Hyperphagia and impulsivity: use of self-administered Dykens' and in-house impulsivity questionnaires to characterize eating behaviors in children with severe and early-onset obesity

Abstract

Background: The determinants of early-onset obesity (< 6 years) are not completely elucidated, however eating behavior has a central role. To date no study has explored eating behavior in children with severe, early-onset obesity. Self-administered questionnaire data from these children were examined to evaluate eating behavior and the etiology of early-onset obesity.

Methods: Children with severe, early-onset obesity (body mass index [BMI] > International Obesity Task Force [IOTF] 30) of different etiologies (hypothalamic obesity [HO], intellectual disability with obesity [IDO], common polygenic obesity [CO]) were prospectively included. BMI history and responses from the Dykens' Hyperphagia Questionnaire and an in-house Impulsivity Questionnaire at first visit were compared between groups.

Results: This cohort of 75 children (39 girls; mean age ± standard deviation [SD] 10.8 ± 4.4 years) had severe, early-onset obesity at an age of 3.8 ± 2.7 years, with a BMI Z-score of 4.9 ± 1.5. BMI history varied between the 3 groups, with earlier severe obesity in the HO group versus 2 other groups (BMI > IOTF40 at 3.4 ± 1.6 vs. 4.6 ± 1.6 and 8.4 ± 4.1 years for the IDO and CO groups, respectively [P < 0.01]). Absence of adiposity rebound was more prevalent in the HO group (87% vs. 63% and 33% for the IDO and CO groups, respectively [P < 0.01]). The Dykens' mean total score for the cohort was 22.1 ± 7.2 with no significant between-group differences. Hyperphagia (Dykens' score > 19) and impulsivity (score > 7) were found in 50 (67%) and 11 children (15%), respectively, with no difference between the HO, IDO and CO groups regarding the number of patients with hyperphagia (10 [67%], 14 [74%], and 26 [63%] children, respectively) or impulsivity (2 [13%], 1 [7%], and 8 [19%] children, respectively). Children with food impulsivity had significantly higher total and severity scores on the Dykens' Questionnaire versus those without impulsivity.

Conclusion: The Dykens' and Impulsivity questionnaires can help diagnose severe hyperphagia with/without food impulsivity in children with early-onset obesity, regardless of disease origin. Their systematic use can allow more targeted management of food access control in clinical practice and monitor the evolution of eating behavior in the case of innovative therapeutic targeting hyperphagia.

Keywords: Childhood obesity; Dykens’ questionnaire; Eating behaviors; Food impulsivity questionnaire; Genetics; Hyperphagia; Hypothalamus.

Fig. 1

The in-house questionnaire on food impulsivity

Fig. 2

Frequency of positive responses to each question from the in-house questionnaire in case of Hyperphagia (defined as a Total Dykens’ questionnaire score of over nineteen). Q.1: “Food falls” or “When eating, is there a lot of food that falls by the side of your child’s plate because he is in such a hurry to eat?”; Q.2: “Drink excessively” or “Whatever the volume of the container, does your child tend to drink all the water, even if it means putting some aside?”; Q.3: “Difficulty in chewing” or “Is it very difficult for your child to chew food?”; Q.4: “Swallow large pieces” or “Does your child often swallow large pieces?”; Q.5: “Eat quickly” or “At the table, does your child always finish his or her plate before everyone else?”; Q.6: “Distracted by smell” or “When your child smells a bakery, is it very difficult to keep them out?”; Q.7: “Eat even after the meal is over” or “When your child sees a food he likes, can he not stop eating it, even after the meal is over?”; Q.8: “Food stealing” or “Have you ever found out that your child was stealing food?”; Q.9: “Eat from other people’s plates” or “Have you ever found out that your child was stealing food?”; Q.10: “Difficulty to stop eating” or “No matter what the food is, is it impossible for your child to stop eating it?”. Bold values indicate P > 0.05