Pathways to Eating in Children and Adolescents with Obesity

Childhood and Adolescent Obesity ConferenceOttawa, OntarioOctober 25, 2016

Hayyah Clairman, B.Sc. (Hons.)M.Sc. Student, Institute of Medical Science, University of TorontoDivision of Endocrinology, The Hospital for Sick Children

Conflict of InterestI have no conflicts of interest to disclose.

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Introduction & Eating Behaviours

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Current Treatment

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+Images from: http://www.clipartkid.com/fitness-physical-exercise-cliparts/, http://www.healthy-diet-healthy-you.com/new_food_pyramid.html

One Size Does Not Fit All

5Image from: http://musingsoninfection.blogspot.ca/2014/02/infection-prevention-one-size-does-not.html

Children with Obesity vs Non-Obese Peers

(Braet & van Strien, 1997)

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Children with Obesity vs Non-Obese Peers

(Hoffmann et al, 2015)

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Eating Mechanisms Co-occur in Children with Obesity

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(Reinblatt et al, 2015)

Appetite Regulation is Complex

9Image from: Van Vugt (2010) Brain imaging studies of appetite in the context of obesity and the menstrual cycle. Human Reproduction Update 16(3): 276-292

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Eating Mechanisms

Objectives

Objectives1) To determine the clustering properties of eating mechanisms in children and adolescents with obesity

2) To relate identified phenotypes to demographic, anthropometric, and eating environment measures

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Methodology

Study PopulationAges 10-18 years

English-speaking

Enrolled in CIHR-funded CANPWR (Baseline or 12 month visit)

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Data CollectionResponses to 2 child/adolescent self-report and 2 parent-for-child-report questionnaires

Questionnaires (total items: parent = 31, child = 25): EDE-Q: Loss of control eatingDEBQ: Emotional, Restrained, and External Eating subscalesHQ: Total hyperphagia scoreSWAN: Hyperactivity/Impulsivity and Inattention subscales

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Analytic Plan

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Cross-Sectional AnalysisObjective #1: Latent Profile Analysis (LPA)

Phenotypes identified using indicator variables (mechanisms)

Membership assigned to “latent” cluster from similarities between variables

Sample size of 250-300 is comparable to similar analyses

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Sample Model: 4 Clusters/Phenotypes

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IMPULSIVITYRESPONSE TO EXTERNAL CUES

LOSS OF CONTROLEATING

INATTENTION

HYPERPHAGIA

RESPONSE TO EXTERNAL CUES

LOSS OF CONTROLEATING

RESTRAINEDEATING

EMOTIONAL EATING

HyperphagicEmotional-Restrained

Impulsive-External

Distracted-Uninhibited

Strategies for Treatment

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IMPULSIVITYRESPONSE TO EXTERNAL CUES

LOSS OF CONTROLEATING

INATTENTION

HYPERPHAGIA

RESPONSE TO EXTERNAL CUES

LOSS OF CONTROLEATING

RESTRAINEDEATING

EMOTIONAL EATING

HyperphagicEmotional-Restrained

Impulsive-External

Distracted-Uninhibited

DBT/CBT Behavioural Therapy/Medication

Mindfulness ADHD coach/Medication for ADHD

Cross-Sectional AnalysisObjective #2: Analysis of Variance (ANOVA)

Clinical characteristics will be compared across phenotypes

Demographics (e.g. age, sex, family structure)

Anthropometrics (BMI)

Eating Environment (e.g. meals with family, meals in front of TV)

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Current Progress & Significance

Recruitment8 CANPWR sites

~220 participants to date

300 anticipated by January 2017

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Significance Identifying latent phenotypes in children and adolescents with obesity will lead to increased investigation into better targeted weight-management interventions

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AcknowledgementsSupervisor: Dr. Jill Hamilton

Thesis Committee:Dr. Debra KatzmanDr. Valerie Taylor

Hamilton Research Team:Kristina CordeiroKatharine HamiltonPing LiShawna Steele

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Sickkids STOMP Team

CANPWR Investigators

Funding:

Questions

25Image from: http://www.123rf.com/stock-photo/eating_questions.html

Extra Slides

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Recruitment UpdateBC Children’s (Vancouver) 3Alberta CH (Calgary) 37 Stollery CH (Edmonton) 19McMaster (Hamilton) 61Credit Valley (Toronto) 21SickKids (Toronto) 53CHEO (Ottawa) 29Montreal CH (Montreal) 0

TOTAL 223

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