The current study investigated the reporting accuracy of LOC or binge-type foods (i.e., desserts and snacks) among children with and without loss of control (LOC) eating. Whereas reporting accuracy of total energy intake was not associated with LOC status, youth reporting LOC were less accurate than those without LOC at describing their percentage of intake from carbohydrate and dessert intake.
Consistent with prior literature (Bandini, et al., 1990
; Fisher, et al., 2000
; Lanctot, et al., 2008
; Ventura, et al., 2006
; Waling & Larsson, 2009
), findings from the current study confirmed that adiposity was robustly associated with under-reporting of total energy intake. As has been suggested previously, possible explanations for under-reporting among heavier youth include social desirability biases, insufficient awareness of how much energy is consumed, or minimization of intake due to guilt about eating (Fisher, et al., 2000
; Herbert, Ma, & Clemow, 1997
; Livingstone, et al., 1992
). Misreporting of energy intake is a significant problem in dietary assessment, with unique challenges arising in the measurement of children’s energy intake (Livingstone & Robson, 2000
). Given the current high rates of pediatric obesity (Ogden, Carroll, Curtin, Lamb, & Flegal), inaccurate report of food intake may complicate weight management recommendations. Our findings bolster prior literature suggesting that relying upon dietary recall methods, especially among heavier youth or those with reported LOC eating patterns, may provide spurious data.
The observed associations between LOC and reporting inaccuracy for percentage carbohydrate consumption and desserts were found after accounting for the significant contribution of body composition. That youth with LOC were more unaware of their dessert consumption—both under- and over-reporting—supports the possibility that highly palatable dessert foods may be associated with “numbing” in youth with LOC. Thus, children with LOC may be less aware of what, or how much, they are eating as opposed to consciously underestimating the amount consumed. Although this effect persisted even after adjusting for differences in total energy intake, in the most conservative analyses accounting for the actual amount of dessert intake, the effect was attenuated. This pattern suggests that the association between LOC eating and poorer recall of dessert intake may be in large part accounted for by the fact that youth with LOC consumed more desserts than youth without LOC (Tanofsky-Kraff, McDuffie, et al., 2009
; Theim, et al., 2007
). Nevertheless, we also found that children with LOC were less accurate in estimating their percentage intake of carbohydrates compared to youth without LOC, controlling for body composition as well as actual percentage carbohydrate intake and other relevant covariates. It is plausible that youth with LOC may be prone to inaccurate estimation of “comfort foods” consumed, because most of the carbohydrate-dense foods on the test meal array were highly palatable (Tanofsky-Kraff, Yanovski, et al., 2009
Unawareness of amounts of carbohydrate-dense or comfort food consumed among youth with LOC would be consistent with Escape Theory, which suggests that binge eating results from an attempt to escape from state affective distress (Heatherton & Baumeister, 1991
). Strategies to escape from negative emotional states are thought to predispose individuals toward ignoring feedback, including physiological satiety signals that typically inhibit overeating (Everill & Waller, 1995
; Fuller-Tyszkiewicz & Mussap, 2008
; Heatherton & Baumeister, 1991
). Research investigating alexithymia and binge eating further supports a possible association between numbing and unawareness of amounts of palatable food consumed. Alexithymia, a term describing an inability to identify and express emotions (Sifneos, 1996
), appears to be common in adults with binge eating disorder (Pinaquy, Chabrol, Simon, Louvet, & Barbe, 2003
) and has been found to be positively related to severity of binge eating (Carano, et al., 2006
). Thus, it is possible that alexithymia may be related to dissociative experiences such as “numbing” and may contribute to uncertainty about amounts of food consumed among those with LOC.
It is important to note that while “numbing” is one possible explanation for the misreporting of palatable foods among youth with LOC, there are likely other theories that might account for our findings. For example, a desire to consume foods that are perceived as socially acceptable (e.g., healthy foods) has been associated with misreporting of energy intake in adult (Maurer, et al., 2006
; Scagliusi, et al., 2003
) and child studies (Livingstone & Robson, 2000
). Binge eating has been linked to craving sweets (White & Grilo, 2005
) and there are data indicating that carbohydrate consumption may be the result of cravings similar to an addictive model (Corsica & Spring, 2008
; Spring, et al., 2008
). Therefore, it is possible that children with LOC eating patterns who are prone to crave carbohydrate-laden, sweet foods might view consumption of such foods as unhealthy and therefore socially unacceptable. Such perception might cause them to under-report the amount of carbohydrate-dense and sweet foods consumed.
Strengths of the current study include the inclusion of a relatively large sample of non-treatment seeking boys and girls varying in body composition and age. Furthermore, we used a semi-structured clinical interview to assess the presence of LOC eating in addition to a well-controlled multi-item laboratory test meal. Study limitations include the cross-sectional design which precludes causal inferences. In addition, despite the fact that children were not seeking treatment, they were not recruited in a population-based fashion. Therefore, because of their willingness to participate in metabolic studies at the NIH, study children may have differed from the general population. Moreover, although LOC youth were more likely than those without reported LOC to perceive experiencing LOC during test meals, we did not specifically gather information about whether youth experienced “numbing” during the meal visit. Therefore, it is not possible to discern whether reporting inaccuracies were due to “numbing” per se in youth with LOC. In conclusion, greater reporting inaccuracies in percentage of calories consumed from carbohydrates and dessert intake were found among youth reporting LOC eating as compared to youth without LOC. Although these cross-sectional data cannot provide support for a causal mechanism for excess weight gain among youth with LOC, greater discrepancies may perhaps translate into over-consumption of palatable foods outside of the laboratory due to an unawareness of how much sweet foods are being consumed. Further research is required to determine if such reporting discrepancies are predictive of excess body weight gain over time. Future studies also are necessary to investigate possible mechanisms for such inaccuracies, including feelings of “numbing” and the possibility that youth with LOC may present with elevated alexithymia.