Reprinted from Eating Disorders Review
January/February 2007 Volume 18, Number 1
©2007 Gürze Books
More than 30% of children and teens in the U.S. are now classified as overweight or at risk of becoming overweight, and it’s predicted that most of these children will become overweight or obese as adults. While children who report binge eating gain more weight than children who don’t report binge eating, little is known about how binge eating affects children’s food intake or its effects on their levels of satiation, satiety, and energy intake.
Dr. Margaret C. Mirch and colleagues at the National Institutes of Health, Bethesda, MD, studied 60 overweight children 6 to 12 years of age; 10 were categorized as binge eaters; the other 50 children reported no episodes of binge eating (Am J Clin Nutr 2006; 84:732).
Two buffets with lots of choices
The children were admitted for a three-day inpatient stay, during which they ate from standardized lunch buffets two days apart. All the children selected lunch twice from a multiple-item (9835 kcal) buffet meal. After an overnight fast and a standardized breakfast, the children ate at will until they reported they were full. The researchers recorded energy intake during the meals and the period that the children reported being full after the meal. Relative body mass indexes were calculated according to the Centers for Disease Control and Prevention 2000 Growth Charts.
To assess binge eating, each child completed the Questionnaire for eating and Weight Patterns—Adolescent Version (QEWP-A). The QEWP-A has been used with children as young as 6 years of age. The children also completed the Three-Factor Eating Inventory, a 51-item questionnaire designed to measure cognitive restraint, disinhibition, and hunger.
The foods offered in the buffet were selected after determining the foods the children liked. The children were asked to select their lunch from a multiple-item buffet meal; foods offered at all other meals between the two buffet meals were selected by a registered dietitian to maintain the child’s current body weight. The children were tested individually and when each child entered the buffet room, he or she was invited to eat as much as desired but they didn’t have to eat anything they didn’t like. The child was then left alone, to eat as much or as little as he wished. Afterward, the children were asked about how full they felt, and the children indicated how much more they felt they could eat on a visual analog scale.
Results: Intake and hunger were greater among children who binge-ate
The self-reports of hunger and fullness before the post-fast meal and the duration of the meal were not statistically different between the two groups. However, children in the binge eating group reported a significantly greater desire to eat before the meal than did children in the non-binge eating group. Total intake during the post-fast meal, adjusted for covariates such as age, height and weight, was significantly greater in children who reported binge eating than in children who did not binge eat.
Dr. Mirch and colleagues found that when overweight children who reported binge eating were asked to choose their lunch from a buffet that contained large portions of palatable foods, they over-ate to a significantly greater degree than did equally overweight children who did not binge eat. In fact, children with a history of binge eating ate 400 kcal more than did children who did not report binge eating. Then, despite their greater intake of food, the children who reported binge eating became hungry at least an hour earlier than did children in the non-binge-eating group. When the results of the Three-Factor Eating Inventory were analyzed, the authors found that while restraint levels among children who reported binge eating did not differ significantly from those who did not binge eat, children in the binge eating group did have significantly higher levels of disinhibition and hunger.
Data similar to that in adults
The authors noted that the greater energy intakes seen in children with a history of binge eating are consistent with data from laboratory studies of adults with binge eating disorder who, when instructed to eat, consume significantly more energy than adults who do not engage in binge eating. The children who report binge eating behaviors appear to have deficits in appetite regulation that place them at risk for developing obesity because of their lack of satiety or other complex factors.