Elsevier

Eating Behaviors

Volume 4, Issue 2, August 2003, Pages 197-209
Eating Behaviors

Overweight children overeat after exposure to food cues

https://doi.org/10.1016/S1471-0153(03)00011-4Get rights and content

Abstract

Overweight is becoming more common in children, but we know nearly nothing about the eating behavior of overweight children. Learning theory predicts that overeating follows from learned associations between the smell and taste of palatable food on the one hand and intake on the other hand. It was tested whether overweight children overeat after confrontation to these cues. They indeed failed to regulate food intake after both the exposure to the intense smell of tasty food (without eating it) and after eating a small preload of appetizing food, whereas normal-weight children decreased their intake after both cues. Overweight children are thus more vulnerable to triggers of overeating. Their overeating was not related to psychological factors like mood, body esteem, and a restrained eating style, but it was related to cue-elicited salivation flow. Apart from supporting the cue reactivity model of overeating, the data point to an interesting satiety phenomenon in normal eaters after prolonged and intense smelling palatable food without eating it.

Introduction

Obesity is a major health problem and its prevalence is rising, not only in the United States but also in the Netherlands; about 40% of the Dutch adults is overweight or obese now (Visscher, Kromhout, & Seidell, 2002). Moreover, the prevalence of Dutch overweight children increased from 9.5% in 1980 to 13.5% in 1997 (Hirasing, Fredriks, van Buuren, Verloove-Vanhorick, & Wit, 2001). The risk of being an obese adult is significantly higher for overweight children than for their nonoverweight counterparts (Dietz, 1995), implicating that the prevention of adult obesity should start in childhood. However, little is known about the eating behavior of overweight children. Laessle, Uhl, and Lindel (2001) found that the presence of the child's mother led to faster eating in overweight children as compared to normal-weight children, whereas in the absence of their mother, the speed of eating was the same in overweight and normal-weight children. The authors argue that instrumental learning principles might be responsible for the overeating of overweight children in the presence of their mothers; a parent giving frequent prompts to eat in order to get the plate empty lowers the self-control of overweight children and increases their caloric intake in that way.

When parents prompt their children to eat when food is available, classically conditioned associations between cues that predict food intake and actual eating behavior will be strong. The classical conditioning model of overeating states that after systematic association of cues with food intake, the cues will reliably signal the food effects such as increased blood sugar and salivary flow (Jansen, 1998). The moment the cues are good predictors of intake, they acquire the ability to elicit physiological responses that are useful for digestion (e.g., salivation and insulin responses), which is called cue reactivity. That physiological cue reactivity is supposed to be experienced as appetite or craving and increases the likelihood of food intake (Jansen, 1998). The predictive cues often are directly related to food intake (such as the smell and taste of food), but they might also be contextual (e.g., home, company) or interoceptive (e.g., feelings, cognitions). Indeed, a large number of studies showed that the physiological responses brought about by food intake, e.g., insulin release, blood sugar increase, and salivation, can be brought under the control of any stimulus predictive of food intake, like odors, sounds, time of the day, eating-related situations, seeing, smelling, tasting, and even thinking of food Nederkoorn et al., 2000, Rodin, 1985, Wardle, 1990, Woods, 1991, and some recent studies support the idea of cue reactivity in binge eaters and obese people as a method of priming the body to absorb and use the nutrients to ingest Karhunen et al., 1997, Mattes, 1997, Vögele & Florin, 1997. Furthermore, mere exposure to cues that typically predict food intake, i.e., the taste or smell of tasty food, led to overeating in people that tried to restrain their food intake Fedoroff et al., 1997, Jansen & Van den Hout, 1991, Rogers & Hill, 1989.

Classically conditioned associations between cues that predict food intake and actual eating behavior might be stronger in overweight than in normal-weight children since parents of overweight children more frequently prompt their children to eat their plate empty (Laessle et al., 2001) and overweight children show higher external eating styles, meaning that their intake is more often triggered by food cues like seeing or smelling food (Braet & van Strien, 1997). Both increase the probability that a food cue is followed by food intake, which strengthens the bond between cues and intake and makes smell and taste more predictive of intake in overweight than in normal-weight children.

If associations between cues predicting food intake and actual eating are stronger in overweight than in normal-weight children, overweight children will show more cue reactivity and caloric overconsumption after confrontation with food cues than normal-weight children. In the present study, it was predicted that overweight children report more appetite and hunger and show increased salivary flow—as an objective index of appetite/hunger—after confrontation with cues that elicit appetite (eating a tasty preload, smelling tasty food) than normal-weight children. It was also expected that the exposure to food cues leads to increased caloric intake in the overweight children, and that increased cue reactivity (appetite/hunger/salivation) and increased food intake are related. Because current models of overeating stress the importance of restraint, low body esteem, and mood as triggers of disinhibited eating (e.g., Fairburn et al., 1993, Rosen, 1996, Wegner et al., 2002), we also explored whether restraint, body esteem, and mood play a role in the overeating of overweight children.

Section snippets

Design

Overweight and normal-weight children between 8 and 12 years participated three times in a taste test: after the consumption of an appetizing preload (preload condition), after the intense smelling of tasty food (exposure condition), and after playing without food confrontation (control condition). The order of conditions was counterbalanced and for each participant there was a 1-week gap between conditions. Main dependent variable was caloric intake during the taste test. Also, salivary flow

Results

Hypothesis 1

Overweight children show more cue reactivity after confrontation with food cues, i.e., they report more appetite/hunger and show increased salivary flow after eating a tasty preload and smelling tasty food than after a neutral cue.

Because Pearson's product–moment correlations between hunger and appetite were highly significant (r=.81), it was decided to restrict cue reactivity measures to appetite and salivation. Table 2 shows the appetite and salivation responses for each group before and

Discussion

The main question of the present study was whether overweight children would show increased cue reactivity and food intake after eating a tasty preload and after the intense smelling of tasty food. It was also examined whether cue reactivity, restraint, mood, and body esteem were related to caloric intake. The data indeed show that overweight children do not regulate their food intake like normal-weight children do. Normal-weight children eat less after having eaten a preload and after intense

Acknowledgements

Thanks are expressed to Fren Smulders for his useful comments on an earlier draft of this paper.

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