Novel Model of Childhood Appetitive Traits in Children with Obesity.

Background/Objectives: Appetitive traits have a central role in energy intake and development of obesity. Child Eating Behavior Questionnaire (CEBQ) is a validated psychometric tool to measure appetitive traits in children. This study sought to assess the CEBQ factor structure in children with obesity. We hypothesized that hedonic traits are more prominent with obesity and in older children. Subjects/Methods: This cross-sectional observational study used CEBQ data from three geographically diverse centers in children with obesity. Eight known CEBQ subscales and the established factor model were compared by severity of obesity, age and sex. Exploratory factor analysis (EFA) to define the appetitive trait factor structure was undertaken in a training dataset and validated in a test set. Results: Children with obesity (n=814) showed higher food response, enjoyment of food, emotional overeating and desire to drink compared to population-based controls (p < 0.001) that correlated with obesity severity. The EFA identified a novel six-factor model with a new "Food avidity" factor that explained 15.8% of the variance. Satiety responsiveness (p < 0.001) and emotional undereating (p = 0.03) were lower in youth over six years compared to younger, while food fussiness and food avidity were the same, without any sex differences. Conclusions: CEBQ is useful to assess appetitive traits in children with obesity. The novel factor structure in youth with obesity suggests that temporal or phenotypic differences necessitate a revision of the established factor model. The new factor structure may be used to develop a hyperphagia questionnaire.