Author's School

Graduate School of Arts & Sciences

Author's Department/Program



English (en)

Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)

Chair and Committee

Denise Wilfley


A significant subset of overweight children report loss of control: LOC) over eating: i.e., feeling unable to stop eating), a correlate of poorer psychosocial functioning and obesity. Another obesogenic appetitive trait, high food reinforcement, is characterized by a strong drive to obtain palatable food. LOC and high food reinforcement both predict increased energy intake and excessive weight gain, although the association between LOC and high food reinforcement has not been examined in youth. Additionally, the impact of LOC or high food reinforcement on pediatric weight loss treatment response remains unclear, including whether children with fewer alternate: non-snack food) reinforcers available in their environment are particularly at risk for poor outcomes. Overweight children: N = 241), each with one parent, were assessed at baseline and following 4-month family-based behavioral weight loss treatment. Children who reported ≥1 LOC episode in the past 3 months were categorized as LOC: n = 62, 25.7%) and compared against children reporting no recent LOC: No LOC). As hypothesized, LOC children were more likely to demonstrate high food reinforcement, as well as self-reported higher emotional eating, depressive and anxiety symptoms, and poorer quality of life than No LOC children, although LOC groups did not differ on corresponding parent-report on child variables. Moreover, LOC and food reinforcement interacted with child gender and reinforcers in the environment, respectively—boys with LOC, and children with low food reinforcement and higher alternate reinforcers, achieved the best weight outcomes. Although child-parent associations were not observed for LOC, relations between child and parent food reinforcement and between parent food reinforcement and alcohol reinforcement indicate high food reinforcement's potential heritability and lack of domain-specificity. Overall, pediatric LOC eating appears associated with higher food reinforcement and poorer perceived quality of life, but may not hinder short-term family-based treatment success. Future longitudinal studies are needed to assess improvement in LOC severity over time and its potential impact on both short- and long-term treatment response. Findings additionally underscore the importance of targeting the provision of alternate reinforcers to high energy-dense foods as a means of enhancing treatment response within pediatric weight control programs.


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