The study examined survey data from 3,670 young people in the United Kingdom and the Netherlands to see if early childhood appetite features can predict the development of eating disorder symptoms up to ten years later. The researchers discovered that having particularly high food responsiveness, defined as the desire to eat when you see, smell, or taste palatable food, at the ages of four and five was associated with a higher risk of reporting a variety of eating disorder symptoms between the ages of 12 and 14.
According to a recent study done by academics at UCL and Erasmus University Rotterdam, an enthusiastic response to food in early childhood may be associated with a higher risk of developing eating disorder symptoms in adolescence.
The study, published in The Lancet Child & Adolescent Health, examined survey data from 3,670 young individuals in the United Kingdom and the Netherlands to determine how early childhood appetite features may connect to the chance of developing eating disorder symptoms up to ten years later.
The researchers discovered that having particularly high food responsiveness, defined as the desire to eat when you see, smell, or taste palatable food, at the ages of four and five was associated with a higher risk of reporting a variety of eating disorder symptoms between the ages of 12 and 14.
The team also found that a slower pace of eating and feeling full more quickly (high sensitivity to satiety) in early childhood may be protective against developing some eating disorder symptoms later.
Although our study cannot prove causality, our findings suggest food cue responsiveness may be one predisposing risk factor for the onset of eating disorder symptoms in adolescence. However, high responsiveness to food is also a normal and very common behavior and should be seen as just one potential risk factor among many rather than something to cause parents to worry.
Dr Ivonne Derks
Co-lead author Dr Ivonne Derks (UCL Institute of Epidemiology & Health Care) said: “Although our study cannot prove causality, our findings suggest food cue responsiveness may be one predisposing risk factor for the onset of eating disorder symptoms in adolescence.
“However, high responsiveness to food is also a normal and very common behavior and should be seen as just one potential risk factor among many rather than something to cause parents to worry.”
Higher food responsiveness was linked to a 16% to 47% increase in the odds of reporting eating disorder symptoms, including binge eating symptoms, uncontrolled eating, emotional eating, restrained eating, and compensatory behaviors.
The 47% increase was found for binge eating symptoms (eating a large amount of food and/or feeling out of control over eating), implying that adolescents whose parents rated them highest on food responsiveness were nearly three times more likely to report binge eating symptoms than adolescents whose parents rated them lowest.
Restrained eating, which involves restricting one’s food intake to reduce weight or avoid weight gain, was found to raise the odds by 16%. Emotional overeating in early childhood, like food responsiveness, has been associated with an increased likelihood of participating in compensatory behaviors aimed at avoiding weight gain, such as missing meals, fasting, and excessive exercise.
As a result, some hunger features appeared to be protective against acquiring eating problem symptoms later. Higher satiety response — that is, feeling full faster and for longer after eating — was associated with a lower risk of uncontrolled eating (defined as feeling out of control and eating more than normal) and compensatory behaviors.
Meanwhile, eating at a slower pace was associated with a lower risk of compensatory behaviors and restrained eating. The researchers also discovered that hunger features such as food fussiness, emotional undereating (eating less owing to a negative mood), and food satisfaction in early childhood were not associated with subsequent eating disorder symptoms in adolescence.
The researchers analyzed data from two longitudinal studies: Generation R, which followed infants born in Rotterdam, the Netherlands, from 2002 to 2006, and Gemini, which followed twins born in England and Wales in 2007.
When the youngsters were four or five years old, appetite features were examined using questionnaire responses from their parents. Eating disorder symptoms were self-reported by teenagers aged 12 to 14, which is when eating disorder symptoms normally appear.
About 10% of the adolescents reported binge eating symptoms, where people eat an unusual amount of food and/or experience the feeling of loss of control over eating. Next to that, 50% reported at least one behavior to compensate for their food intake or to avoid gaining weight, such as skipping a meal.
Co-senior author Dr. Clare Llewellyn (UCL Institute of Epidemiology & Health Care) said: “While the role of appetite in the development of obesity has been studied for many decades, this is the first study to comprehensively examine the role of appetite traits in the development of eating disorder symptoms.
“Eating disorders can be difficult to treat effectively once they develop, so it is preferable to prevent them from occurring in the first place.” Our study identifying risk factors in early life intends to help create potential preventative methods. These could include, for example, providing additional support to at-risk youngsters.”
Appetite qualities describe how we react to food and the opportunity to eat, as well as how much we desire to eat when we are feeling bad. They are classified as food approach appetitive qualities (e.g., food responsiveness, pleasure of food, emotional overeating) and food avoidance traits (e.g., satiety responsiveness, food fussiness, sluggish eating, emotional undereating).
Co-senior author Professor Pauline Jansen of Erasmus University Rotterdam said: “Overall, our findings suggest that developing and testing prevention strategies may be a worthwhile effort. Although appetite has a substantial genetic component, we also know that there are environmental influences that offer opportunities for behavior change.”
The researchers indicate that a healthy food environment and responsive parental feeding strategies may help to lower the risk of developing eating disorders.
Co-lead author Dr Zeynep Nas (UCL Institute of Epidemiology & Health Care) explained: “A healthy food environment is an environment in which healthy foods are available and more prominent, salient and affordable than less healthy options. This also includes wider access to food such as what types of food outlets are available in our neighbourhood and what food we see on TV.
“Responsive feeding is about providing nutritious food at set mealtimes and snack times, and then allowing the child to decide what to eat and how much to eat (if anything at all) without pressuring them.”
In a separate paper, accepted for publication in the International Journal of Eating Disorders, a similar research team examined the same two cohorts, Generation R and Gemini, to see how parental feeding practices in early childhood might influence the likelihood of eating disorder symptoms in adolescence.
The researchers discovered that non-responsive feeding practices, such as pressuring children to eat or using food as a reward or to soothe emotions, were associated with a higher risk of developing particular eating disorder symptoms later. However, the connections were minor and varied between the two cohorts, and the researchers stated that additional replication studies were required.
