Appetite and adiposity in children: Evidence for a behavioral susceptibility theory of obesity

Background: Pressures from the "obesogenic" environment are driving up obesity rates, but adiposity still varies widely within the population. Appetitive characteristics could underlie differences in susceptibility to the environment. Objective: We examined associations between adiposity and 2 appetitive traits: satiety responsiveness and food cue responsiveness in children. Design: Parents of 2 groups of children, 8-11-y-olds (n = 10 364) from a population-based twin cohort and 3-5-y-olds (n = 572) from a community sample, completed the Child Eating Behavior Questionnaire. Adiposity was indexed with body mass index (BMI; in kg/m²) SD scores. For the 8-11-y-olds, waist circumference was also recorded and used to derive waist SD scores. Results: In both samples, higher BMI SD scores were associated with lower satiety responsiveness (8-11-y-olds: r = -0.22; 3-5-y-olds: r = -0.19; P <0.001) and higher food cue responsiveness (r = 0.18 and 0.18; P <0.001). In the twin sample, waist SD scores were associated with satiety responsiveness (r = -0.23, P < 0.001) and food cue responsiveness (r = 0.20, P < 0.001). By analyzing the data by weight categories, children in higher weight and waist categories had lower satiety responsiveness and higher responsiveness to food cues in both samples (8-11-y-olds: both P < 0.001; 3-5-yolds: both P < 0.05), but the effect was more strongly linear in the older children. All associations remained significant, controlling for child age and sex and parental education and BMI. Conclusions: Associations between appetite and adiposity are consistent with a behavioral susceptibility model of obesity. Assessing appetite in childhood could help identify higher-risk children while they are still at a healthy weight, enabling targeted interventions to prevent obesity.