. Food package and children’s diet quality. Pediatrics. 2016;137:e20153557 https://doi.org/10.1542/peds.2015-3557

    Article  PubMed  PubMed Central  Google Scholar 

  33. Eicher-Miller HA. A review of the food security, diet and health outcomes of food pantry clients and the potential for their improvement through food pantry interventions in the United States. Physiol Behav. 2020;220:112871 https://doi.org/10.1016/j.physbeh.2020.112871

    Article  CAS  PubMed  Google Scholar 

  34. Trude ACB, Kharmats AY, Hurley KM, Anderson Steeves E, Talegawkar SA, Gittelsohn J. Household, psychosocial, and individual-level factors associated with fruit, vegetable, and fiber intake among low-income urban African American youth. BMC Public Health. 2016;16:872 https://doi.org/10.1186/s12889-016-3499-6

    Article  PubMed  PubMed Central  Google Scholar 

  35. Nightingale CM, Rudnicka AR, Ram B, Shankar A, Limb ES, Procter D, et al. Housing, neighbourhood and sociodemographic associations with adult levels of physical activity and adiposity: baseline findings from the ENABLE London study. BMJ Open. 2018;8:e021257 https://doi.org/10.1136/bmjopen-2017-021257

    Article  PubMed  PubMed Central  Google Scholar 

  36. Nobari TZ, Whaley SE, Blumenberg E, Prelip ML, Wang MC. Severe housing-cost burden and obesity among preschool-aged low-income children in Los Angeles County. Prev Med Rep. 2019;13:139–45. https://doi.org/10.1016/j.pmedr.2018.12.003

    Article  PubMed  Google Scholar 

  37. Lohman BJ, Stewart S, Gundersen C, Garasky S, Eisenmann JC. Adolescent overweight and obesity: links to food insecurity and individual, maternal, and family stressors. J Adolesc Health. 2009;45:230–7. https://doi.org/10.1016/j.jadohealth.2009.01.003

    Article  PubMed  Google Scholar 

  38. Parks EP, Kumanyika S, Moore RH, Stettler N, Wrotniak BH, Kazak A. Influence of stress in parents on child obesity and related behaviors. Pediatrics. 2012;130:e1096–104. https://doi.org/10.1542/peds.2012-0895

    Article  PubMed  PubMed Central  Google Scholar 

  39. Shankardass K, McConnell R, Jerrett M, Lam C, Wolch J, Milam J, et al. Parental stress increases body mass index trajectory in pre-adolescents. Pediatr Obes. 2014;9:435–42. https://doi.org/10.1111/j.2047-6310.2013.00208.x

    Article  CAS  PubMed  Google Scholar 

  40. Parks EP, Kazak A, Kumanyika S, Lewis L, Barg FK. Perspectives on stress, parenting, and children’s obesity-related behaviors in black families. Health Educ Behav. 2016;43:632–40. https://doi.org/10.1177/1090198115620418

    Article  PubMed  PubMed Central  Google Scholar 

  41. Baskind MJ, Taveras EM, Gerber MW, Fiechtner L, Horan C, Sharifi M. Parent-perceived stress and its association with children’s weight and obesity-related behaviors. Prev Chronic Dis. 2019;16:180368 https://doi.org/10.5888/pcd16.180368

    Article  Google Scholar 

  42. Adam TC, Epel ES. Stress, eating and the reward system. Physiol Behav. 2007;91:449–58. https://doi.org/10.1016/j.physbeh.2007.04.011

    Article  CAS  PubMed  Google Scholar 

  43. Tomiyama AJ, Dallman MF, Epel ES. Comfort food is comforting to those most stressed: evidence of the chronic stress response network in high-stress women. Psychoneuroendocrinology. 2011;36:1513–9. https://doi.org/10.1016/j.psyneuen.2011.04.005

    Article  PubMed  PubMed Central  Google Scholar 

  44. Torres SJ, Nowson CA. Relationship between stress, eating behavior, and obesity. Nutrition. 2007;23:887–94. https://doi.org/10.1016/j.nut.2007.08.008

    Article  PubMed  Google Scholar 

  45. Goulding AN, Rosenblum KL, Miller AL, Peterson KE, Chen YP, Kaciroti N, et al. Associations between maternal depressive symptoms and child feeding practices in a cross-sectional study of low-income mothers and their young children. Int J Behav Nutr Phys Act. 2014;11:75 https://doi.org/10.1186/1479-5868-11-75

    Article  PubMed  PubMed Central  Google Scholar 

  46. Bronte-Tinkew J, Zaslow M, Capps R, Horowitz A, McNamara M. Food insecurity works through depression, parenting, and infant feeding to influence overweight and health in toddlers. J Nutr. 2007;137:2160–5. https://doi.org/10.1093/jn/137.9.2160

    Article  CAS  PubMed  Google Scholar 

  47. Tate EB, Wood W, Liao Y, Dunton GF. Do stressed mothers have heavier children? A meta-analysis on the relationship between maternal stress and child body mass index. Obes Rev. 2015;16:351–61. https://doi.org/10.1111/obr.12262

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Golan M, Kaufman V, Shahar DR. Childhood obesity treatment: targeting parents exclusively v. parents and children. Br J Nutr. 2006;95:1008–15. https://doi.org/10.1079/bjn20061757

    Article  CAS  PubMed  Google Scholar 

  49. Wrotniak BH, Epstein LH, Paluch RA, Roemmich JN. The relationship between parent and child self-reported adherence and weight loss. Obes Res. 2005;13:1089–96. https://doi.org/10.1038/oby.2005.127

    Article  PubMed  Google Scholar 

  50. Saelens BE, McGrath AM. Self-monitoring adherence and adolescent weight control efficacy. Child Health Care. 2003;32:137–52. https://doi.org/10.1207/S15326888CHC3202_5

    Article  Google Scholar 

  51. Germann JN, Kirschenbaum DS, Rich BH. Child and parental self-monitoring as determinants of success in the treatment of morbid obesity in low-income minority children. J Pediatr Psychol. 2007;32:111–21. https://doi.org/10.1093/jpepsy/jsl007

    Article  PubMed  Google Scholar 

  52. Steele MM, Steele RG, Hunter HL. Family adherence as a predictor of child outcome in an intervention for pediatric obesity: different outcomes for self-report and objective measures. Child Health Care. 2009;38:64–75. https://doi.org/10.1080/02739610802615898

    Article  Google Scholar 

  53. Theim KR, Sinton MM, Goldschmidt AB, Van Buren DJ, Doyle AC, Saelens BE, et al. Adherence to behavioral targets and treatment attendance during a pediatric weight control trial. Obesity. 2013;21:394–7. https://doi.org/10.1002/oby.20281

    Article  PubMed  Google Scholar 

  54. Cena H, Stanford FC, Ochner L, Fonte ML, Biino G, De Giuseppe R, et al. Association of a history of childhood-onset obesity and dieting with eating disorders. Eat Disord. 2017;25:216–29. https://doi.org/10.1080/10640266.2017.1279905

    Article  PubMed  PubMed Central  Google Scholar 

  55. Fairburn CG, Wilson GT, Schleimer K. Binge eating: nature, assessment, and treatment. Guilford Press; 1993

  56. Gormally J, Black S, Daston S, Rardin D. The assessment of binge eating severity among obese persons. Addict Behav. 1982;7:47–55. https://doi.org/10.1016/0306-4603(82)90024-7

    Article  CAS  PubMed  Google Scholar 

  57. Goldschmidt AB. Are loss of control while eating and overeating valid constructs? A critical review of the literature. Obes Rev. 2017;18:412–49. https://doi.org/10.1111/obr.12491

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

This study was supported by the Centers for Disease Control and Prevention National Center for Chronic Disease Prevention and Health Promotion (Award no.: U18DP006259). Dr Fiechtner is supported by grant number K23HD090222 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Dr Harshman is supported by grant number F32MH118824 from the National Institute of Mental Health. Dr Taveras is supported by grant K24 DK10589 from the National Institute of Diabetes and Digestive and Kidney Diseases. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Centers for Disease Control, or the National Institutes of Health.

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Authors and Affiliations

  1. Neuroendocrine Unit, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA

    Stephanie G. Harshman

  2. Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA

    Stephanie G. Harshman

  3. Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, 125 Nashua Street, Suite 860, Boston, MA, USA

    Ines Castro, Meghan Perkins, Man Luo, Katelee Barrett Mueller, Elsie Taveras & Lauren Fiechtner

  4. Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy

    Hellas Cena, Sandra Portale & Benedetta Raspini

  5. Clinical Nutrition and Dietetics Service, Unit of Internal Medicine and Endocrinology, ICS Maugeri IRCCS, Pavia, Italy

    Hellas Cena

  6. Department of Gastroenterology and Nutrition, MassGeneral Hospital for Children, 175 Cambridge St, Boston, MA, USA

    Lauren Fiechtner

  7. Greater Boston Food Bank, 70S. Bay Avenue, Boston, MA, 02118, USA

    Lauren Fiechtner

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Contributions

LF and ET were involved in all parts of the study, including study concept and design, obtaining funding, data collection, analysis, and writing of manuscript; MP was involved in administrative, technical, and material support of the study as well as design of the analysis; ML conducted the data analysis, SGH and SP, KBM, HC, IC, and BR were involved in the data analysis plan development and execution, and manuscript preparation; all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Stephanie G. Harshman.

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Harshman, S.G., Castro, I., Perkins, M. et al. Pediatric weight management interventions improve prevalence of overeating behaviors. Int J Obes 46, 630–636 (2022). https://doi.org/10.1038/s41366-021-00989-x

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