Incorporation of patient and family values and preferences for health-related outcomes in paediatric obesity management: A systematic review.

OBJECTIVE: A systematic review of value and preference studies conducted in children and their caregivers related to the estimated benefits and harms of interventions for managing paediatric obesity. METHODS: We searched Ovid Medline (1946-2022), Ovid Embase (1974-2022), EBSCO CINAHL (inception to 2022), Elsevier Scopus (inception to 2022), and ProQuest Dissertations & Theses (inception to 2022). Reports were eligible if they included: behavioural and psychological, pharmacological, or surgical interventions; participants between (or had a mean age within) 0-18 years old with overweight or obesity; systematic reviews, primary quantitative, qualitative, or mixed/multiple methods studies; and values and preferences as main study outcomes. At least two team members independently screened studies, abstracted data, and appraised study quality. RESULTS: Our search yielded 11 010 reports; eight met the inclusion criteria. One study directly assessed values and preferences based on hypothetical pharmacological treatment for hyperphagia in individuals with Prader-Willi Syndrome. Although not having reported on values and preferences using our a priori definitions, the remaining seven qualitative studies (n = 6 surgical; n = 1 pharmacological) explored general beliefs, attitudes, and perceptions about surgical and pharmacological interventions. No studies pertained to behavioural and psychological interventions. CONCLUSION: Future research is needed to elicit the values and preferences of children and caregivers using the best available estimates of the benefits and harms for pharmacological, surgical, and behavioural and psychological interventions.

Disconnect between sympathetically-induced hunger suppression and consumption among highly restrained eaters following stress.

Despite emphasis on findings suggesting restrained eaters increase food consumption under stress, unrestrained eaters' reduction in intake is more robust. Early proposals asserted unrestrained eaters significantly reduced intake after certain threats due to the hunger-inhibiting effects of autonomic influences, presuming unrestrained eaters are more responsive to these effects and restrained eaters rely less on physiological cues for eating. However, scant empirical evidence has substantiated these claims. This study examined whether a sequence exists whereby stress elicits autonomic activation, autonomic activation impacts hunger, and hunger then impacts eating, with dietary restraint altering the hunger-intake link. It was hypothesized that sympathetic nervous system activation would be greatest when ongoing safety from stress was uncertain, sympathetic activation would be linked to reduced hunger, and lower hunger would be associated with attenuated intake. Restraint, conceptualized via Hagan et al.'s (2017) latent restraint factors, was hypothesized to reduce the association between hunger and intake. Female participants (n = 147) were randomized to a stress + certain safety, stress + uncertain safety, or control condition. Sympathetic nervous system activity was recorded prior to a bogus taste test, which quantified ad libitum consumption of highly-palatable snack foods post-stress. Only the stress + uncertain safety condition exhibited greater sympathetic nervous system activity than the control condition. A significant index of moderated serial mediation emerged for Preoccupation with Dieting and Weight-Focused Restraint in the stress + uncertain safety condition. Though sympathetic activation decreased hunger similarly regardless of dietary restraint, only less restrained individuals significantly decreased intake. More restrained individuals ate more despite experiencing lower hunger. The disconnect between hunger and intake in more restrained eaters suggests that focus on enhancing attunement to hunger may yield greater benefit than enhancing restraint. 281 words.

Is There a Role for Self-Referral in Pediatric Weight Management?

Background: A physician or health care provider (HCP) referral is usually needed for children to access multidisciplinary health services for obesity management; however, offering families the option to self-refer can enhance equity and access to care. Methods: We completed a retrospective medical record review to explore patient characteristics and program engagement of children with obesity who were self- (n = 18) or HCP-referred (n = 120) for obesity management. Results: Our descriptive data suggested that children who were self-referred presented with a healthier clinical profile and missed fewer appointments than their peers referred by HCPs. Conclusions: Prospective research is needed to examine whether health services and treatment outcomes differ between self- and HCP-referred children in obesity management.

The calorie counter-intuitive effect of restaurant menu calorie labelling.

As of January 1, 2017, the Healthy Menu Choices Act mandates that food service premises with 20 or more locations in Ontario must display the number of calories in every food item sold on menus. The impetus for this legislation was to enable Ontarians to become aware of the calorie content of foods and beverages consumed outside the home, and make healthier dietary choices while dining out. Though arising as an initiative to attenuate the development of obesity and current obesity rates, evidence suggests menu labelling does not significantly alter individuals' food choices. Moreover, focusing primarily on caloric content may be an ineffective, and perhaps detrimental, strategy to effect change in the obesity epidemic. Beyond the initiative's questionable utility, there has been a lack of consideration as of yet to the unintended negative implications this initiative may have on eating disorder (ED) symptomatology in the general population and those attempting to recover from an ED. The objective of the current commentary is thus to argue that in light of evidence of minimal benefit and the potential for harm, nutrition labelling on menus may be a misguided public health initiative.

Frontal EEG asymmetry moderates the association between attentional bias towards food and body mass index.

High global incidence of obesity has led to efforts to identify factors that may contribute to elevated body mass index (BMI). Studies have shown individuals with obesity tend to display an attentional bias (AB) towards food. Left frontal EEG alpha asymmetry (FA) has been associated with motivation to approach rewards and may heighten reactivity to food cues. The current study thus explored whether the association between AB to food and BMI is moderated by FA. EEG was recorded while 93 female participants watched a video confederate incidentally consume potato chips. Participants subsequently completed a visual-probe task to assess AB towards food. Results revealed that AB was positively associated with BMI when FA was skewed left but not right. Individuals' predisposition to approach appetitive stimuli may interact with a bias to attend to food to facilitate overconsumption in obesogenic food environments. Future studies should examine this interaction in relation to consumption.

Social modeling of eating mediated by mirror neuron activity: A causal model moderated by frontal asymmetry and BMI.

The social modeling of eating effect refers to the consistently demonstrated phenomenon that individuals tend to match their quantity of food intake to their eating companion. The current study sought to explore whether activity within the mirror neuron system (MNS) mediates the social modeling of eating effect as a function of EEG frontal asymmetry and body mass index (BMI). Under the guise of rating empathy, 93 female undergraduates viewed a female video confederate "incidentally" consume either a low or high intake of chips while electroencephalogram (EEG) activity was recorded. Subsequent ad libitum chip consumption was quantified. A first- and second-stage dual moderation model revealed that frontal asymmetry and BMI moderated an indirect effect of model consumption on participants' food consumption as mediated by MNS activity at electrode site C3, a3b3=-0.718, SE=0.365, 95% CI [-1.632, -0.161]. Left frontal asymmetry was associated with greater mu activity and a positive association between model and participant chip consumption, while right frontal asymmetry was associated with less mu activity and a negative association between model and participant consumption. Across all levels of frontal asymmetry, the effect was only significant among those with a BMI at the 50th percentile or lower. Thus, among leaner individuals, the MNS was demonstrated to mediate social modeling of eating, as moderated by frontal asymmetry. These findings are integrated within the normative account of social modeling of eating. It is proposed that the normative framework may benefit from consideration of both conscious and unconscious operation of intake norms.