Self-reported vs. actual energy intake in youth with and without loss of control eating
Research Highlights
► Youth with and without LOC did not differ in reporting accuracy of total intakes. ► Youth with LOC were less accurate at reporting percentage of carbohydrate intake. ► Youth with LOC were less accurate at reporting dessert intake.
Introduction
Loss of control (LOC) eating – the subjective experience of a lack of control while eating any amount of food – is one of the most prevalent disordered eating patterns among youth (Tanofsky-Kraff, 2008). LOC eating is reported by 2–10% of children and adolescents among community samples (Field et al., 1999, Lamerz et al., 2005, Maloney et al., 1989). Compared to youth without LOC eating, those who report LOC eating episodes have higher body fat mass and a greater likelihood of being overweight (Morgan et al., 2002, Tanofsky-Kraff et al., 2004). Furthermore, reported LOC is predictive of excessive weight gain over time (Tanofsky-Kraff, Yanovski, Schvey, Olsen, Gustafson & Yanovski, 2009).
Although the mechanisms by which LOC eating lead to excess adiposity are not fully understood, it is quite likely that youth who report LOC exhibit specific eating patterns that predispose them to a positive energy balance. Questionnaire reports (Theim, Tanofsky-Kraff, Salaita, Haynos, Mirch, Ranzenhofer et al., 2007) and observational data from a laboratory feeding study (Tanofsky-Kraff, McDuffie, Yanovski, Kozlosky, Schvey, Shomaker et al., 2009) suggest that youth who report LOC can be differentiated from those without LOC by the consumption of greater percentage energy intake from carbohydrate and less from protein, largely due to greater energy intake of dessert and snack-type foods. These patterns are somewhat consistent with the descriptions of adult binge eating episodes, which are characterized frequently by consumption of foods high in sugar and fat (Guertin and Conger, 1999, Hadigan et al., 1989, Yanovski, 2003).
Intake of palatable foods may serve to alleviate negative affective states via their physiological activation of the opioid and dopaminergic pleasure and reward systems (Gosnell & Levine, 2009). From an Escape Theory perspective, individuals prone to LOC eating episodes may consume palatable foods in an attempt to relieve emotional distress (Heatherton & Baumeister, 1991). Indeed, children who report LOC eating endorse more frequent eating in response to negative emotions than youth without LOC (A. Hilbert and Tuschen-Caffier, 2007, Tanofsky-Kraff et al., 2007). In theory, consumption of highly palatable foods in an attempt to cope with negative affective states may foster a lack awareness of what or how much is being eaten (Heatherton & Baumeister, 1991). Consistent with this notion are empirical data from a large, multi-site study of pediatric LOC eating (Tanofsky-Kraff, et al., 2007). Children with LOC often described a sense of “numbing out” while eating, using terms such as “numb out,” “zone out,” “blank out,” “paralyzed,” or “stunned” during LOC episodes (Tanofsky-Kraff, et al., 2007). These findings suggest that youth with LOC eating could have less awareness of the types or amounts of food they consume compared to those with no LOC. Research investigating misreporting and eating behavior/disordered eating cognitions appears to be limited to the adult literature, with findings indicating greater misreporting among adults with restrained eating, high body dissatisfaction (Novotny et al., 2003, Scagliusi et al., 2003), disinhibited eating (Asbeck, Mast, Bierwag, Westenhofer, Acheson & Muller, 2002), and a desire for weight change (Johansson, Solvoll, Bjorneboe, & Drevon, 1998). However, to our knowledge, no study to date has examined the food intake reporting accuracy of children with and without LOC.
The objective of the current study was to investigate the reporting accuracy for consumption of foods frequently reported as being preferentially consumed during LOC or binge episodes (i.e., dessert and snack foods) among children with reported LOC eating compared to children without LOC. We used a lunchtime multiple-item laboratory food buffet (Tanofsky-Kraff, McDuffie, et al., 2009) to assess actual energy intake from a large sample of children and adolescents with and without LOC. Based on the premise that LOC eating may be associated with a sense of emotional numbing (Tanofsky-Kraff, et al., 2007) and data indicating that children with LOC are more likely to consume snack-type and carbohydrate-laden foods (Hilbert et al., Tanofsky-Kraff, McDuffie, et al., 2009, Theim et al., 2007), we hypothesized that youth with LOC would be less accurate at reporting percentage of calories consumed from carbohydrate and their intake of palatable foods (i.e., dessert and snack foods) compared to their non-LOC counterparts, even after controlling for body composition. Because past research has shown a tendency for heavier youth to under-report food intake as assessed by dietary recall or records (Bandini et al., 1990, Fisher et al., 2000, Lanctot et al., 2008, Ventura et al., 2006, Waling and Larsson, 2009), we also hypothesized that there would be a relationship between percentage body fat and poorer reporting accuracy of observed food intake at a laboratory test meal.
Section snippets
Participants
Participants were a subset drawn from a larger study of healthy volunteers participating in a study of eating behaviors in children (NCT00320177) (Tanofsky-Kraff, McDuffie, et al., 2009). Youth were recruited through flyers posted on bulletin boards at the National Institutes of Health (NIH) as well as at local area supermarkets, libraries, and listservs in the Washington, DC greater metropolitan area. The study was advertised as a non-treatment investigation of the eating behaviors of youth
Descriptive demographic characteristics of sample
Participants were 156 children and adolescents ranging from 8 to 17 years of age (M ± SD, 12.9 ± 2.8 y). The sample was comprised of approximately equal numbers of females (49.4%) and males and was 63.5% White, Non-Hispanic. The mean BMI of the sample was 24.1 ± 9.0 kg/m2 (Range = 13.4 to 69.0 kg/m2), and correspondingly, the mean BMI-z score was 0.9 ± 1.2 (Range = 0.2 to 3.2).
Descriptive information on reporting accuracy of food intake
Actual total energy intake consumed at the test meal ranged from 350.5 to 2983.9 kcal (M ± SD, 1431.0 ± 596.0 kcal), and reported total
Discussion
The current study investigated the reporting accuracy of LOC or binge-type foods (i.e., desserts and snacks) among children with and without loss of control (LOC) eating. Whereas reporting accuracy of total energy intake was not associated with LOC status, youth reporting LOC were less accurate than those without LOC at describing their percentage of intake from carbohydrate and dessert intake.
Consistent with prior literature (Bandini et al., 1990, Fisher et al., 2000, Lanctot et al., 2008,
Role of funding sources
Funding for this study was provided by NICHD Grant Z01-HD-00641, NIDDK grant 1R01DK080906-01A1 and USUHS grant R072IC. Neither NICHD nor USUHS had any involvement in the study design, collection, analysis or interpretation of data, writing of the manuscript, or decision to submit the paper for publication.
Contributors
M. Tanofsky-Kraff, S. Yanovski, and J. Yanovski were responsible for the study design. L. Wolkoff assisted with data collection and wrote the first draft of the manuscript. L. Shomaker assisted with data analysis and interpretation. M. Kozlosky participated in the data analysis.
K. Columbo, C. Elliott, L. Ranzenhofer, and R. Osborn assisted with data collection.
All authors contributed to and approved the final manuscript.
Conflict of interest
No authors have any conflicts of interest.
Acknowledgements
Research support: Intramural Research Program, NIH, grant Z01-HD-00641 (to J. Yanovski) from the NICHD, supplemental funding from NCMHD (to J. Yanovski), NIDDK grant 1R01DK080906-01A1 (to M. Tanofsky-Kraff), USUHS grant R072IC (to M. Tanofsky-Kraff). J. Yanovski and M. Kozlosky are commissioned officers in the U.S. Public Health Service, DHHS. Disclaimer: The opinions and assertions expressed herein are those of the authors and are not to be construed as reflecting the views of USUHS or the
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