Are Peripheral Biomarkers Determinants of Eating Styles in Childhood and Adolescence Obesity? A Cross-Sectional Study

Disturbances in eating behaviors have been widely related to obesity. However, little is known about the role of obesity-related biomarkers in shaping habitual patterns of eating behaviors (i.e., eating styles) in childhood. The objective of the present study was to explore the relationships between several biomarkers crucially involved in obesity (ghrelin, insulin resistance, and leptin/adiponectin ratio) and eating styles in children and adolescents with obesity. Seventy participants aged between 8 and 16 (56.2% men) fulfilled the Spanish version of the Dutch Eating Behavior Questionnaire for Children to measure external, emotional, and restrained eating styles. In addition, concentrations of ghrelin, leptin, adiponectin, insulin, and glucose were obtained through a blood test. Hierarchical multiple regression analyses controlling for age and sex were computed for each eating style. Results indicated that individuals with higher ghrelin concentration levels showed lower scores in restrained eating (β = −0.61, p < 0.001). The total model explained 32% of the variance of the restrained pattern. No other relationships between obesity-related biomarkers and eating behaviors were found. This study highlights that one of the obesity-risk factors, namely lower plasma ghrelin levels, is substantially involved in a well-known maladaptive eating style, restraint eating, in childhood obesity.

The relationship between reward context and inhibitory control, does it depend on BMI, maladaptive eating, and negative affect?

Background Recent studies suggest that higher Body Mass Index (BMI) is associated with reduced inhibitory control in contexts of palatable food. However, due to limitations of previous studies, it remained the question whether this reduction is specific to food contexts, and whether it generalizes to other contexts of reward, such as money. This main question was addressed in the current study. In addition, we explored the effect of maladaptive eating and stress regarding inhibitory control across the contexts that differed in terms of reward. Methods In total, 46 participants between 19 and 50 years old (39% males and 61% females) with an average BMI of 23.5 (SD = 3.9) participated. Participants filled out questionnaires and performed a go/no-go task (indexing inhibitory control) with three conditions (neutral, food, and money condition). Results Relatively high (above median) BMI was associated with challenged inhibitory control in the food relative to the neutral context, but not in the money relative to neutral context. Explorative analyses suggested that maladaptive eating and stress were associated with reduced inhibitory control in the food context. Only rumination was associated with reduced inhibitory control in the money context. Conclusions The effects of BMI, maladaptive eating behavior, and stress on inhibitory control were specific to the food context, and did not generalize to a non-intrinsic reward condition, operationalized with money pictures. Our results imply that (research on) interventions directed at improving inhibitory control in relation to overweight and obesity, should consider food-reward context.

Negative Affect and Maladaptive Eating Behavior as a Regulation Strategy in Normal-Weight Individuals: A Narrative Review

Emotions have a powerful influence on eating behavior, and eating behavior can have a powerful effect on emotions. The objective of the present narrative review was to evaluate the relationship between negative affect and maladaptive eating behavior as a regulation strategy in normal-weight individuals. A search of the literature within PubMed®, MEDLINE® and PsycINFO was conducted using a combination of the following terms: “affect”, “negative affect”, “affect regulation” and “maladaptive eating behavior”. A total of 106 papers were identified for full text review and were included in the final set of literature. The manuscript presents an overview of the literature on negative affect and maladaptive eating behavior. It offers a brief overview of restrained, uncontrolled and emotional eating in normal-weight individuals and looks at maladaptive eating behavior used to regulate their affect. Based on the previous research findings, we argue that using more adaptive strategies for emotion regulation (cognitive reappraisal) might result in downregulating integral negative affect to food and in improving eating behavior.

Contributing roles of depression, anxiety, and impulsivity dimensions in eating behaviors styles in surgery candidates

Background Even if bariatric surgery is considered the most effective therapeutic approach, it is not equally successful among individuals suffering from severe obesity and candidates for this weight loss surgery. Among the factors that influence postsurgical outcomes, eating behaviors styles are known to play a key role in relapses. The aim of our study was to assess eating behaviors styles and several modulating psychopathological factors in patients suffering from severe obesity. Methods Patients seeking bariatric surgery (N = 127) completed a set of standardized tools assessing eating behaviors (Dutch Eating Behavior Questionnaire), comorbid psychiatric conditions (Mini International Neuropsychiatric Interview), depression, and anxiety scores (Beck Depression Inventory, State-Trait Anxiety Inventory), and impulsivity scores (UPPS-P Impulsive Behavior Scale). Results We detected significant correlations between DEBQ Emotional Eating (EmoE) and depression, state and trait anxiety, and all dimensions of impulsivity. Significant correlations were also present between DEBQ External Eating (ExtE) and depression, state and trait anxiety and UPPS-P positive urgency, lack of perseverance and sensation seeking. Regression analyses identified sex (female), trait anxiety, and lack of perseverance as explanatory factors for EmoE, and depression severity score and positive urgency for ExtE. Conclusions EmoE might be a means of dealing with negative emotions and/or intrusive thoughts, while ExtE might result from a mechanism associated with depression. These results should help to improve patients’ outcomes by defining specific therapeutic targets in psychological interventions. Plain English summary After bariatric surgery, some patients regain weight. This is likely due to various factors, including a return of maladaptive eating styles, such as emotional eating (which occurs as a response to negative emotions, like depression, anxiety, anger, sadness, and discouragement), external eating (which refers to the tendency to eat in response to positive external cues, regardless of internal signals of hunger and satiety), and restraint eating (implying to make efforts to develop and maintain strategies to control calories intake, associated with weight loss after lifestyle intervention). Our goal in this research project was to explore associated factors (particularly depression, anxiety, and impulsivity) to these eating styles in patients suffering from obesity prior to bariatric surgery. Individuals seeking bariatric surgery were asked questions about their eating styles and their levels of depression, anxiety, and impulsivity using standardized questionnaires. We found that emotional eating might be a means of dealing with negative emotions and/or intrusive thoughts (e.g. about food or body dissatisfaction), while external eating might result from a mechanism associated with depression. We detected no association between restraint eating and any of the dimensions of impulsivity, nor depression and anxiety. Therapies aimed at improving patients’ abilities to regulate negative affects seem promising among subjects suffering from obesity and those seeking bariatric surgery. If well learned, these therapies might also help them to maintain weight loss after surgery by limiting maladaptive eating styles.

Awareness drives changes in reward value which predict eating behavior change: Probing reinforcement learning using experience sampling from mobile mindfulness training for maladaptive eating

Background and aimsMaladaptive eating habits are a major cause of obesity and weight-related illness. The development of empirically-based approaches, such as mindfulness training (MT) that target accurate mechanisms of action to address these behaviors is therefore critical. Two studies were conducted to examine the impact of MT on maladaptive eating and determine the involvement of reinforcement learning mechanisms underlying these effects.MethodsIn Study1, maladaptive eating behaviors were assessed using self-report questionnaires at baseline and 8 weeks after an app-based MT intervention (n = 46). A novel mindful eating craving tool was embedded in our intervention to assess: eating behaviors (intake frequency/magnitude), and reward (contentment ratings) experienced after eating. Using a well-established reinforcement learning (Rescorla-Wagner) model, expected reward values (EV) were estimated as a function of contentment levels reported after eating. In Study2 (n = 1,119), craving tool assessments were examined in an independent sample using the app in a real-world naturalistic context.ResultsStudy 1's results revealed a significant decrease in EV and eating behaviors across craving tool uses. In addition, changes in reward values predicted decreases in eating behaviors. Finally, Study 1's results revealed significant pre-post intervention reductions in self-reported eating behaviors. In Study2, we observed a significant decrease in EV, but not in eating behaviors, across craving tool uses. Study 2 also revealed a predictive relationship between EV and eating behaviors.Discussion and conclusionsThese results support the implementation of MT to prevent and treat maladaptive eating behaviors, which target reinforcement learning processes as mechanisms of action.

Association of Disinhibited Eating and Trait of Impulsivity With Insula and Amygdala Responses to Palatable Liquid Consumption

Eating behavior is not only influenced by the current energy balance, but also by the behavioral characteristics of eating. One of the recognized eating behavior constructs is ‘disinhibited eating,’ which refers to the tendency to overeat in response to negative emotional states or the presence of highly palatable foods. Food-related disinhibition is involved in binge eating, weight gain, and obesity and is also associated with the trait of impulsivity, which in turn, is linked to weight gain or maladaptive eating. However, the relationships among food-related disinhibition, the trait of impulsivity, and the neural substrates of eating behaviors in adolescence remain unclear. Therefore, we designed a functional magnetic resonance imaging (fMRI) study to examine the associations between brain responses to palatable liquid consumption and disinhibited eating behavior or impulsivity in healthy adolescents. Thirty-four adolescents (mean age ± standard deviation = 17.12 ± 1.91 years, age range = 14–19 years, boys = 15, girls = 19) participated in this study. Disinhibited eating was assessed with the disinhibition subscale of the Three-Factor Eating Questionnaire, while impulsivity was assessed using the Barratt impulsiveness scale. Participants received two fMRI sessions−a palatable liquid consumption fMRI and a resting-state fMRI. The fMRI experiment showed that increased disinhibited eating was positively associated with a greater insular response to palatable liquid consumption, while increased impulsivity was positively correlated with a greater amygdala response. The resting-state fMRI experiment showed that increased disinhibited eating was positively correlated with strengthened intrinsic functional connectivity between the insula and the amygdala, adjusting for sex (estimates of the beta coefficients = 0.146, standard error = 0.068, p = 0.040). Given that the amygdala and insular cortex are structurally and functionally connected and involved in trait impulsivity and ingestive behavior, our findings suggest that increased disinhibited eating would be associated with impulsivity via strengthened intrinsic functional connectivity between the insula and amygdala and linked to maladaptive eating.

Effect of SARS-CoV-2 (COVID-19) Pandemic and Lockdown on Body Weight, Maladaptive Eating Habits, Anxiety, and Depression in a Bariatric Surgery Waiting List Cohort

Purpose On January 30, 2020, the World Health Organization declared COVID-19 as a “public health emergency of international concern.” The primary aim of the study was to evaluate weight and food habit changes during COVID-19 outbreak. The secondary endpoint was to explore the psychological factors, arising during the pandemic, influencing weight and dietary variations. Materials and Methods A survey composed of four different items was conducted by telephone interview: (1) anthropometric data and type of procedure, (2) Hospital Anxiety and Depression Scale (HADS), (3) maladaptive eating behaviors, and (4) personal feelings moved by the COVID-19 spread and lockdown. Results Fifty-six patients were enrolled. No significant changes in weight, BMI, and maladaptive eating habits were observed. A significant reduction in the anxiety index score was observed. In 17.8% of cases, a change in obesity class was reported, and among these patients, a substantial modification in bariatric procedures was planned (60%). Conclusion This study showed no effect on weight and BMI nor on rates of maladaptive eating habits associated with quarantine/social isolation among severely obese individuals waiting for the bariatric surgery. At the end of lockdown, a considerable proportion of patients modified their initial obesity class, and in selected cases, it could represent a criteria for rearrangement of the planned bariatric procedure. In obese patients, the lockdown and social distancing generated a reduction of fear of confronting and being negatively judged by others. This psychological aspect was assessed with the reduction of the HADS score.