Lansigan,R.K., Emond,J.A. and Gilbert-Diamond,D., (2015) Appetite 85C:36-47 S0195-6663(14)00515-7
OBJECTIVE: To improve understanding of correlates of eating in the absence of hunger (EAH) in children, taking into account genetic, physiological, psychological, behavioural, familial and larger social influences, in order to help inform obesity prevention programs at the individual, familial and societal levels, and to identify research gaps.
DESIGN: Systematic review. Databases searched were Medline (PubMed), Web of Science, Cochrane Library, EINAHL, and PsycINFO. A total of 123 relevant articles were retrieved. Eligible studies were those in which EAH was self-reported and in which studies testing a snack or drink preload rather than a meal fed ad libitum were excluded. Included studies were those that operationalised EAH as the absolute number of kcals of palatable foods consumed during the free access phase in the absence of hunger, or as the weight of palatable foods consumed. The review included 19 eligible studies of which 12 were cross-sectional studies, 6 were prospective cohort studies, and 1 was a behavioural intervention study.
SETTING: Various.
PARTICIPANTS: Children ≤12 years, though studies were also included that reported age-specific analyses in pre-adolescents.
MAIN OUTCOME MEASURES: EAH expressed as total amount of kcals consumed or as the grams of palatable food consumed.
RESULTS: In cross-sectional studies EAH was positively associated with various measures of adiposity. Prospective studies also supported a positive association between excess weight and EAH. Though no studies specifically compared EAH across age categories, EAH was reported in children as young as 3 years up to 18 years in the eligible studies, and evidence suggested it is likely to increase with age at least until age 13 years. The association between EAH with respect to age-adjusted daily caloric needs remains understudied. EAH occurs in both genders, and gender was found to modify the associations between other correlates of EAH including weight status. EAH is present among children across diverse racial and ethnic backgrounds. However, studies comparing EAH by race and ethnicity are absent, as are studies to assess how race or ethnicity may modify the association with other characteristics with respect to EAH. The impact of a child’s eating style and their emotional state on EAH remain largely unexplored. It is likely that the propensity to engage in EAH has a genetic component that is observable in children as young as 4 years, before excess weight gain occurs, and further studies are needed to explore associations between genetics and EAH and weight gain as children age.
The data for an effect of parental weight status and a child’s EAH are mixed suggesting that main effects may be moderated by other characteristics among households with an overweight parent. Some studies suggest that maternal feeding styles impact EAH among daughters, but more studies are needed to assess how parental gender may moderate associations relevant to EAH. In one study there was a positive correlation between daughters’ EAH at ages 9, 11 and 13 years with overweight mothers who had higher levels of self-reported dietary disinhibition compared with normal weight mothers. There were no significant associations between paternal dietary disinhibition and girls’ EAH. Dietary disinhibition may be a learned behaviour that contributes to EAH among girls as they mature from early childhood to adolescence. Maternal restrictiveness of palatable foods may impact daughters’ EAH at an early age and this impact may continue through early adolescence among families with overweight mothers. However, restrictiveness at an early age is likely to be correlated with other genetic, environmental and learned dietary behaviours that impact a daughter’s dietary behaviours in later life.
Standard treatment of EAH has not been established. Results are promising that behavioural training based on building self-efficacy to control food cravings may reduce EAH among overweight and obese children. CONCLUSIONS: EAH was observable across all age groups of children (3-12 years) in both boys and girls. Various studies have examined different aspects of EAH ranging from individual characteristics of the child to those of the child’s parent. The most consistent evidence supported a positive association between increased weight status and EAH. Overweight and obese children engaged in greater levels of EAH in cross-sectional studies and increased weight status was positively correlated with levels of EAH over time in prospective studies.
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