Puberty and the manifestations of loss of control eating in children and adolescents

Abstract

Objective: We investigated the manifestations of pediatric loss of control (LOC) eating at different stages of pubertal development.

Method: Participants were a nonclinical sample of 468 youth (8-17 years). Physical examination determined pubertal stage. LOC eating and disordered eating attitudes were assessed with the Eating Disorder Examination. In a randomized crossover design, a subset (n = 244) ate ad libitum from two test meals designed to capture normal and LOC eating.

Results: There were no differences in the prevalence rates or frequency of reported LOC eating episodes across pubertal stages (ps ≥ 0.50). There were, however, puberty by LOC eating interactions in disordered eating attitudes and palatable food consumption (ps ≤ .05), even after adjusting for age and body composition. LOC eating was associated with elevated global disordered eating attitudes, weight concern, and shape concern in post-pubertal youth (ps ≤ .001), but not pre-pubertal youth (ps ≥ .49). In late-puberty, youth with LOC eating consumed less energy from protein (p < .001) and more from carbohydrate (p = .003) and snack-type foods (p = .02) than those without LOC eating, whereas endorsement of LOC eating in pre- or early-to-mid-puberty was not associated with differences in eating behavior (ps ≥ 0.20).

Conclusions: Findings suggest that puberty may be a critical risk period, when LOC eating behaviors in boys and girls may become accompanied by greater weight and shape concerns and more obesogenic food consumption patterns. Interventions for LOC eating during pre-puberty should be evaluated to determine if they are particularly beneficial for the prevention of exacerbated eating disorder psychopathology and adverse weight outcomes.

Trial registration: ClinicalTrials.gov NCT00320177 NCT00631644.

Keywords: binge eating; body image; eating disorders; loss of control eating; puberty; weight and shape concern.

© 2014 Wiley Periodicals, Inc.

Figures

Figure 1. Association between Loss of Control (LOC) Eating and Global Disordered Eating Attitudes Across Pubertal Stages

Disordered eating attitudes were assessed with the Eating Disorder Examination (26; 27). Among youth in early-to-mid-puberty and in late-puberty, those with LOC eating reported higher global disordered eating attitudes than those without LOC eating, adjusting for age, sex, race, height (cm), and fat mass (kg) (ps < .001). Pre-pubertal youth reported similar global disordered eating attitudes, regardless of LOC status (p = .53). This pattern of results was the same for weight concern (p = .03) and shape concern (p = .01).

Figure 2. Macronutrient Consumption across Normal and Loss of Control (LOC) Test Meals in Youth with and without LOC Eating at Different Pubertal Stages

Among late-pubertal youth, those with LOC eating consumed a lower percentage of energy from protein (p < .001) and a greater percentage of energy from carbohydrate (p = .003) than those without LOC eating, adjusting for age, sex, race, height (cm), fat mass (%), fat-free mass (kg), and total energy intake (kcal, logarithm transformed). Among youth in pre-puberty and early-to-mid-puberty, there were no significant differences between those with and without LOC eating with regard to percent protein or carbohydrate consumption (ps ≥ .13). Endorsement of LOC eating was not associated with percent fat intake at any pubertal stage (ps > .14).

Figure 3. Consumption of Snack-Type Foods at the Loss of Control (LOC) Test Meal

A significant Puberty by LOC eating interaction among girls (p = .006), but not boys (p = .35), adjusting for age, race, height (cm), fat mass (%), and fat-free mass (kg). Among girls in late-puberty, those with LOC eating consumed more energy from snack-type foods than those without LOC eating (p = .001), whereas there were no differences in snack intake among pre- and early-to-mid-pubertal girls with and without LOC eating (ps ≥ .13). Among boys, there were no significant differences between youth with and without LOC eating at any pubertal stage (ps ≥ .14).