Using confidence interval-based estimation of relevance to explore bottom-up and top-down determinants of problematic eating behavior in children and adolescents with obesity from a dual pathway perspective

Prevalence of overweight and obesity in children and adolescents is high, not only in Western countries but also in developing countries. Efforts to improve prevention and treatment programs are needed. Given their essential role in weight problems, knowledge of determinants of problematic eating behavior ('External Eating' and 'Emotional Eating') is crucial for intervention development. Inspired by Appelhans' Dual Process Theory of Eating Behavior, the present study evaluated the importance of top-down regulative capacities and bottom-up reactivity, using the CIBER approach. CIBER is an innovative statistical approach to test the importance of behavior determinants, based on confidence intervals, instead of significance testing of point estimates. Survey data on different aspects of executive functioning (as indices of regulative capacities: Inhibition, Cognitive Flexibility, Emotional Control, Initiation, Working Memory, Planning/Organizing, Organization of materials, and Monitoring) and reward sensitivity (as an index of reactivity) were collected in a large sample of children and adolescents (n = 572) with severe obesity (adjBMI > 180%). Results showed that Emotional Eating is determined by Emotional Control, while External Eating is determined by Reward Sensitivity. The finding that differential mechanisms underlie different aspects of problematic eating suggests the need for using tailored intervention techniques to address altered reactivity and weak regulative capacities

Maladaptive eating in children and adolescents with obesity : scrutinizing differences in inhibition

Introduction In order to grasp the complex etiology of childhood obesity, we aim to clarify the relationship between external eating and weight. Based on theory and empirical evidence, we claim that inhibition is an important moderator in this association. In our first research question we expected that high external eating would be related to a higher weight status, especially for those with high inhibition problems. Secondly, we explored the moderating role of inhibition in the association between external eating and weight change after a multidisciplinary obesity treatment. Method We investigated n=572 participants (51% boys, aged 7-19) with moderate to extreme obesity recruited in a Belgian inpatient treatment center. At intake, parents reported on inhibition (BRIEF), while the children and adolescents reported on their eating behavior (DEBQ). Weight and length were objectively measured pre and post treatment (ADJUSTED BMI). Two hierarchical linear regression models were built to scrutinize the influence of inhibition on the association between external eating and both baseline weight and weight change. Results First, predicting baseline weight, we found no significant moderating effect of inhibition problems. Second, predicting weight loss, inhibition turned out to be a substantial moderator, specifically in adolescents. Some unexpected gender differences occurred in favor of adolescent boys, in a way that those with high external eating and low inhibition problems lost most weight. Conclusion Inhibition problems act as a moderator explaining weight loss, but this only holds for adolescents. This suggests that external eating and inhibition play a complex role in weight loss in certain age and gender categories, and stresses the importance of identifying subgroups for tailoring interventions. For those with high inhibition problems, interventions aimed at increasing inhibition skills might be needed to optimize treatment outcomes

A pictorial dot probe task to assess food-related attentional bias in youth with and without obesity : overview of indices and evaluation of their reliability

Several versions of the dot probe detection task are frequently used to assess maladaptive attentional processes associated with a broad range of psychopathology and health behavior, including eating behavior and weight. However, there are serious concerns about the reliability of the indices derived from the paradigm as measurement of attentional bias towards or away from salient stimuli. The present paper gives an overview of different attentional bias indices used in psychopathology research and scrutinizes three types of indices (the traditional attentional bias score, the dynamic trial-level base scores and the probability index) calculated from a pictorial version of the dot probe task to assess food-related attentional biases in children and youngsters with and without obesity. Correlational analyses reveal that dynamic scores (but not the traditional and probability indices) are dependent on general response speed. Reliability estimates are low for the traditional and probability indices. The higher reliability for the dynamic indices is at least partially explained by general response speed. No significant group differences between youth with and with obesity are found, and correlations with weight are also non-significant. Taken together, results cast doubt on the applicability of this specific task for both experimental and individual differences research on food-related attentional biases in youth. However, researchers are encouraged to make and test adaptations to the procedure or computational algorithm in an effort to increase psychometric quality of the task and to report psychometric characteristics of their version of the task for their specific sample

WELCOME : improving WEight controL and CO-Morbidities in children with obesity via Executive function training : study protocol for a randomized controlled trial

Background: Obesity is a widespread problem that not only leads to medical and psychological diseases in adults, but also in children and adolescents at an early stage in life. Because of its global burden on both the individual and society, it is necessary to develop effective evidence-based treatments. Current " Multidisciplinary Obesity Treatments" (MOT) already provide significant weight loss, but still leave room for more long-lasting improvements. In this protocol paper, we outline the research goals of the WELCOME trial, based on a substantial proof of concept. Methods: In this Randomized Controlled Trial (RCT) - conducted in both an inpatient and two outpatient treatment settings -existing MOT will be supplemented with an Executive Function (EF) training and compare effects on various parameters in an experimental versus an active control group of obese youngsters (8-18 years old). WELCOME aims to (a) train youngsters' executive functions to facilitate effects on weight loss, psychological and medical comorbidities, (b) to enhance the long-term effects by continuing the training in the daily home context with booster sessions, and (c) to investigate its effects until a 6-month follow-up. In comparison to the active control group, better progress is expected in the experimental group on following variables: weight, psychological comorbidities (unhealthy eating behavior, internalizing symptoms, impaired self-esteem) and medical comorbidities (metabolic syndromes, endothelia dysfunction, tonsillar hypertrophy and sleep obstruction). Discussion: It is stated that this EF-training for enhancing self-control abilities is necessary for a long-lasting effect of childhood obesity treatment interventions