Parental Feeding Practices for Childhood Obesity

Overseen By Jennifer Emond, PhD

Age: < 18

Sex: Any

Trial Phase: Academic

Sponsor: Trustees of Dartmouth College

Must not be taking: Appetite medications

Disqualifiers: Food allergies, Dietary restrictions, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 6

330 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications, but children taking medication that affects appetite or attention are excluded from participating.

What data supports the effectiveness of the treatment Attentional bias to food cues for childhood obesity?

Research suggests that children with obesity have a stronger attention bias towards food, similar to adults with obesity. This indicates that addressing attentional biases could be a useful part of obesity treatment, although a pilot study found that training to reduce this bias was not effective in maintaining weight loss in obese children. ^{1 2 3 4 5}

Is the treatment of attentional bias to food cues safe for humans?

The research does not provide specific safety data for the treatment of attentional bias to food cues, but it does not report any adverse effects or safety concerns in the studies conducted. ^{2 6 7 8 9}

How does the treatment for parental feeding practices for childhood obesity differ from other treatments?

This treatment focuses on modifying parental feeding practices to address childhood obesity, which is unique compared to other treatments that may focus on diet, exercise, or medication. It targets the underlying behavioral aspects of feeding, aiming to change how parents influence their children's eating habits, rather than directly altering the child's diet or physical activity. ^{2 5 7 10 11}

What is the purpose of this trial?

The preschool years (2-5 years of age) is a critical timeframe to shape the lifetime risk of obesity. While the causes of obesity are complex, appetitive traits related to overeating, such as high food approach and low food avoidance, are robustly associated with a greater BMI among children. Some children are genetically pre-disposed to expressing obesogenic appetitive traits, and those traits may mediate a genetic risk for obesity. Separately, parental feeding practices are emerging as an important, yet modifiable, influence on children's obesity risk. Coercive control feeding practices, such as strictly limiting a child's intake of highly palatable foods (restriction) and using food to control children's negative emotions (emotional feeding), are believed to be detrimental for young children because they impede self-regulatory skills around eating and may increase the saliency of highly palatable foods. The goal for this project is to disentangle the inter-relationships between coercive control feeding practices, children's obesogenic appetitive traits, and children's dietary intake across the preschool years to understand how coercive control feeding practices ultimately impact children's adiposity gain over time. Importantly, the investigators aim to understand how those effects differ based on children's underlying genetic risk for obesity. The investigators hypothesize that parents will respond to children's obesogenic appetitive traits by exhibiting more coercive control feeding practices (restriction, emotional feeding), which in turn, will promote future increase in obesogenic appetitive traits and overconsumption, leading to excess adiposity gain among children. Importantly, the investigators hypothesize children with a high genetic risk for obesity will be most susceptible to the negative effects of coercive control feeding practices because food is highly salient for them. The investigators will test the hypotheses among a cohort of children aged 2.5 years old using a longitudinal study design with repeated assessments every 6 months until children are 5 years old. If successful, study findings may be leveraged to develop tailored strategies to help parents support healthy eating behaviors among their young children that consider the heterogeneity in obesogenic appetitive traits among young children due to genetic risk factors.

Research Team

Jennifer Emond, PhD

Principal Investigator

Dartmouth College

Diane Gilbert-Diamond, ScD

Principal Investigator

Dartmouth College

Eligibility Criteria

This trial is for children aged 2.5 to 5 years who may be at risk of obesity due to genetic factors and certain eating behaviors. It focuses on understanding how parents' feeding practices influence their child's weight gain over time, especially in those with a high genetic predisposition for obesity.

Inclusion Criteria

My child is between 2 years 3 months and 2 years 11 months old with normal or corrected vision.

Exclusion Criteria

I do not have food allergies, dietary restrictions, take medication that affects my appetite or attention, and no relatives are in this study.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Baseline Assessment

Initial assessment of children's genetic risk for obesity and baseline measurement of appetitive traits and adiposity

1 visit

1 visit (in-person)

Longitudinal Assessment

Repeated assessments of coercive parental food practices, eating in the absence of hunger, appetitive traits, and adiposity every 6 months

2.5 years

5 visits (in-person)

Follow-up

Participants are monitored for changes in appetitive traits and adiposity after the main assessment period

6 months

Treatment Details

Interventions

• Attentional bias to food cues

Trial Overview The study examines the relationship between parental feeding methods, like restricting food or using it as an emotional tool, and children's appetitive traits that can lead to overeating. The goal is to see how these factors contribute to childhood obesity, particularly in genetically susceptible kids.

Participant Groups

Group I: Food Cues Active Control 1 Intervention

Attentional bias to Food cues experimental measurement

Group II: Control Cues Active Control 1 Intervention

Attentional bias to food cues control measurement

Who Is Running the Clinical Trial?

Trustees of Dartmouth College

Lead Sponsor

Trials

32

Recruited

14,500+

Dartmouth-Hitchcock Medical Center

Collaborator

Trials

548

Recruited

2,545,000+

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

Collaborator

Trials

2,513

Recruited

4,366,000+

Dartmouth College

Collaborator

Trials

93

Recruited

1,415,000+

Findings from Research

A study involving interviews and diaries from 22 mothers of healthy weight children aged 3-5 revealed that parental feeding behaviors are primarily motivated by practical and health considerations rather than concerns about weight.

Parents demonstrated a variety of feeding strategies, including promoting or restricting food intake and responding to their children's individual appetitive traits, suggesting that obesity prevention efforts should align with parents' motivations and focus on their children's unique characteristics.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Parental feeding behaviours and motivations. A qualitative study in mothers of UK pre-schoolers. Carnell, S., Cooke, L., Cheng, R., et al.[2021]

A study involving 50 children (25 overweight and 25 healthy-weight) aged 8-12 years found that both groups initially orient towards food stimuli, but overweight children continue to show a preference for food images during longer attention spans (500 ms and 1500 ms).

This suggests that while all children may initially notice food cues, overweight children have a sustained attentional bias towards food, indicating a potential mechanism that could contribute to the risk of obesity later in life.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The role of attentional biases to appetitive stimuli in childhood overweight. Rojo-Bofill, LM., Ortiz-Roldán, A., Moreno-Giménez, A., et al.[2020]

A training program aimed at improving cognitive control over unhealthy food choices was found to be feasible and acceptable for 36 obese youngsters aged 9-15 years in an inpatient treatment program.

However, the preliminary results indicated that the cognitive training tasks did not effectively help these children in maintaining weight loss after treatment, suggesting a need for further research to improve intervention strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Computer training of attention and inhibition for youngsters with obesity: A pilot study. Verbeken, S., Braet, C., Naets, T., et al.[2022]

Obese children do not show a greater attention bias for food compared to healthy-weight children, suggesting that the ability to focus on food cues is similar across weight statuses.

However, an initial orientation bias towards food is linked to less weight loss in obese children after 6 months of a weight loss intervention, indicating that this automatic attention to food may hinder their weight loss efforts.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Food through the child's eye: An eye-tracking study on attentional bias for food in healthy-weight children and children with obesity. Werthmann, J., Jansen, A., Vreugdenhil, AC., et al.[2018]

A study involving 60 adolescents (30 obese and 30 controls) found that obese adolescents showed different patterns of visual attention to food cues, particularly high-calorie foods, compared to their non-obese peers, especially in later stages of viewing.

Higher cognitive abilities, as measured by the Perceptual Reasoning Index, were associated with reduced attention to high-calorie food images over time in the obese group, suggesting that cognitive factors may influence how food cues are processed.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Dynamic changes in the food-cue processing of obese adolescents: A controlled eye-tracking study from a dual-system perspective. Akcay, E., Oztop, DB., Aydın, Ö., et al.[2022]

In a study of 222 children, maternal feeding styles did not show significant associations with child overweight at ages 21, 27, and 33 months, suggesting that feeding practices may not be a strong causal factor in early childhood obesity.

Despite various maternal feeding styles being tracked throughout toddlerhood, the research indicates that other factors may play a more critical role in influencing childhood overweight, highlighting the need for future studies to explore different conceptualizations and measurement methods.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Longitudinal associations between maternal feeding and overweight in low-income toddlers. Lumeng, JC., Kaciroti, N., Retzloff, L., et al.[2019]

A meta-analysis of studies on attentional bias to food stimuli found no significant differences between individuals with overweight/obesity and those with a healthy weight, suggesting that attentional bias may not be a key factor in the maintenance of obesity.

The review highlighted limitations in existing research, such as unreliable measures and the need to consider factors like binge eating, indicating that more rigorous methods are needed to accurately assess attentional bias in relation to obesity.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A systematic review and meta-analysis of attentional bias toward food in individuals with overweight and obesity. Hagan, KE., Alasmar, A., Exum, A., et al.[2021]

In a study of 69 participants, the pictorial visual probe task revealed a greater food-related attentional bias compared to the lexical task, indicating that the type of stimuli used can significantly affect the measurement of attentional bias.

The study found poor test-retest reliability for the pictorial task, suggesting that attentional bias may not be stable over time and highlighting the need for standardized measurement methods in future research.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Measuring Food-Related Attentional Bias. Franja, S., McCrae, AE., Jahnel, T., et al.[2021]

A study involving 31 healthy young adults showed that food labels, particularly low-calorie labels, can significantly influence implicit motivation to approach or avoid caloric rewards, even when the actual taste of the beverages is identical.

fMRI results indicated that low-calorie labels increased brain activity in areas related to motor control during the approach phase, while high-calorie labels activated regions associated with aversion, suggesting that labeling can shape our eating behaviors and preferences without any sensory differences.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Top-down expectation effects of food labels on motivation. Wegman, J., van Loon, I., Smeets, PAM., et al.[2019]

A study involving 58 obese women revealed a significant attentional bias towards food cues compared to normal weight controls, indicating that obesity is associated with heightened focus on food-related stimuli.

In a follow-up experiment with 96 obese women, training to avoid food pictures successfully reduced this attentional bias, suggesting that modifying attentional processing could be a promising strategy for addressing overeating behaviors.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Biased attentional processing of food cues and modification in obese individuals. Kemps, E., Tiggemann, M., Hollitt, S.[2018]

The human attentional system is naturally more responsive to food items compared to nonfood items, as shown in two visual search experiments where participants detected food targets faster.

Individuals with lower Body Mass Index (BMI) exhibited a stronger attentional bias towards food, suggesting that this bias may influence energy consumption and could be a risk factor for weight gain.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Food catches the eye but not for everyone: a BMI-contingent attentional bias in rapid detection of nutriments. Nummenmaa, L., Hietanen, JK., Calvo, MG., et al.[2021]

References

1. England pubmed.ncbi.nlm.nih.gov

Parental feeding behaviours and motivations. A qualitative study in mothers of UK pre-schoolers. [2021]

2. United States pubmed.ncbi.nlm.nih.gov

The role of attentional biases to appetitive stimuli in childhood overweight. [2020]

3. England pubmed.ncbi.nlm.nih.gov

Computer training of attention and inhibition for youngsters with obesity: A pilot study. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

Food through the child's eye: An eye-tracking study on attentional bias for food in healthy-weight children and children with obesity. [2018]

5. England pubmed.ncbi.nlm.nih.gov

Dynamic changes in the food-cue processing of obese adolescents: A controlled eye-tracking study from a dual-system perspective. [2022]

6. England pubmed.ncbi.nlm.nih.gov

Longitudinal associations between maternal feeding and overweight in low-income toddlers. [2019]

7. England pubmed.ncbi.nlm.nih.gov

A systematic review and meta-analysis of attentional bias toward food in individuals with overweight and obesity. [2021]

8. Switzerland pubmed.ncbi.nlm.nih.gov

Measuring Food-Related Attentional Bias. [2021]

9. United States pubmed.ncbi.nlm.nih.gov

Top-down expectation effects of food labels on motivation. [2019]

10. United States pubmed.ncbi.nlm.nih.gov

Biased attentional processing of food cues and modification in obese individuals. [2018]

11. United States pubmed.ncbi.nlm.nih.gov

Food catches the eye but not for everyone: a BMI-contingent attentional bias in rapid detection of nutriments. [2021]