Cluster randomized control trial promoting child self-regulation around energy-dense food

Abstract

Children with lower inhibitory control have greater weight gain over time and consume more snack food. Our goal was to test whether a pilot program based on enhancing self-regulation in preschool children could decrease consumption of energy-dense foods. Ninety-two preschool children were randomized to the intervention or control group. The intervention was a three-week, play-based program that focused on enhancing executive function skills and decreasing consumption of energy dense snack foods. Controls met for a similar length of time, but focused on dental hygiene, good sleep habits/routines, and physical activity. Primary outcome included calories consumed during the post-intervention "Eating in the Absence of Hunger" paradigm, controlling for baseline calories consumed. Inhibitory control was assessed using the "Day/Night" and "Less is More" tasks. There were no differences in post-intervention calories consumed between groups (p = 0.42). However, post-hoc analysis revealed a significant interaction between group and weight status (p = 0.04). In the intervention group, overweight/obese and healthy weight children consumed a similar number of calories (118.0 kcals vs. 124.1 kcals respectively, p = 0.64). However, in the control group, overweight/obese children consumed more than normal weight children (155.9 kcals vs. 103.6 kcals respectively; p = 0.01). With regards to inhibitory control, post-hoc analysis revealed a significant interaction between group and age (p = 0.03), with younger children in the intervention group scoring higher than younger children in the control group (0.93 vs 0.78 respectively, p = 0.007). No differences were observed between groups among older children (0.93 vs 0.96, p = 0.42). These types of programs for preschool children may help to temper consumption of excess calories among overweight/obese children. Further development and investigation of pediatric programs that prevent consumption of excess calories are warranted. Trial registration: Clinicaltrials.gov: NCT02077387.

Children's Sugar-Sweetened Beverage Consumption: Striking Parallels With Substance Use Disorder Symptoms

“…Incorporation of psycho-behavioral approaches used in complex and multifactorial SUDs may be useful for addressing excess SSB consumption among children. For example, children may be taught to identify situations where they experience cravings for SSB and to use self-regulation strategies to successfully reduce SSB consumption (19). Furthermore, interventions may benefit from identifying and addressing situational and contextual cues for children's SSB intake, which may result from learned associations developed over time through repeated SSB exposure (20).…”

How Lifestyle Factors Affect Cognitive and Executive Function and the Ability to Learn in Children

“…As indicated above, feelings of hunger or feeling over-full both might affect children’s ability to process information in a manner conducive to learning. Eating in the absence of hunger, or overeating [29], is a contributor to excess body fat and childhood obesity [30]. Studies aimed at understanding the relationship between obesity and cognition during childhood have only recently emerged, and the majority of findings have been limited to the domain of executive control [31,32,33].…”

Exploring the relationship between appetitive behaviours, executive function, and weight status among preschool children

“…They are also developing higher‐level executive functions 44,45 and eating behaviors 46 at this time, and may be more amenable to training efforts than when they are older 47 . Programmes that promote executive function in preschool‐age children exist, 48 but are not frequently adapted to address food stimuli 33 . Efforts to increase inhibitory control or emotional control skills in children would target another skill set currently not addressed in many treatment/prevention programmes, and may be particularly useful for those with higher levels of FR or lower levels of SR.…”

“…This study is a cross‐sectional secondary analysis of data collected from preschool‐age children who were recruited to participate in a play‐based intervention targeting food‐based self‐regulation with the goal of decreasing consumption of energy‐dense snack foods. Details regarding the intervention protocol and eligibility criteria have been previously published 33 . This protocol was approved by the Institutional Review Board of the University of California, San Diego, and registered in http://clinicaltrials.gov (NCT02077387).…”

“…The goal of this project was to conduct exploratory analysis and examine the relationship between both higher‐level cognitions and appetitive behaviours on weight status in a cohort of preschool‐age children. Using baseline data from an intervention targeting self‐regulation in preschool children around the consumption of energy‐dense snack foods, 33 we examined the association between EFs and child BMI percentile among preschool children who were higher in FR or satiety responsiveness than those who were lower in FR or satiety responsiveness. We hypothesized that EFs would play a more important role in children who were high in FR or low in satiety responsiveness and had stronger desires to eat when presented with tempting stimuli in the environment.…”