PACE: a Novel Eating Behavior Phenotype to Assess Risk for Obesity in Middle Childhood.

BACKGROUND: Behavioral phenotypes that predict future weight gain are needed to identify children susceptible to obesity. OBJECTIVES: This prospective study developed an eating behavior risk score to predict change in adiposity over 1 y in children. METHODS: Data from 6 baseline visits (Time 1, T1) and a 1-y follow-up visit (Time 2, T2) were collected from 76, 7- to 8-y-old healthy children recruited from Central Pennsylvania. At T1, children had body mass index (BMI) percentiles <90 and were classified with either high (n = 33; maternal BMI ≥30 kg/m2) or low (n = 43; maternal BMI ≤25 kg/m2) familial risk for obesity. Appetitive traits and eating behaviors were assessed at T1. Adiposity was measured at T1 and T2 using dual-energy x-ray absorptiometry, with a main outcome of fat mass index (FMI; total body fat mass divided by height in meters squared). Hierarchical linear regressions determined which eating measures improved prediction of T2 FMI after adjustment for covariates in the baseline model (T1 FMI, sex, income, familial risk, and Tanner stage). RESULTS: Four eating measures-Portion susceptibility, Appetitive traits, loss of control eating, and eating rate-were combined into a standardized summary score called PACE. PACE improved the baseline model to predict 80% variance in T2 FMI. PACE was positively associated with the increase in FMI in children from T1 to T2, independent of familial risk (r = 0.58, P < 0.001). Although PACE was higher in girls than boys (P < 0.05), it did not differ by familial risk, income, or education. CONCLUSIONS: PACE represents a cumulative eating behavior risk score that predicts adiposity gain over 1 y in middle childhood. If PACE similarly predicts adiposity gain in a cohort with greater racial and socioeconomic diversity, it will inform the development of interventions to prevent obesity. This trial was registered at clinicaltrials.gov as NCT03341247.

The Cerebellar Response to Visual Portion Size Cues Is Associated with the Portion Size Effect in Children.

The neural mechanisms underlying susceptibility to eating more in response to large portions (i.e., the portion size effect) remain unclear. Thus, the present study examined how neural responses to portion size relate to changes in weight and energy consumed as portions increase. Associations were examined across brain regions traditionally implicated in appetite control (i.e., an appetitive network) as well as the cerebellum, which has recently been implicated in appetite-related processes. Children without obesity (i.e., BMI-for-age-and-sex percentile < 90; N = 63; 55% female) viewed images of larger and smaller portions of food during fMRI and, in separate sessions, ate four meals that varied in portion size. Individual-level linear and quadratic associations between intake (kcal, grams) and portion size (i.e., portion size slopes) were estimated. The response to portion size in cerebellar lobules IV-VI was associated with the quadratic portion size slope estimated from gram intake; a greater response to images depicting smaller compared to larger portions was associated with steeper increases in intake with increasing portion sizes. Within the appetitive network, neural responses were not associated with portion size slopes. A decreased cerebellar response to larger amounts of food may increase children's susceptibility to overeating when excessively large portions are served.

Does 'portion size' matter? Brain responses to food and non-food cues presented in varying amounts.

Larger portions of food elicit greater intake than smaller portions of food, particularly when foods are high in energy density (kcal/g; ED). The neural mechanisms underlying this effect remain unclear. The present study used fMRI to assess brain activation to food (higher-ED, lower-ED) and non-food (office supplies) images presented in larger and smaller (i.e., age-appropriate) amounts in 61, 7-8-year-olds (29 male, 32 female) without obesity. Larger amounts of food increased activation in bilateral visual and right parahippocampal areas compared to smaller amounts; greater activation to food amount (larger > smaller) in this cluster was associated with smaller increases in food intake as portions increased. Activation to amount (larger > smaller) was stronger for food than office supplies in primary and secondary visual areas, but, for office supplies only, extended into bilateral parahippocampus, inferior parietal cortex, and additional visual areas (e.g., V7). Activation was greater for higher-vs. lower-ED food images in ventromedial prefrontal cortex for both larger and smaller amounts of food; however, this activation extended into left lateral orbital frontal cortex for smaller amounts only. Activation to food cues did not differ by familial risk for obesity. These results highlight potentially distinct neural pathways for encoding food energy content and quantity.

Observational Methods in Studies of Infant and Young Child Feeding Practices in Low- and Middle-Income Countries: A Twenty-Year Retrospective Review.

This narrative review describes the observational approaches used to study infant and young child feeding (IYCF) practices in low- and middle-income countries (LMICs) published between 2001 and 2021. Articles were included in this narrative review if they were (1) original peer-reviewed articles published in English in PubMed and Web of Science; (2) published between 1 January 2001, and 31 December 2021; (3) conducted in an LMIC; and (4) employed observations and focused on IYCF practices among children aged 6-59 months. The studies (n = 51) revealed a wide-ranging application of direct meal and full-day observations, as well as indirect spot checks, to study IYCF. The findings revealed that meal observations were typically conducted during a midday meal using precise recording approaches such as video and aimed to understand child-caregiver interactions or specialized nutritious food (SNF) usage. Conversely, full-day observations lasted between 6 and 12 h and often used a field notes-based recording approach. Behaviors occurring outside of mealtime, such as snacking or interhousehold food sharing, were also a primary focus. Finally, spot checks were conducted to indirectly assess SNF compliance during both announced and unannounced visits. This review highlights the adaptability of observations across contexts and their versatility when used as a primary data collection tool to help monitor and evaluate nutrition programs.

Children's Energy Intake Generally Increases in Response to the Energy Density of Meals but Varies with the Amounts and Types of Foods Served.

BACKGROUND: Food energy density (ED; kcal/g) is positively related to energy intake in numerous studies. A recent secondary analysis proposed that when the ED of consumed food is above a breakpoint, adults sense calories and adjust meal size to minimize overconsumption. OBJECTIVES: We conducted a secondary analysis of measured intakes in preschool children to assess how meal energy intake was related to meal ED as well as to meal portions, eating occasions, and menus. METHODS: We analyzed weighed intakes from 6355 meals served to 94 children aged 3 to 5 y in 2 randomized crossover trials. We provided children with all their daily food and milk for multiple periods of 5 consecutive days in their usual childcare setting. We used linear mixed models with repeated measures to analyze the effects on energy intake of meal ED and meal weight, either as served or as consumed. RESULTS: Energy intake at meals was related to the ED and portions of served food and also to the ED and weight of consumed food (all P < 0.0001). Energy intake was also significantly affected by the eating occasion and the foods served on the menus. Children selectively ate higher-ED items, which were served in smaller amounts than lower-ED options. Meal energy intake was curvilinear across consumed ED; it initially increased (slope: 113 ± 2 kcal/ED unit) but decreased at higher-ED meals (deceleration: -11 ± 1 kcal/ED unit2) without evidence of a clear breakpoint. This trajectory may be attributable to the relatively limited portions of higher-ED foods that were served. CONCLUSIONS: Children's energy intake generally increased with greater ED; at higher-ED meals, however, energy intake decreased in a curvilinear manner without a clear breakpoint. This reduction in intake at higher ED could be explained by meal-related factors such as the portions served rather than by sensitivity to meal energy content. This study was registered at clinicaltrials.gov as NCT03010501 and NCT03242863.

Poorer inhibitory control was related to greater food intake across meals varying in portion size: A randomized crossover trial.

Individuals eat more food when larger portions are served, and this portion size effect could be influenced by inhibitory control (the ability to suppress an automatic response). Inhibitory control may also relate to obesogenic meal behaviors such as eating faster, taking larger bites, and frequent switching between meal components (such as bites of food and sips of water). In a randomized crossover design, 44 adults ate lunch four times in the laboratory. Lunch consisted of a pasta dish that was varied in portion size (400, 500, 600, or 700 g) along with 700 g of water. Meals were video-recorded to assess meal duration and bite and sip counts, which were used to determine mean eating rate (g/min), mean bite size (g/bite), and number of switches between bites and sips. Participants completed a food-specific stop-signal task, which was used to calculate Stop-Signal Reaction Time (SSRT). Across participants, SSRT values ranged from 143 to 306 msec, where greater SSRT indicates poorer inhibitory control. As expected, serving larger portions increased meal intake (p < 0.0001); compared to the smallest portion, intake of the largest increased by 121 ± 17 g (mean ± SEM). SSRT did not moderate the portion size effect (p = 0.34), but individuals with poorer inhibitory control ate more across all meals: 24 ± 11 g for each one SD unit increase in SSRT (p = 0.035). SSRT was not related to eating rate or bite size (both p > 0.13), but poorer inhibitory control predicted greater switching between bites and sips, such that 1.5 ± 0.7 more switches were made during meals for each one SD unit increase in SSRT (p = 0.03). These findings indicate that inhibitory control can contribute to overconsumption across meals varying in portion size, potentially in part by promoting switching behavior.

Children at high familial risk for obesity show executive functioning deficits prior to development of excess weight status.

OBJECTIVE: The objective of this study was to determine whether children with healthy weight who vary by familial risk for obesity differ in executive functioning. METHODS: Children (age 7-8 years) without obesity (n = 93, 52% male) who differed by familial risk for obesity (based on maternal weight status) completed go/no-go and stop-signal tasks to assess inhibitory control and an N-back task to assess working memory. Dual energy x-ray absorptiometry measured adiposity. Linear and mixed-effect models assessed unique effects and relative importance analysis-quantified relative effects of familial risk and percent body fat. RESULTS: Children at high compared with low familial risk showed worse inhibitory control; however, child adiposity was not associated with inhibitory control. Both high familial risk and greater child adiposity were associated with worse N-back performance when cognitive demand was high (2-back), but not low (0- and 1-back). The relative effect of familial risk on executive functioning was 2.7 to 16 times greater than the relative effect of percent body fat. CONCLUSIONS: These findings provide initial evidence that deficits in executive functioning may precede the development of obesity in children at high familial risk for this disease. Additional family risk studies are needed to elucidate the pathways through which maternal obesity influences child executive functioning and risk for obesity.

Portion size affects food selection in an immersive virtual reality buffet and is related to measured intake in laboratory meals varying in portion size.

A crucial step for validating the utility of an immersive virtual reality (iVR) buffet to study eating behavior is to determine whether variations in food characteristics such as portion size (PS) are relevant predictors of food selection in an iVR buffet. We tested whether manipulating PS in an iVR buffet affects the weight of food selected, and whether this response to PS is similar to participants' measured intake when PS varies at laboratory meals. In a randomized crossover design, 91 adults (18-71 y; 64 females; BMI = 25.3 ± 5.7) used their iVR remote to select lunch and dinner portions from an iVR buffet before consuming a standardized lab meal at two visits separated by one week. The PS in the iVR buffet and lab meals varied between a standard PS and a large PS. This design enabled comparisons of PS effects between iVR and lab settings, despite the scale difference in food weight between the environments. Portion size significantly affected food selection and food intake (p < 0.001). Subjects selected an additional 350 g in iVR and consumed an additional 154 g of food in the lab meals when offered the large portion compared to the small portion. The effect of PS showed a similar percentage increase in iVR (36.5%) and lab meals (39.2%). There was no significant difference in the effect of PS between iVR and lab meals after accounting for scale differences in food weight between the environments. The response to PS was not influenced by subject characteristics such as body mass index, sex, or age. These results demonstrate the utility of iVR for replicating real-world eating behaviors and enhancing our understanding of the intricate dynamics of food-related behaviors in a variety of contexts.

Variety and portion size combine to increase food intake at single-course and multi-course meals.

Increases in food variety and portion size independently promote intake. Little is known about how these effects combine or how they depend on meal structure. In two randomized crossover experiments, once a week for four weeks, women ate a lunch meal that was varied in two properties: variety (low: three bowls of the favorite dish vs. high: three bowls, each with a different main dish) and portion size (small: 450 g vs. large: 600 g). In Experiment 1 (n = 42), dishes were served simultaneously and in Experiment 2 (n = 49), dishes were served sequentially over three courses. At each meal, the primary outcome of food intake was measured; additionally, we measured sensory-specific satiety (SSS; the relative hedonic decline of a food as it is eaten). In Experiment 1 (simultaneous structure) variety and portion size did not interact (p = 0.72) but both independently increased intake; participants consumed 15 ± 7 g more at meals with high variety compared to low and 57 ± 7 g more from large portions compared to small (both p < 0.03). Similarly, in Experiment 2 (sequential structure) variety and portion size did not interact (p = 0.99) but participants consumed 30 ± 8 g more at high-variety meals and 51 ± 8 g more from large portions (both p < 0.001). SSS was not influenced by portion size in either experiment (both p > 0.16) or by variety in Experiment 1 (p = 0.58), but SSS was smaller at high-variety meals in Experiment 2 (p = 0.001). Thus, variety and large portions promoted greater food intake for a similar or smaller hedonic decline, indicating these effects were facilitated by delayed SSS. At meals with either a simultaneous or sequential structure, high variety and large portions combined to increase intake, suggesting that these common properties act together to promote overconsumption.

Inter-individual differences in children's short-term energy compensation: a systematic review and meta-analysis.

BACKGROUND: The ability to regulate energy intake is often assessed using a preloading paradigm to measure short-term energy compensation. In children, large variability exists with this paradigm both within- and across- studies and is poorly understood. OBJECTIVES: This systematic review and meta-analysis aimed to better understand factors contributing to variability in children's energy compensation. We tested 1) whether children demonstrated "good" energy compensation, defined as adjusting meal intake commensurate with preload intake and 2) differences in children's energy compensation by child age, sex, and weight status (assessed both continuously and categorically). METHODS: Standard guidelines for systematic review were followed to search PubMed, PsychInfo, and Web of Science. Data on study design (preload form, preload-to-meal interval, preload energy difference, study setting) and participant characteristics (sex, age, weight status) were extracted from 29 experiments meeting inclusion criteria, and 13 were included in meta-analyses. COMPx (energy compensation index), a linear transformation comparing food intake following a high- vs. low-energy preload, was the outcome. Hedge's g was calculated, and random intercept-only models tested associations between COMPx and sex, age, and weight status. RESULTS: The systematic review revealed mixed results regarding children's energy compensation and the role of inter-individual differences. Meta-analytic models revealed that children undercompensated (overate) for preload energy (ß = -0.38; P = 0.008). Sex (ß = 0.11; P = 0.76), age (ß = 0.03; P = 0.75), and weight (assessed continuously; ß = -0.07, P = 0.37) were not related to compensation. Children with overweight/obesity (assessed categorically) undercompensated more than children with healthy weight (ß = 0.18; P = 0.04). CONCLUSIONS: The systematic review highlighted wide variability across studies, while the meta-analysis demonstrated differences in COMPx by child weight status but not by age or sex. Standardizing protocols across studies is recommended, along with designing adequately powered studies aiming to test inter-individual differences a priori. Alternative approaches to the use of COMPx are recommended to allow better characterization of children's energy compensation ability. This study was registered at PROSPERO as CRD42020197748.

Switching between foods: A potential behavioral phenotype of hedonic hunger and increased obesity risk in children.

CONTEXT: Reward-based eating is a trait that increases risk for eating in the absence of hunger (EAH) and obesity. Eating behaviors such as switching more frequently between different foods may increase intake during EAH by delaying the onset of sensory-specific satiation (SSS); however, this question has not been empirically tested. OBJECTIVES: 1) Test whether switching between foods mediates the relationship between reward-based eating and EAH intake. 2) Test whether switching between foods during EAH moderates the relationship between reward-based eating and weight status. METHODS: Data were analyzed from a study assessing decision-making in children (n = 63 children; 9.4 ± 1.4 years, 77.0 ± 22.4 BMI%tile). Reward-based eating was quantified using the Children's Eating Behaviour Questionnaire. EAH was assessed as the amount of palatable food consumed following ad libitum consumption of a standard meal. Videos of eating behavior were coded for eating time, number of different foods consumed, and food switches. Ordinary least squares regressions were conducted to test hypotheses. RESULTS: Switching was positively associated with EAH intake for both kcal (p < 0.01) and grams (p < 0.01) such that each additional switch was associated with an increased intake of 17.0 kcal or 3.5 gs. Switching mediated the relationship between reward-based eating and EAH (p < 0.01) such that more frequent switching fully accounted for the positive association between reward-based eating and EAH (ps < 0.01). While reward-based eating was also positively associated with weight status (p < 0.01), this association was moderated by food switching (p < 0.01) such that the relationship was stronger for children who switch more frequently (p < 0.01). CONCLUSIONS: Frequent switching between foods was positively associated with EAH intake and mediated the relationship between reward-based eating and EAH. Moreover, reward-based eating was more strongly related to weight status in children who switched more frequently. Thus, food switching may contribute to overconsumption and be an important behavioral indicator of increased obesity risk in children. Studies across multiple meals and contexts will help determine if switching is a reliable behavioral phenotype.

Dimensions of sleep quality are related to objectively measured eating behaviors among children at high familial risk for obesity.

OBJECTIVE: The aim of this study was to evaluate whether dimensions of sleep quality were associated with homeostatic and hedonic eating behaviors among children with healthy weight (BMI-for-age < 90%) but varying maternal weight status. METHODS: A total of 77 children (mean [SD], age: 7.4 [0.6] years; BMI z score: -0.10 [0.7]) with healthy weight and high (n = 32) or low (n = 45) familial obesity risk based on maternal weight status were served an ad libitum meal (homeostatic eating) followed by palatable snacks to assess eating in the absence of hunger (EAH; hedonic eating). Habitual sleep quality was quantified from seven nights of wrist actigraphy. Partial correlations, adjusted for child energy needs, pre-meal hunger, food liking, and socioeconomic status, evaluated associations of sleep with meal intake and EAH. Additionally, sleep-by-obesity risk interactions were assessed. RESULTS: Greater sleep fragmentation was associated with higher homeostatic meal energy intake, but only among children at high familial obesity risk (p value for interaction = 0.001; ß high risk = 48.6, p = 0.001). Sleep fragmentation was not associated with total EAH but was related to higher and lower intake of carbohydrates (r = 0.33, p = 0.003) and fat (r = -0.33, p = 0.003), respectively. CONCLUSIONS: Adverse associations of poor sleep with energy intake may be amplified among children already predisposed to obesity. Furthermore, that fragmented sleep relates to preferential intake of carbohydrates over fat during EAH may suggest alterations in taste preferences with poor sleep.

Designing a childhood obesity preventive intervention using the multiphase optimization strategy: The Healthy Bodies Project.

BACKGROUND/AIMS: Preventing the development of childhood obesity requires multilevel, multicomponent, comprehensive approaches. Study designs often do not allow for systematic evaluation of the efficacy of individual intervention components before the intervention is fully tested. As such, childhood obesity prevention programs may contain a mix of effective and ineffective components. This article describes the design and rationale of a childhood obesity preventive intervention developed using the multiphase optimization strategy, an engineering-inspired framework for optimizing behavioral interventions. Using a series of randomized experiments, the objective of the study was to systematically test, select, and refine candidate components to build an optimized childhood obesity preventive intervention to be evaluated in a subsequent randomized controlled trial. METHODS: A 24 full factorial design was used to test the individual and combined effects of four candidate intervention components intended to reduce the risk for childhood obesity. These components were designed with a focus on (a) improving children's healthy eating behaviors and nutrition knowledge, (b) increasing physical activity and reducing sedentary activity in the childcare setting, (c) improving children's behavioral self-regulation, and (d) providing parental web-based education to address child target outcomes. The components were tested with approximately 1400 preschool children, ages 3-5 years in center-based childcare programs in Pennsylvania, the majority of which served predominantly Head-Start eligible households. Primary child outcomes included healthy eating knowledge, physical and sedentary activity, and behavioral self-regulation. Secondary outcomes included children's body mass index and appetitive traits related to appetite regulation. RESULTS: Four intervention components were developed, including three classroom curricula designed to increase preschool children's nutrition knowledge, physical activity, and behavioral, emotional, and eating regulation. A web-based parent education component included 18 lessons designed to improve parenting practices and home environments that would bolster the effects of the classroom curricula. A plan for analyzing the specific contribution of each component to a larger intervention was developed and is described. The efficacy of the four components can be evaluated to determine the extent to which they, individually and in combination, produce detectable changes in childhood obesity risk factors. The resulting optimized intervention should later be evaluated in a randomized controlled trial, which may provide new information on promising targets for obesity prevention in young children. CONCLUSION: This research project highlights the ways in which an innovative approach to the design and initial evaluation of preventive interventions may increase the likelihood of long-term success. The lessons from this research project have implications for childhood obesity research as well as other preventive interventions that include multiple components, each targeting unique contributors to a multifaceted problem.

Children with lower ratings of executive functions have a greater response to the portion size effect.

Deficits in executive functions (EFs), a set of cognitive processes related to self-regulation, are associated with the development of obesity. Prior studies from our group showed that lower food-cue related activation in brain regions implicated in self-regulation was related to a larger portion size effect. We tested the hypothesis that lower EFs in children would be positively related to the portion size effect. Healthy weight children aged 7-8 y (n = 88), who varied by maternal obesity status, participated in a prospective study. At baseline, the parent primarily in charge of feeding completed the Behavior Rating Inventory of Executive Function (BRIEF2) to assess child EFs, including Behavioral (BRI), Emotional (ERI), and Cognitive (CRI) indices. At 4 baseline sessions, children consumed meals in which the portion sizes of foods (pasta, chicken nuggets, broccoli, and grapes) varied by visit (total meal weight of 769, 1011, 1256, or 1492g). Intake increased with increasing portions in a linear trajectory (p < 0.001). EFs moderated the portion size effect such that lower BRI (p = 0.003) and ERI (p = 0.006) were associated with steeper increases in intake as portions increased. As amount of food increased, children in the lowest functioning tertiles for BRI and ERI increased intake by 35% and 36%, respectively, compared to children in the higher tertiles. Increases in intake among children with lower EFs were for higher- but not lower-energy-dense foods. Thus, in healthy weight children who varied by obesity risk, lower parentally reported EFs were associated with a larger portion size effect, and these results were independent of child and parent weight status. Therefore, EFs may be target behaviors that could be strengthened to help children moderate excess intake in response to large portions of energy-dense foods.

The effects of snack foods of different energy density on self-served portions and consumption in preschool children.

It is recommended that preschoolers serve themselves their own food portions; however, it is unclear what factors influence the amount they select for consumption, and particularly how their selected portions are influenced by food properties such as energy density, volume, and weight. We offered preschool children snacks differing in energy density (ED) and investigated the effects on the amounts they served and then consumed. In a crossover design, 52 children aged 4-6 y (46% girls; 21% overweight) ate an afternoon snack on 2 days in their childcare classrooms. Before each snack time, children served the amount they would like to eat of 4 snacks presented in equal volumes but differing in ED (higher-ED: pretzels, cookies; lower-ED: strawberries, carrots). Across the 2 sessions, children were given their self-served amount of either pretzels (3.9 kcal/g) or strawberries (0.3 kcal/g) and intake was measured. Later, children tasted all 4 snacks and rated liking. Results showed that the portions children served themselves were influenced by their liking ratings (p = 0.0006), but after accounting for liking, the volumes they served were similar for all 4 foods (p = 0.27). At snack time, children ate a greater proportion of self-served strawberries (92 ± 4%) than pretzels (73 ± 4%; p = 0.0003), but because of the ED difference they consumed 55 ± 4 kcal more from pretzels than strawberries (p < 0.0001). The difference in snack intake by volume was not attributable to liking ratings (p = 0.87). That children served a consistent volume of similarly-liked snacks suggests that their portions were affected more by visual cues than by weight or energy content. Despite eating a greater volume of lower-ED strawberries, children consumed more energy from the higher-ED pretzels, highlighting the contribution of energy density to children's energy intake.

Food Properties and Individual Characteristics Influence Children's Intake Across Multiple Days of Weighed Assessments in Childcare Programs.

BACKGROUND: Because children often consume substantial proportions of their diets in childcare programs, it is critical to determine what they eat when served menus meeting dietary recommendations and how intake is related to individual characteristics. OBJECTIVES: Using weighed assessments, we characterized children's consumption across 15 daily menus and investigated the relationship between properties of the food consumed and child characteristics. METHODS: In 3 crossover trials in childcare centers that followed dietary guidelines, we provided and weighed all meals and snacks for 5 consecutive days. For this descriptive secondary analysis, we characterized primary outcomes (daily food weight, energy density, and energy intake) by including the most typical set of menus from each trial, yielding 603 daily intakes for 128 preschool children (15% with overweight or obesity). Physical activity was measured by accelerometry during childcare sessions. Children's appetitive traits were assessed by parental questionnaires. RESULTS: Both food properties and child characteristics were related to daily intake. More food was consumed from menus with greater food weight, and the energy density of consumed food was greater from menus with higher energy density (both P < 0.0001); these menu differences resulted in greater energy intake (P = 0.009). Children with overweight and obesity had greater energy intake as a proportion of requirements than did children with healthy weight (113 ± 6% versus 101 ± 2%; P = 0.039). Vegetable intake was 39 ± 2% of the recommended amounts and boys had lower consumption than girls (P = 0.004). Children with appetitive traits of lower satiety responsiveness or higher food responsiveness had greater daily energy intake (both P < 0.003). CONCLUSIONS: Weighed intakes showed that when children were served daily menus with substantial portions of foods that met dietary recommendations, they selectively consumed higher-energy-dense items and ate few vegetables. A particular concern was that children with overweight ate amounts that exceeded their energy needs. The trials were registered at clinicaltrials.gov (NCT02963987, NCT03010501, NCT03242863).

The impact of between-session habituation, within-session habituation, and weight gain on response to food exposure for adolescents with eating disorders.

OBJECTIVE: Exposure therapy is a promising treatment for eating disorders (EDs). However, questions remain about the effectiveness of exposure to feared foods during the weight restoration phase of treatment, and the importance of between-session and within-session habituation. METHOD: We recruited 54 adolescents from a partial hospitalization program (PHP) for EDs which included daily food exposure. Throughout treatment, participants provided subjective units of distress (SUDS) ratings before and after eating a feared food, and completed measures of ED symptomatology. RESULTS: Multilevel models found that pre-exposure SUDS decreased over time, providing some evidence that between-session habituation occurred. In contrast, the difference between pre-exposure and post-exposure SUDS did not decrease over time, indicating that within-session habituation did not occur. Weight gain predicted greater between-session habituation to feared foods, but did not predict within-session habituation. Between-session habituation, but not within-session habituation, predicted favorable treatment outcomes, including weight gain and improvements on the Children's Eating Attitudes Test and Fear of Food Measure. DISCUSSION: Partial hospitalization programs that include daily exposure to feared foods may be effective at decreasing anxiety about foods for adolescents with EDs who are experiencing weight restoration. Further research is warranted to replicate our findings challenging the importance of within-session habituation, and to better understand between-session habituation and inhibitory learning as mechanisms of change when conducting food exposure for EDs. PUBLIC SIGNIFICANCE: This study provides some evidence that PHPs that include food exposure may be useful for adolescents with EDs who are experiencing weight restoration. Between-session habituation, but not within-session habituation, predicted favorable treatment outcomes. Further research is needed to determine whether clinicians can disregard within-session habituation when conducting food exposure for EDs, and understand the importance of between-session habituation as a potential mechanism of food exposure.

Switching between bites of food and sips of water is related to food intake across meals varying in portion size.

Individuals eat more when served more food, but little is known about how this portion size effect is moderated by meal-related characteristics, particularly the inclusion of water served as a beverage. Patterns of eating and drinking as well as consumption of water could affect satiation by modifying exposure to the sensory qualities of food. In a crossover design, 44 adults ate lunch in the laboratory once a week for 4 weeks and intake was measured. The meal was a pasta dish that was varied in portion size (400, 500, 600, or 700 g) plus 700 g of water. Meals were video-recorded to count bites and sips and the number of switches between them. Sensory-specific satiety (SSS) was evaluated as the relative decline in hedonic ratings of the pasta after consumption. Serving larger portions led to a curvilinear increase in food intake (p < 0.0001). Neither switching between bites and sips nor water intake moderated the portion size effect. Independent of portion served, across all meals switching more frequently was related to greater food consumption (5.7 ± 1.8 g more food consumed for each additional switch, p = 0.004). Greater water intake was also related to greater food intake across portions (1.1 ± 0.5 g more food consumed for each additional 10 g of water, p = 0.025), but this effect was not significant after accounting for switching (p = 0.38). The magnitude of SSS was unaffected by switching, suggesting that switching allowed greater food intake for a given hedonic decline. At a meal with a single food, intake was greater when larger portions were served and also when there was more switching between bites and sips. Switching between food and water may promote energy intake by attenuating the development of SSS.

Eating rate and bite size were related to food intake across meals varying in portion size: A randomized crossover trial in adults.

Serving larger portions leads to increased food intake, but behavioral factors that influence the magnitude of this portion size effect have not been well characterized. We investigated whether measures of eating microstructure such as eating rate and bite size moderated the portion size effect. We also explored how sensory-specific satiety (SSS; the relative hedonic decline of a food as it is eaten) was affected by eating microstructure and larger portions. In a randomized crossover design, 44 adults aged 18-68 y (66% women; 46% with overweight and obesity) ate lunch in the laboratory once a week for 4 weeks. The meal consisted of pasta that was varied in portion size (400, 500, 600, or 700 g) and 700 g of water. Meals were video-recorded to assess bite count and meal duration, which were used to calculate mean eating rate (g/min) and mean bite size (g/bite). At each meal participants also completed an assessment of SSS. The results showed that as larger portions were served, meal intake increased in a curvilinear manner (p < 0.0001). Measures of eating microstructure did not moderate the portion size effect but were related to intake across all portions; faster eating rate, larger bite size, higher bite count, and longer meal duration were associated with greater consumption at all meals (all p < 0.0001). SSS was not influenced by any measure of eating microstructure or by portion size (all p > 0.10). In summary, the portion size effect was not moderated by eating microstructure, but relatively faster eating rates and larger bite sizes at meals, along with large portions, combined to increase food intake.

The food and beverage cues in digital marketing model: special considerations of social media, gaming, and livestreaming environments for food marketing and eating behavior research.

Digital marketing to children, teens, and adults contributes to substantial exposure to cues and persuasive messages that drive the overconsumption of energy dense foods and sugary beverages. Previous food marketing research has focused on traditional media, but less is known about how marketing techniques translate within digital platforms, such as social media, livestreaming, and gaming. Building upon previous theories and models, we propose a new model entitled food and beverage cues in digital marketing (FBCDM). The FBCDM model specifies key marking elements and marketing integration strategies that are common on digital platforms and are hypothesized to enhance the effects of advertising and incentive sensitization process. FBCDM also categorizes measurable outcomes into three domains that include brand, food, and social outcomes. Additionally, repeated marketing exposure and the resulting outcomes are hypothesized to have long term consequences related to consumer markets, consumption behavior, culture, and health. We include a discussion of what is currently known about digital marketing exposure within the outcome domains, and we highlight gaps in research including the long-term consequences of digital marketing exposure. The FBCDM model provides a conceptual framework to guide future research to examine the digital marketing of food and beverages to children and adolescents in order to inform government and industry policies that restrict the aggressive marketing of products associated with obesity and adverse diet related outcomes.