In this investigation of overweight and normal weight children's reported food intake, we found that children who described eating episodes during which they experienced loss of control reported eating relatively fewer calories from protein and more calories from carbohydrates during these episodes. When types of foods eaten were examined, children endorsing loss of control while eating reported consuming more snacks and desserts than those who described episodes with no reported loss of control.
Our finding that reported LOC eating episodes are comprised of less protein are consistent with the preliminary findings of Morgan et al of reported episodes in a sample of overweight children (Morgan et al., 2002
) and with studies of adults with binge eating disorder (Raymond et al., 2003
; Rossiter et al., 1992
; Yanovski et al., 1992
; Yanovski & Sebring, 1994
) and bulimia nervosa (Gendall, Sullivan, Joyce, Carter, & Bulik, 1997
; Hetherington et al., 1994
). With regard to the types of foods ingested during LOC eating episodes, our data suggesting that children who report LOC ingest a greater percentage of their intake from dessert foods compared to children without LOC is also consistent with adult literature (Allison & Timmerman, in press
; Hadigan et al., 1989
; Kales, 1990
; Rosen et al., 1986
The nature of binge and LOC eating among children and adolescents may be in part illuminated by our finding that such eating episodes contain less protein and more carbohydrates, desserts and snack foods than episodes without LOC. Episodes of LOC eating may occur more often outside of normal meal circumstances, such as during celebrations or at school or restaurants, when parents may have less ability to supervise eating habits and when more palatable foods may be available. Parents' restriction of their children's intake of palatable foods, such as desserts or high-fat snacks, may play a role in children's binge eating as well. Indeed, some research has suggested that perceived parental restriction of eating is associated with disinhibited eating when children are in the presence of palatable foods (Carper, Orlet Fisher, & Birch, 2000
). Similarly, our finding that LOC episodes contained more snacks and desserts than No LOC episodes suggests that children and adolescents may experience LOC when consuming foods that are thought to be less healthy or “forbidden foods,” which contain more fat and refined carbohydrates. Finally, the frequencies with which individuals ingest dessert-type foods have been found to be positively associated with body weight in children (Nicklas, Yang, Baranowski, Zakeri, & Berenson, 2003
). Thus, our findings suggesting that LOC eating episodes contain a higher proportion of palatable foods with high energy density may serve as a mechanism for the excess weight and adiposity that have been identified in both cross-sectional (Ackard, Neumark-Sztainer, Story, & Perry, 2003
; Field, Colditz, & Peterson, 1997
; Morgan et al., 2002
; Neumark-Sztainer et al., 1997
; Tanofsky-Kraff et al., 2004
) and prospective (Field et al., 2003
; Stice et al., 1999
; Stice et al., 2002
; Tanofsky-Kraff et al., 2006
) studies of children and adolescents who report binge eating. Indeed, participants in the present investigation who reported LOC episodes had significantly greater BMI-Z scores than those without such episodes.
Our finding that episodes of LOC eating did not differ from those without LOC with regard to total energy content was somewhat unexpected, particularly given the significant group differences in mean BMI-Z score. This finding may be the result of how children were grouped; those who described objective and subjective overeating LOC episodes were compared to children who did and who did not engage in overeating episodes, potentially minimizing the difference in caloric intake. The greater proportion of snack and dessert foods consumed during LOC episodes may be representative of an overall diet containing more energy-dense foods than the diet of children with no LOC episodes. Furthermore, the finding that LOC eating episodes contain less protein may also possibly contribute to weight gain. A diet lower in protein may be less satiating, causing children to consume more total energy throughout the day. Data suggest that subjects who consume a meal higher in protein report less hunger (Poppitt, McCormack, & Buffenstein, 1998
) and that a diet higher in protein may increase satiety (Weigle et al., 2005
) and decrease perceived hunger (Nickols-Richardson, Coleman, Volpe, & Hosig, 2005
). However, given that the present investigation only examined one eating episode per subject as opposed to each child's daily dietary intake, this potential explanation should be interpreted cautiously and requires further exploration. Finally, systematic under-reporting of quantities consumed may also have affected the results. Heavier children have previously been shown to have greater error in reported energy intake (Bandini, Schoeller, Cyn, & Dietz, 1990
). Accuracy of recall of energy consumed also decreases during adolescence (Bandini et al., 2003
The present study is limited in that participants were not recruited in a population-based fashion. Families in the studied sample chose to respond to our notices and thus may be more health-conscious than the general population, limiting the external validity of the study. Similarly, the recent eating habits of treatment-seeking children and adolescents may also be distinct because such children have chosen to attempt weight loss. Furthermore, food descriptions were based upon child recall, which has been demonstrated to be imperfect (Bryant-Waugh et al., 1996
). However, recall was bolstered by detailed review of the circumstances surrounding reporting eating episodes and the assistance of a book of photographed foods and portion sizes. Finally, we only assessed the reported food intake of one eating episode per child. Future investigations should include measurement of daily food intake in addition to episodes of LOC in order to capture a broader understanding of the overall dietary consumption of children. Strengths include the use of interview methodology to establish the presence of disordered eating episodes, the relatively large and diverse sample, which included African American, Hispanic and Caucasian children, and the involvement of both normal weight and overweight participants.
In conclusion, children and adolescents who report episodes during which they report loss of control over their eating describe qualitatively different food intake during such episodes compared to youth who do not describe loss of control eating. These findings may help explain why children who report loss of control eating are heavier and potentially at risk for excessive weight gain.