UC San Diego

Rationale: Overeating is a significant driver of current pediatric obesity rates; however, overeating encompasses a range of behaviors. Moreover, many overeating assessments are conceptualized as assessing distinct constructs simply because they use differing terminology. The uncontrolled eating model proposes a framework by which a variety of related overeating behaviors can be subsumed under the spectrum of “uncontrolled eating,” which ranges from normative overeating to loss of control (LOC) eating but has not been validated in youth. Methods: This 3-paper dissertation evaluated the concordance of several measures of the least severe form of uncontrolled eating (i.e., cue responsive eating) in school-age youth, explored the frequency and predictors of a range of uncontrolled eating behaviors in adolescents utilizing ecological momentary assessment, and evaluated a model of uncontrolled eating in pediatric samples. Results: Study 1 (published; N=111; mean age=10.6, 70% female) evaluated the psychometric properties of and concordance among five measures of cue responsive eating in school age youth with overweight/obesity (OW/OB) and found little concordance. Study 2 (N=157; mean age=14.9, 57.2% female) demonstrated cue responsive eating and LOC, particularly the former, are common in adolescents with OW/OB, and found that neither negative affect nor stress consistently predicted uncontrolled eating behaviors. Study 3 (N=458) provided preliminary validation of a model of uncontrolled eating in youth with OW/OB, with models in school age youth (N=310; mean age=10.0, 53.2% female; χ2 =  6476.2, df = 2481, p < .001, RMSEA = .072) and adolescents (N=148; mean age=14.9, 56.8% female; χ2 =  4827.7, df = 2770, p < .001, RMSEA = .068) demonstrating good model fit. Discussion: This research contributes to the literature by questioning the construct validity of several well-established measures said to capture aspects of cue responsive eating, in addition to questioning the extent to which negative affectivity precedes the range of uncontrolled eating behaviors, including LOC, in adolescents. This also contributes to the literature by providing the first preliminary validated model of uncontrolled eating in youth with OW/OB and underscores the interconnected nature of “distinct” overeating behaviors. This work highlights that adult models of eating behavior may not fit for youth and may inform clinical practice by providing a greater understanding of the range of uncontrolled eating behaviors in youth.