Restricting Food Can Increase Eating Without Hunger in Kids

September 27, 2012 (San Antonio, Texas) — More than 1 in 4 overweight children in a recent survey of parents were "sneaking and hoarding" food between meals, possibly as a consequence of their parents restricting their food intake at mealtime, researchers say.

Kendrin Sonneville, ScD, RD, LDN, of Harvard Medical School and Boston Children's Hospital in Massachusetts, designed a study to measure the prevalence of sneaking, hiding, and hoarding of food by overweight children. The investigators also wanted to see whether there was an association between the children's dysfunctional behavior and their parents' own controlling behavior.

"We had no guidelines to tell parents what to do when presented with their children's behavior," Dr. Sonneville told Medscape Medical News. "The distress of the parents and this cohort of overweight kids we had gave us the opportunity to do a simple prevalence study to find out if this was just a problem in our clinic, or if it was a more general problem."

The cluster-randomized controlled trial included 419 children from 10 primary care sites in the Boston area. Participants had to be overweight, obese, or have an overweight parent.

The study asked parents to respond to the questions, "Does your child ever eat large amounts of food, even when not hungry?," "Does your child ever sneak, hide or hoard food?," and to the statement, "I have to be careful that my child does not eat too much."

In the study group, the mean age of the children was 7.1 years. The racial division was 57% white, 18% black, and 17% Latino. With regard to the body mass index, 16% of the parents were normal, 35% were overweight, and 49% were obese.

"A staggering 27% of the parents reported their children were sneaking, hiding, or hoarding food," Dr. Sonneville told Medscape Medical News. "Fifty-eight percent reported they controlled their children's eating, and 17% reported that their children were eating when they were not hungry."

Sneaking and hiding behavior was not positively correlated in the study with any of the variables, although eating when not hungry was positively correlated with parental control of eating.

"It's been suggested that sneaking, hiding, and hoarding food should be part of the diagnostic criteria of binge eating in young children," said Dr. Sonneville. "We do know that binge eating is common among adolescents, and it's the most common eating disorder among adults.

"I think it's possible to assume this behavior is on that same continuum," Dr. Sonneville continued. "It would be interesting to follow these children longitudinally to find out if they develop DSM-5-diagnosed binge eating disorder and what the associated outcomes are for this behavior. We don't know."

Dr. Sonneville believes that her study suggests some clear instructions to parents. "Have them talk to their kids and tell them they will be allowed to eat if they are hungry. 'We as parents will help you make healthy decisions about what you should be eating, but you shouldn't feel ashamed to eat or be embarrassed or do it in private.' Shame seems to be involved with sneaking and hiding food with children," she concluded.

Robert Pretlow, MD, a pediatrician in Seattle, Washington, whose book Overweight: What Kids Say illuminates young people's own reasons for overeating, found the study useful as far as it went. "For me, her study confirmed some symptoms," Dr. Pretlow told Medscape Medical News. "However, she didn't attribute it to any underlying problem. But it's evident if you talk to overweight kids. This behavior is extremely prevalent. Obese kids by definition eat in the absence of hunger; these kids don't know what hunger is. They're grazing all day long, and although they think they feel hunger, they don't."

Dr. Pretlow said he has observed a vicious cycle in the interactions between obese kids and their parents. "First, if a parent discovers that his or her child is overweight and it bothers the parent, the parent will become somewhat withdrawn from that child in wanting to get them to change. The child will then turn to food for comfort. The parent reacts more and more, and when the kid as a consequence eats more, it becomes a vicious circle. It can become an alienation thing where the kid won't even talk to the parent about their weight."

Dr. Pretlow's main thrust in his pediatric obesity practice is having his young patients recognize that they use food as a coping mechanism, which then becomes an addiction. "As one wise obese kid told me, 'If you don't overeat emotionally, then why else do you overeat?' They do this emotionally as a coping mechanism to self-medicate depression," Dr. Pretlow said. "They do it to self-entertain out of boredom; they call it 'eater-tainment.'

"This is very common," he continued. "Once the brain realizes it can eat its way out of stress, that depression and boredom are eased by eating these very pleasurable foods, then the brain undergoes changes to keep this behavior going. So then you've got an addiction and they can't stop. They have to realize there's a part of their brain that's out of control."

Dr. Sonneville's study did not ask parents whether their children are sneaking food because they are actually always hungry or whether they are doing so for other reasons. "We identified no predictors of sneaking, hiding, and hoarding, and we still don't know what causes it or what implications it has on future weight status," she said. "What we did show was that this behavior is associated with eating in the absence of hunger, even if it wasn't associated with parental control."

Some of the study's other limitations are that the results are self-reported, that the results may not be generalized to nonoverweight children, and that parents' attempts at control may be due to the fact that the children are already overweight, Dr. Sonneville said.

Dr. Sonneville and Dr. Pretlow have disclosed no relevant financial relationships.

Obesity 2012: The Obesity Society 30th Annual Scientific Meeting. Abstract 29-OR. Presented September 21, 2012.