Treating Overweight Children

Did you know that approximately 32% of children in the United States are obese? With the numbers growing, more research is looking into effective treatment to reduce this obesity rate. That is the intention of a randomized controlled trial carried out by the University of Minnesota, University of California San Diego, and Duke University. According to these researchers, the current gold standard of treatment for overweight and/or obese children is family-based intervention that combines behavior therapy techniques with nutrition information and exercise. Although this is a proven method, not all overweight or obese children, for reasons that are still unclear, respond to this approach. Other approaches are clearly needed.

Reducing Eating in the Absence of Hunger

The goal of this pilot study was to review new and diverse treatment options, particularly for a subtype of children in need: those children who eat in the absence of hunger (EAH). This population of children is 4.6 times more likely than other children to be overweight by age 7. EAH is suggested as a factor that contributes to episodes of binge eating, so a treatment that helps reduce EAH could lower caloric intake and possibly slow down a child’s weight increase.

External Cues and Internal Signals

The study uses as a theoretical background Schachter’s externality theory on obesity, which states that overeaters are more reactive to external cues to eat (e.g. time, situation, and access to food) and less sensitive to internal hunger and satiety signals. According to this theory and the article reviewed here, an increased reactivity to external cues may be seen as a learned response. That is, for these children, cues that signal or accompany food intake (smell, taste, eating ritual, or environment) may elicit the conditioned response of eating in the absence of hunger. A further aspect of this phenomenon may be lack of awareness about or diminished sensitivity towards eating and satiety.

Study of Two Interventions

With these premises in mind, researchers set up a study to assess the efficacy of two promising interventions for children EAH: Cue exposure treatment and food and appetite awareness training, in order to learn to regulate eating and decrease overeating, with a view to future weight management.  

Cue Exposure Treatment exposed participants to techniques to reduce the strength of the association between subjective and physiological experiences when presented with food cues.    

Appetite Awareness Training trained participants to increase their sensitivity to hunger and satiety by increasing their perception of internal states and using this as a guide for the amount of food consumption.  

Some of the most important results of this study are as follows: 

1.  Cue exposure treatment may reduce EAH, whereas appetite awareness training seems to have little effect.

2.  Both interventions are effective in reducing episodes of binge eating.

3.  Neither of the interventions seems to be effective on its own as a means of reducing weight.   

Need for Double-Intervention Study

As these results show, there is still a great need for further investigation to understand EAH in children better and to find effective interventions. This pilot study represents an initial attempt to create a treatment protocol specifically for a behavioral phenotype of overweight and obese children who do not seem to benefit from existing protocols. The researchers believe that both interventions seem promising and worthy of further development, particularly by integrating the two treatments. Anecdotal data suggest that participants in the cue exposure therapy group, who had to cope with cravings, were not fully able to distinguish between cravings and hunger; in other words, they lacked appetite awareness training. Therefore, combining these two interventions could work.  

?Questions?

If you are satiated but still have general or specific food cravings, how do you handle them? From your own experience of trying to avoid eating when you are not hungry—or observing others attempting to do so, can you think of strategies that might prove effective for children?