Reducing eating pace: a behavioral intervention for childhood obesity

The prevalence of childhood obesity has grown substantially over the last years. Recent estimates suggest that, globally, as many as 37 million children under the age of 5 are overweight. When looking at the ages between 5 and 19, these numbers rise to a staggerng 390 million. As a result, childhood obesity is considered one of most serious public health challenges of the 21st century.

Children who are overweight suffer from many short-term and long-term health problems. From a young age, they are at risk for diabetes, physical disabilities, certain types of cancer, and heart disease. Overweight and obese children are also likely to stay obese and maintain these health risks into adulthood.

The World Health Organization (WHO) emphasizes that becoming overweight can largely be prevented. Specifically, they recommend increasing physical activity and decreasing the intake of energy-dense, nutrient-poor foods.

High eating rate and obesity

One way to decrease the intake of unhealthy foods is by changing one’s eating rate. Eating rate describes the amount of food that is consumed within a given time frame, often measured as mouthfuls or kilocalories per minute.

Research has shown that a high eating rate during childhood is associated with obesity and expedited weight gain. However, reducing eating rate in children has received little attention so far. Furthermore, the few studies on this subject only focused on older children or adolescents.

That's why researcher Faith and his team examined the effectiveness of a behavioral intervention for young children (RePace). This family-based treatment is designed to reduce eating rate and includes different educational and behavioral techniques to influence eating behavior.

Learning to eat more slowly

The researchers included 28 parent-child dyads in their study, with children between four and eight years old. To participate in the study, both the parent and the child had to be overweight or obese, and children had to display a rapid eating rate.

Families attended five interactive meal sessions at a laboratory, which were focused on raising awareness of eating speed, learning to eat more slowly, and increasing social interactions during meal times.

For example, rabbit and turtle puppets were used to show the difference between fast and slow eating. Families also learned to use a ‘Turtle Timer,’ which vibrates every 30 seconds and helps children to pace their eating. Lastly, a ‘Chat Jar’ filled with open-ended questions was used to stimulate conversation.

Measuring eating behavior

To assess eating rate, researchers asked parents to fill in a questionnaire about their child’s eating behavior. Furthermore, eating behavior was observed in the lab before and after treatment.

Observational data was recorded and coded using MediaRecorder and The Observer XT.

Researchers also studied BMI scores, a 24-hour dietary intake, and child eating patterns. Particularly, they were interested in changes in responsiveness to satiety and food cues, as well as enjoyment of eating.

All measurements were compared to a control group, consisting of families that attended one 30-minute educational session about healthy eating.

Changing eating pace

Results showed that children from the RePace intervention group decreased their eating rate more than children from the control group, as reported by parents.

At first, these differences were not found in the laboratory observations. When examined more closely, Faith and his colleagues found that these results were influenced by how typical a meal at the lab was, compared to a meal at home.

Specifically, if the amount of food presented at both meals was similar, children from the intervention group showed a greater decrease in eating rate compared to children from the control group.

Better BMI and food enjoyment

Researchers also found greater improvements in BMI in children from the intervention group, as well as an increase in food enjoyment. Lastly, when examining families with a high session attendance, results showed a decrease in total energy intake.

This study shows that eating rate can be changed effectively with behavioral interventions. Importantly, the results also suggest that changing one’s eating rate has a positive impact on both bodyweight and creating a healthy eating pattern.

With the WHO recommendation to decrease intake of energy-dense foods, studies like these play an important role in preventing and reducing childhood obesity. More research is still needed to assess and develop interventions for children from all age groups.

References

Faith, M.; Diewald, L.; Crabbe, S.; Burgess, B.; Berkowitz, R. (2019). Reduced eating pace (RePace) behavioral intervention for children prone to or with obesity: does the turtle win the race? Obesity, 27(1), 121-129.

https://www.who.int/dietphysicalactivity/childhood/en/