Appetitive traits and long-term risk of disordered eating: a 3-year follow-up in children with overweight and obesity

PURPOSE: Disordered eating (DE) is common among children living with overweight and obesity, and individual appetitive traits may contribute to the persistence of both DE and excess weight. This study examined whether pre-intervention appetitive traits in 7- to 14-year-olds with overweight/obesity attending a 10-week lifestyle camp were associated with DE at a 3-year follow-up. Second, correlations between pre-intervention appetitive traits and Body Mass Index-Standard Deviation Score (BMI-SDS) 3 years later were explored. METHODS: Children with overweight/obesity were recruited from two Danish lifestyle camps. Self-reported questionnaires were completed to collect data on appetitive traits and DE, assessed as overeating (OE) and loss-of-control (LOC) eating. Five categories (No DE, occasional/regular OE and occasional/regular binge eating (BE)) were generated based on OE frequency (1-3 vs. ≥4 episodes) and the presence or absence of LOC eating. Measured weight and height were used to calculate BMI-SDS. RESULTS: 190 children were included, and 102 reassessed at 3 years. Higher pre-intervention Food Responsiveness was associated with a twofold increased risk of Regular BE (vs. no DE) at follow-up (RRR = 2.05 95% CI: 1.03;4.09, p = 0.04). Higher scores of Slowness in Eating and Emotional Undereating were associated with Occasional OE 3 years later (RRR = 2.22 95% CI: 1.05;4.68, p = 0.04) and (RRR = 5.16 95% CI:1.80;14.79, p = 0.002), respectively. Pre-intervention Food Responsiveness correlated positively with BMI-SDS at 3 years, whereas Emotional Undereating correlated negatively (both p < 0.05). CONCLUSION: Identification of high-risk appetitive traits could offer a unique opportunity for early intervention to prevent later DE and weight gain in children with overweight/obesity. Level of evidence Level II: evidence obtained from well-designed controlled trials without randomization. Trial registration The study was preregistered at clinicaltrials.gov (ID: NCT04522921). The longitudinal part of this study was preregistered at OSF Registries (www.osf.io), https://doi.org/10.17605/OSF.IO/MPE4Z.