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February 21, 2023

Pediatric Obesity Research Update | Acceptability of Time-Limited Eating in Pediatric Weight Management

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Each month, the OMA Pediatric Committee reviews a pediatric-focused obesity research update to help keep you up to date about the latest findings. This month’s update addresses nutrition and pediatric weight management

Acceptability of Time-Limited Eating in Pediatric Weight Management

Article Summary

Although nutrition is one of the pillars of obesity treatment, there is limited data on which dietary intervention is most feasible or acceptable among children and adolescents with obesity. To determine interest and acceptability of time-limited eating in children, investigators surveyed families attending weight management. Read the full article.

Article Review

To determine the acceptability of time-limited eating (TLE), youth ages 8-17 and their parents were recruited from five pediatric weight management programs through the Childhood Obesity Multiprogram Analysis and Study System (COMPASS), a practice-based translational research network in the United States. Participants were surveyed about factors such as sleep habits, meal/snacking patterns, and TLE-specific considerations like the length of time, days of the week (schools, weekends, full week), and potential barriers. Using a 5-point Likert scale (e.g. “extremely unlikely” to “extremely likely”), TLE acceptability was assessed with a series of questions about hypothetical TLE plans – 1) TLE 12-hours per day on school days only or TLE12, 2) TLE 12-hours per day on school days and weekends or TLE12week, 3) TLE 10-hours a day on school days only or TLE10 and 4) TLE 8-hours a day on school days only or TLE8. In addition, the survey included questions about demographic and anthropometric characteristics, as well as a history of psychological/developmental disorders and related medications – specifically, mood disorder, Attention Deficit/Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), learning disabilities, or delays.

In total, more than 200 parents of children 8-17 years of age (n=213) and almost 160 patients aged 11-17 years (n=159) completed the survey. Of note, the survey was available in both English and Spanish. In general, younger children (8-10 years old) slept more hours and had a more consistent bedtime than adolescents (11-17 years old). However, both age groups had a similar total daily eating length of around 12 hours per day. Adolescents and parents across all age groups were most interested in TLE 12 hours a day on school days (TLE12) and least interested in TLE 8 hours a day, with parent-teen dyads demonstrating 45% concordance in interest in TLE12 on school days. Almost half of the patients had at least one psychological disorder (44%), with around twenty percent being diagnosed with ADHD (23%), anxiety (19%) or mood disorder (18%). Interestingly, TLE interest varied across certain patient characteristics. For example, parents of Black/African American youth (40%) were more than twice as interested in TLE 8 hours a day on school days compared to parents of White youth (18%). Among adolescent respondents, White youth (71%) were more than twice as interested in TLE 12 hours a day on school days only (TLE12) compared to Hispanic youth (33%). Parents interested in TLE12 reported fewer snacks and fewer episodes of eating compared to those who were not interested, but there was no significant difference in overall TLE interest when comparing sleep-wake times and sleep duration.

In review of perceived barriers, parents and adolescents reported similar concerns for time/schedule constraints, including parents' work (35%), family schedule (33%), school schedule (26%), and extracurricular activities (27%). Adolescents also reported late bedtime (23%), eating while watching TV (24%), and hunger (28%) as potential barriers more frequently than parents. When considering the interest in TLE12, some barriers were reported less frequently in adolescents, e.g., late bedtime (15% vs. 32%; p=0.016), snacking while watching TV(16% vs. 33%; p=0.022), and snacking without permission (5%vs. 19%; p=0.013). Moreover, the family schedule was viewed less frequently as a barrier to those interested in TLE10 (26% vs. 40%;p=0.045) and TLE8 (19% vs. 40%; p=0.007), as was the school schedule in TLE10 (28% vs. 45%; p=0.035). However, no such differences were seen in barrier frequency for TLE8.

In summary, this study helps to address a gap in the literature about the use of TLE in youth with obesity. Overall interest in time-limited eating was highest for TLE12 and lowest for TLE8. Although more data are needed about the real-time practicality and use of TLE in children and adolescents with obesity, the results of this study are encouraging. Longer duration of TLE may help youth navigate social events and time with peers with less perceived scrutiny about them being on a “diet.” Additionally, TLE may also mitigate restrictive caregiver feeding practices in favor of adopting other aspects of behavior therapy, including stimulus control (i.e., removing high energy/low nutrient and “tempting” foods from the home) and planning (i.e., meal planning, providing structure during fasting periods, etc.) while also encouraging other habits that support good health (i.e., working on sleep schedules to avoid nighttime eating). The results of this study also demonstrate the importance of developing individual plans that align with the needs and interests of the family, especially for those with busy schedules or with children diagnosed with psychological/behavioral disorders.

Additional Resources

Find more resources, curated by OMA’s Pediatric Committee, on our Pediatric Resources page. There you’ll find additional article reviews on various topics related to obesity as well as public resources for clinicians and families.

Tucker JM, Siegel R, Murray PJ, et al. Acceptability of Time-Limited Eating in Pediatric Weight Management. Front Endocrinol (Lausanne). 2022;13:811489. Published 2022 Apr 21. doi:10.3389/fendo.2022.811489