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Diet type does not influence eating behaviors in children with obesity
Children with obesity assigned to three different carbohydrate-modified and portion-controlled diets experienced similar changes in cognitive restraint, hunger level and disinhibition level over 1 year of follow-up, but the relationship between behavior changes and BMI changes differed by diet, according to published findings.
“While a calorie-restricted, low-fat diet has been a widely promoted dietary strategy, our recent findings suggest that a variety of dietary approaches (eg, low-carbohydrate, reduced glycemic load and nutrient-balanced, portion-controlled diets) can be similarly effective in helping youth with overweight and obesity improve their weight status,” Shelley Kirk, PhD, LD, RD, of the Center for Better Health and Nutrition at Cincinnati Children’s Hospital Medical Center, and colleagues wrote. “However, it is not known how these different dietary approaches impact children’s eating behaviors within the context of a multicomponent, pediatric weight management intervention. Understanding if initial eating behaviors or change in these eating behaviors during treatment predicts child weight status changes or differs based on the treatment approach has implications for matching children to treatment approach and/or tailoring approaches for maximum efficacy.”
Kirk and colleagues analyzed data from 102 children aged 7 to 12 years with obesity who were randomly assigned to a low-carbohydrate diet (n = 35), a reduced glycemic load diet (n = 36) or a standard portion-control diet (n = 31) for 12 months (mean age, 11 years; 43 boys; 79 white). Parents completed a three-factor eating questionnaire at baseline and 3, 6 and 12 months to characterize their child’s hunger, disinhibition and cognitive restraint. Researchers evaluated baseline and follow-up questionnaire scores by diet type relative to BMI status over time.
At 3 months, researchers observed a greater decrease in BMI z score for children in the low-carbohydrate diet group vs. the reduced glycemic load and portion-control diet groups; however, there were no between-diet differences in body weight at 6 and 12 months.
In longitudinal models adjusted for sex, race and diet group assignment, researchers found that the disinhibition scores were not associated with BMI percent of 95th percentile. A lower hunger score, however, was associated with lower body weight across all follow-up visits (P = .002). Cognitive restraint scores differed in their relationship with BMI by study visit (P for interaction = .005). A higher cognitive restraint score, for example, was associated with a lower weight status at the 12-month visit, researchers noted.
In diet-specific mixed models adjusted for sex and race, both sex and cognitive restraint scores were associated with BMI percent of the 95th percentile for those in the low-carbohydrate diet group, with interaction depending on visit (P for interaction = .0001). For children in the reduced glycemic load group, sex and race were not significant, but a higher cognitive restraint score was associated with lower weight status across visits (P < .0001), with no evidence of interaction by visit, researchers noted. For children in the portion-control diet group, lower hunger scores were associated with lower weight status across all visits (P = .0006).
In a post hoc analysis to determine which baseline factors were tied to variability in cognitive restraint and hunger scores during follow-up, researchers observed that cognitive restraint scores were higher among those assigned to the low-carbohydrate diet group, among white participants and among those with higher baseline cognitive restraint scores. Lower hunger scores across follow-up visits were associated only with lower hunger scores at baseline.
“Different aspects of the children’s eating behaviors were associated with BMI outcomes by diet group, with higher cognitive restraint more important in [carbohydrate-modified] diets and lower hunger [scores] more important in standard [portion-controlled] diets,” the researchers wrote. “The results of this study may extend our potential to improve long-term treatment outcomes for children with obesity by tailoring intervention strategies to the type of dietary approach and the child’s eating behaviors.” – by Regina Schaffer
Disclosures: The researchers report no relevant financial disclosures.