Food insecurity and eating disorders in obese children


Today Dr June Tester presented the first qualitative study I have seen at Obesity Week ever, on the very interesting topic of disordered eating in children growing up with food insecurity. There is quite a marked association between food insecurity and obesity, which may seem paradoxical, but makes perfect sense to me. Subjects were 47 focus groups from a paediatric weight management clinic. Grounded theory was used to describe themes surrounding food insecurity and eating problems in the children.

There was a lot of secretive eating practices and food hiding, as one would expect. There was also a high frequency of hidden candy wrappers in the children’s rooms. Likewise, food insecure parents also hid food, i.e. fending for themselves: “Otherwise I don’t get any”. It was striking to me the low quality of food that these very poor families can afford to buy. All members of the family tend to binge eat food when there is food insecurity. Parents describe how they want to put locks on their fridges or anywhere there is food. These behaviors certainly complicate treatment of obesity.

Given the marked association between socioeconomics and obesity, we could certainly do with more of this type of studies.


TOS session: Evolving behavioral strategies for weight control


This was a very interesting session where all presenters gave great and informative talks and discussed various new behavioural strategies for improving obesity treatment outcomes. Clearly there has been quite significant progress in the last 5 years or so in improving behavioral treatment program, so that we can improve weight loss and quality of life. Below is a brief summary of what each presenter talked about.

Evan Forman talked about acceptance-based approaches to weight loss, for example how we are often governed by negative internal discomfort, both in terms of diet and exercise, and how this can be overcome. A low distress tolerance clearly predicts poor treatment outcomes, such as weight regain after weight loss. Cues are from both the environment and internal. Commitment and motivation erodes over time. An aversive state, both in terms of cues (hunger and cravings) and emotions (sadness, boredom, anxiety), leads to unhealthy lifestyle choices. The evidence supporting acceptance based therapy vs standard behavioural therapy is still limited, but clearly promising. Studies are now showing better outcomes than older behavioral treatment models, particularly when the intervention was delivered by experts in acceptance therapy. Patients with mood problems appear to benefit greatly from this type of intervention, and also early treatment non-responders.

Jean Kristeller talked about mindfulness-based approaches to obesity treatment. Mindfulness can work to disengage from habitual reactions. There is now a lot more evidence on a very positive role of mindfulness in food intake regulation, for example when eating is emotionally driven. Mindfulness (such as increased awareness of hunger and food cues, awareness of hedonic eating and sensations of fullness) can really help to self-regulate more or less automatic responses, such as eating comfort foods when they are freely available. Mindfulness can be a particularly useful approach for binge eaters and impulsive eaters. There is also a moderately strong association (r=-0.41) between use of mindfulness-based approaches and weight change. The evidence base for greater use of mindfulness-based approaches to weight loss is clearly increasing.

Melinda Sothern talked about the powerful role of parents and families in promoting healthy diet and exercise lifestyles in children. Poor parental role modelling, for example through unhealthy food and eating habits and lack of exercise/excessive TV time, is a major risk factor for childhood obesity. There is great potential in improving childhood obesity treatment outcomes through improving the home environment and parents are obviously critical to get on-board. More play time is recommended as is less screen time. This will also help the children to develop in many areas, not least socially and emotionally. The challenge (I presume) is how to convert these recommendations for socioeconomically disadvantaged families, where obesity is also much more common than in affluent families.

Erik Hemmingsson