Adiposity and 'eating in the absence of hunger' in children

Objective: To examine the association between eating in the absence of hunger (EAH) and adiposity in children. Design: Two cross-sectional studies in community settings. Subjects: For study 1, 348 children (178 girls and 170 boys) aged 7-9 years were recruited as part of the Physical Exercise and Appetite in Children Study. In study 2, participants were a subsample of children aged 9-12 years (N=316; 192 girls and 124 boys) from the Twins Early Development Study. Measurements: EAH was operationalized as intake of highly palatable sweet snacks after a mixed meal at school (study 1) or home (study 2). Weight (kg) and height (m) measurements were used to calculate the body mass index (BMI) s.d. scores. Children were grouped using the standard criteria for underweight, healthy weight, overweight and obesity. The healthy weight range was further subdivided into lower healthy weight (≤50th centile) and higher healthy weight (>50th centile) to examine the distribution of EAH across the adiposity continuum. Results: In both studies, EAH showed a significant positive association with adiposity in boys after adjusting for covariates (P<0.001), with a linear increase in the intake across underweight, healthy weight and overweight groups. The association between EAH and adiposity was not significant in girls in either study, although in study 1, results showed a quadratic trend, with EAH increasing through the underweight and healthy weight ranges and decreasing in overweight and obese groups. Conclusion: EAH is a behavioural phenotype that is not specific to overweight children but instead shows a graded association with adiposity across the weight continuum, particularly in boys. In this study, the effect was less pronounced in girls, which may reflect social desirability pressures constraining food intake among heavier girls.