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Contains fulltext : 237529.pdf (Publisher’s version ) (Open Access) Psychological mechanisms play a crucial role in explaining weight gain. Aim of the present study was to identify subtypes in youngsters with obesity in line with these mechanisms. Defining homogeneous clusters within this heterogeneous group provides relevant information for personalized treatments. Data were collected in N = 572 participants (51% boys, aged 7-19) with extreme obesity (%BMI M = 187.8; SD = 30.9) recruited in an inpatient treatment centre. Based on psychological models of overweight/obesity, the Affect Regulation Model, the Reward Deficiency Model and The Dual Pathway Model, cluster variables were selected assessing emotional eating, reward reactivity and regulative capacities. Youngsters reported on emotional eating (DEBQ Emotional Eating) and reward sensitivity (BAS), while parents reported on children's regulative Executive Functions (BRIEF). Characteristics of the different clusters were examined concerning weight variables (pre and post treatment) and variables indexing problematic eating (DEBQ External Eating, Ch-EDE), affect regulation (FEEL-KJ) and depressive symptoms (CDI). Hierarchical cluster analyses supported the presence of three clusters, further evaluated by K-means cluster analyses. The cluster solutions differed according to age and sex (boys 7-13, boys 14-19, girls 7-13, girls 14-19). In all four age and gender subsamples, an "Emotional Eating" cluster displaying a vulnerable profile (high depression, maladaptive emotion regulation, problematic eating) and a "Reward Deficiency" cluster displaying a more resilient profile were detected. In girls 7-13, a "Weak Executive Functioning" indicative of insufficient self-regulative capacities, showed moderate to high emotional problems and problematic eating. In the other subgroups, the "Mean Level Functioning" cluster also showed elevated emotional problems and problematic eating. Given that different clusters can be identified, and given that these clusters have different profiles on emotional problems and problematic eating, subtyping youngsters with severe obesity is indicated, setting the stage for personalized treatments. 11 p.

Contains fulltext : 222470.pdf (Publisher’s version ) (Closed access) Training self-control as the assumed underlying mechanism for weight loss is a promising pathway for improving long-term outcomes of childhood multidisciplinary obesity treatment (MOT). The present study is the first to analyse adherence to e-health self-control training in paediatric obesity. We hypothesized that low adherence would relate to child characteristics and to contextual treatment barriers. Participants were recruited as a part of a larger randomized controlled trial, evaluating an e-health self-control training during inpatient MOT (intensive phase) and its outpatient aftercare (booster phase). A number of 68 youngsters with severe obesity between 11 to 19 years old were included in the present study. Excellent adherence was observed in the intensive phase during inpatient MOT, but rates decreased in the booster phase. As predicted, the low adherence group had a significantly higher weight status throughout the entire study period. Differences in contextual treatment barriers did not appear. Further in-depth analysis showed that the low adherence group frequently experienced practical obstacles. The end of inpatient MOT and high weight status can be considered important risk factors for low adherence in an additional self-control training aimed at facilitating weight loss. 10 p.

Contains fulltext : 222475.pdf (Publisher’s version ) (Open Access) Introduction: In order to grasp the complex etiology of childhood obesity, we aim to clarify the relationship between external eating and weight. Based on theory and empirical evidence, we claim that inhibition is an important moderator in this association. In our first research question we expected that high external eating would be related to a higher weight status, especially for those with high inhibition problems. Secondly, we explored the moderating role of inhibition in the association between external eating and weight change after a multidisciplinary obesity treatment. Method: We investigated n=572 participants (51% boys, aged 7-19) with moderate to extreme obesity recruited in a Belgian inpatient treatment center. At intake, parents reported on inhibition (BRIEF), while the children and adolescents reported on their eating behavior (DEBQ). Weight and length were objectively measured pre and post treatment (ADJUSTED BMI). Two hierarchical linear regression models were built to scrutinize the influence of inhibition on the association between external eating and both baseline weight and weight change. Results: First, predicting baseline weight, we found no significant moderating effect of inhibition problems. Second, predicting weight loss, inhibition turned out to be a substantial moderator, specifically in adolescents. Some unexpected gender differences occurred in favor of adolescent boys, in a way that those with high external eating and low inhibition problems lost most weight. Conclusion: Inhibition problems act as a moderator explaining weight loss, but this only holds for adolescents. This suggests that external eating and inhibition play a complex role in weight loss in certain age and gender categories, and stresses the importance of identifying subgroups for tailoring interventions. For those with high inhibition problems, interventions aimed at increasing inhibition skills might be needed to optimize treatment outcomes. 9 p.

Background and Objectives Previous studies have suggested that internal cognitive control impairments may play an important role in the development of depression. Despite a growing body of research in adults, the ability to shift internal attention between mental representations in working memory has received little attention in younger populations. This study investigated internal shifting capacity between emotional and non-emotional information in dysphoric and non-dysphoric adolescents. Methods Twenty dysphoric and 34 non-dysphoric adolescents (10–17 years) completed an Internal Shifting Task, with pictures of angry and neutral faces, to measure the ability to shift attention between information held in working memory. Results Dysphoric adolescents showed specific shifting impairments when processing emotional material relative to non-dysphoric adolescents. Valence-specific analyses revealed that shifting was particularly impaired when shifting from negative to neutral information. By comparison, relative to non-dysphoric adolescents, dysphoric adolescents did not show shifting impairments when non-emotional features of the pictures had to be processed. Limitations The study is limited by the absence of a structured clinical interview as dysphoria was determined dimensionally. Furthermore, a comparison of the effects of different negative stimuli on shifting could not be made since sad stimuli were not included in the stimulus set. Conclusions The results confirm the link between depressive symptoms and emotion-specific shifting impairments in adolescents and indicate that targeting shifting ability in response to emotional stimuli may be a promising avenue for prevention programs. Longitudinal research is needed to replicate results and to explore the role of internal shifting impairments in the etiology and maintenance of depression.

In dit hoofdstuk laten we zien hoe ouders cruciale partners zijn in het optimaal laten ontwikkelen van emotieregulatie bij kinderen. Ouders spelen namelijk op verschillende manieren een rol, zoals geconceptualiseerd in het model van Amanda Morris en collega’s (2007). Meer bepaald zijn ouders in de eerste plaats rolmodellen voor goede emotieregulatie. Ook kunnen ze specifieke opvoedingsvaardigheden hanteren om emotieregulatie te ondersteunen (emotie-coaching), en zorgen ze mee voor een emotioneel stabiel gezinsklimaat. Maar hun rol is niet unidirectioneel. In het model laten we zien hoe dit zich dit ontwikkelt in interactie met kindspecifieke kenmerken (zoals diens temperament) en hoe deze interacties dan bijdragen tot emotie-gerelateerde ontwikkelingsuitkomsten, maar ook, bij ongunstige ontwikkeling, tot depressieve symptomen of gedragsproblemen.

Obesity is a widespread problem that not only leads to medical and psychological diseases in adults, but also in children and adolescents at an early stage in life. Because of its global burden on both the individual and society, it is necessary to develop effective evidence-based treatments. Current “Multidisciplinary Obesity Treatments” (MOT) already provide significant weight loss, but still leave room for more long-lasting improvements. In this protocol paper, we outline the research goals of the WELCOME trial, based on a substantial proof of concept. In this Randomized Controlled Trial (RCT) – conducted in both an inpatient and two outpatient treatment settings – existing MOT will be supplemented with an Executive Function (EF) training and compare effects on various parameters in an experimental versus an active control group of obese youngsters (8–18 years old). WELCOME aims to (a) train youngsters’ executive functions to facilitate effects on weight loss, psychological and medical comorbidities, (b) to enhance the long-term effects by continuing the training in the daily home context with booster sessions, and (c) to investigate its effects until a 6-month follow-up. In comparison to the active control group, better progress is expected in the experimental group on following variables: weight, psychological comorbidities (unhealthy eating behavior, internalizing symptoms, impaired self-esteem) and medical comorbidities (metabolic syndromes, endothelia dysfunction, tonsillar hypertrophy and sleep obstruction). It is stated that this EF-training for enhancing self-control abilities is necessary for a long-lasting effect of childhood obesity treatment interventions. The Study Procotol was registered on 10/05/2017 (n° ISRCTN14722584 ).

Contains fulltext : 222469.pdf (Publisher’s version ) (Closed access) Prevalence of overweight and obesity in children and adolescents is high, not only in Western countries but also in developing countries. Efforts to improve prevention and treatment programs are needed. Given their essential role in weight problems, knowledge of determinants of problematic eating behavior ('External Eating' and 'Emotional Eating') is crucial for intervention development. Inspired by Appelhans' Dual Process Theory of Eating Behavior, the present study evaluated the importance of top-down regulative capacities and bottom-up reactivity, using the CIBER approach. CIBER is an innovative statistical approach to test the importance of behavior determinants, based on confidence intervals, instead of significance testing of point estimates. Survey data on different aspects of executive functioning (as indices of regulative capacities: Inhibition, Cognitive Flexibility, Emotional Control, Initiation, Working Memory, Planning/Organizing, Organization of materials, and Monitoring) and reward sensitivity (as an index of reactivity) were collected in a large sample of children and adolescents (n = 572) with severe obesity (adjBMI > 180%). Results showed that Emotional Eating is determined by Emotional Control, while External Eating is determined by Reward Sensitivity. The finding that differential mechanisms underlie different aspects of problematic eating suggests the need for using tailored intervention techniques to address altered reactivity and weak regulative capacities. 7 p.

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