Ecological momentary assessment of maladaptive eating in children and adolescents with overweight or obesity.

OBJECTIVES: Contextual factors related to maladaptive eating behavior in youth with overweight/obesity are poorly understood. This pilot study sought to elucidate immediate internal and external cues related to perceptions of overeating and loss of control (LOC) over eating in a heterogeneous sample of children and adolescents with overweight/obesity assessed in their natural environments.

METHOD: Community-based youth [N = 40; 55% female (n = 22)], aged 8-14 y (M age = 11.2 ± 1.9 y), with overweight/obesity (M z-BMI = 2.07 ± 0.49) reported on all eating episodes and their physiological, environmental, affective, and interpersonal antecedents and correlates via ecological momentary assessment over a 2-week period. Generalized estimating equations were used to assess the relationship between contextual variables and degree of overeating and LOC.

RESULTS: Eating occasions involving greater food hedonics (i.e., perceived palatability of food being consumed) were associated with greater LOC severity (within-subjects effect: B = 0.01, p = .015), although youth with lower overall levels of food hedonics reported higher LOC severity ratings on average (between-subjects effect: B = -0.04, p = .005). Youth reporting higher overall cravings reported higher average ratings of LOC severity (between-subjects effect: B = 0.20, p = .001). Finally, youth reporting greater overall influence of others on eating behavior evidenced greater average levels of overeating severity (between-subjects effect: B = 0.17, p < .001).

DISCUSSION: Eating-related factors appear to be most strongly associated with LOC severity, while environmental factors were most associated with overeating severity. Interventions targeting maladaptive eating in youth with overweight/obesity may benefit from helping youth incorporate palatable foods and satisfy cravings in a planned and controlled manner, and enhancing awareness of social-contextual effects on eating.