The role of Emotion Regulation in childhood obesity
The Nutrition Society Paper of the Month for May is from Nutrition Research Reviews and is entitled ‘The role of emotion regulation in childhood obesity: implications for prevention and treatment’
Stress and negative emotions pose a major threat to public health, by increasing the risk of obesity. Although a drastic reduction of stressors as such is unrealistic, we can change the way people react to these stressors i.e. their emotion regulation (ER). Therefore, we present a novel conceptual framework model on the role of ER in the prevention and treatment obesity. Specifically, we target childhood since ER develops during childhood and children are more vulnerable to stressors but are still very flexible in learning new strategies. The idea is that children who do not develop adequate ER strategies will be less able to cope with new environments where they face conflicts. Typical ER skills include amongst others emotional awareness, emotional acceptance and problem solving.
The theoretical framework
Our framework model indicates that stress along with ineffective ER leads to increased adiposity via abnormal cortisol patterns, emotional eating, sedentary lifestyle, reduced physical activity, and increased sleep problems. By contrast, effective ER decreases obesity-related unhealthy behaviour and enhances protective psychological factors like self-esteem and self-efficacy, which boost health. In all these steps, parents can play a central role.
The existing literature on ER in obesity prevention and treatment
In adult literature, the most frequent strategies are mindfulness therapy, acceptance and commitment therapy, self-compassion therapy, emotionally-focused therapy and dialectical behaviour therapy. These have resulted in less psychological distress, less binge eating episodes, less emotional eating, less food cravings, healthier eating patterns, weight loss, less personal barriers to physical activity, and improved self-efficacy to weight loss. Successful intervention studies have also applied cognitive behavioural therapy to encourage the development of effective ER in obese children. Nevertheless, no solid proofs exist in prevention during childhood since only one pilot and two on-going studies have been published.
In conclusion, encouraging effective ER could be a useful new approach for combating and treating childhood obesity. Nonetheless, ER intervention studies are needed to confirm the validity of this model in children.
Implications for treatment:
- Consider traditional weight loss methods and nutritional recommendations along with ER intervention.
- Target barriers in the treatment progress such as shame and preoccupation with food by fostering greater self-esteem, resilience and body acceptance.
- Families need to be aware of the emotional distress that overweight children suffer from. Consequently, the family should learn effective ER and conflict-solving.
Implications for prevention:
Target mental health, effective ER techniques and healthy lifestyle habits such as eating behaviour, already during childhood.
- A) By family-based community programs and working groups:
- Support or teach parents on conflict and negative emotion management techniques
- Actively involve parents and family members in changing their own behaviour
- B) By school-based programs:
- Teachers can act as health agents
- ER can be incorporated into the school curriculum: focus on learning and encouraging awareness and understanding of feelings, identifying internal strengths and learning effective coping skills
Authors: Nathalie Michels (corresponding author) and Estefania Aparicio Llopis (first author).
Nutrition Society Paper of the Month
Each month a paper is selected by one of the Editors of the five Nutrition Society Publications (British Journal of Nutrition, Public Health Nutrition, Nutrition Research Reviews, Proceedings of the Nutrition Society and Journal of Nutritional Science). The paper is freely available via the following link: journals.cambridge.org/ns/may16 until 20th June 2016.