Eating in Secret or Hiding Food
Eating in secret is an aberrant eating behavior that is included in the diagnostic features of BED. However, very little is known about the prevalence rates of eating in secret among overweight and obese youths. As with many of these behaviors, it may overlap with binge eating, LOC eating, and/or EAH. In a study examining prevalence rates of secretive eating in a sample of overweight adolescents, approximately one third of the sample endorsed at least one episode of secretive eating within the month before the survey (Knatz, Maginot, Story, Neumark-Sztainer, & Boutelle, 2011). Additionally, in another study, 23% of adolescent girls reported eating alone (Vervaet & Van Heeringen, 2000). Prospective data have suggested that eating in secret identifies those who will develop an eating disorder (ED) later on (Fairburn, Cooper, Doll, & Davies, 2005). However, additional data are required to understand the relationship between eating in secret, disordered eating, and overweight and obesity in youths.
Eating in the Absence of Hunger
EAH was initially described in a longitudinal study of preschool children and their parents (Fisher & Birch, 1999). EAH is assessed using a behavioral paradigm in which children are fed a meal to satiety, after which hunger ratings are obtained to ensure fullness. After a short break, children are offered access to a variety of palatable snack foods in addition to toys and games for 10 minutes. Food consumption during the free-access period is measured. In this section, we describe findings related to EAH in children. EAH in adolescents is not well described in the literature, and more research is needed to understand how this behavior affects older children.
In a preschool study, girls were divided into high- and low-snack-intake groups (based on the free-access session) using a median split based on calories consumed (Fisher & Birch, 2002). In this study, EAH was relatively stable because 68% of girls in the high-intake group at age 5 were also in the high-intake group at age 7. EAH is considered a stable phenotypic behavior in young girls that is equivalent to disinhibited eating in adults (Fisher & Birch, 2002). This may also be true for male children; however, the research has focused on female children because of the higher rates of disinhibited eating and ED psychopathology in adult women compared with men. Several subsequent studies have examined EAH in overweight children and have demonstrated that children who are overweight or at higher risk of becoming overweight eat significantly more than normal- weight, lower risk children in the EAH paradigm (Faith et al., 2006; Fisher & Birch, 2002; Fisher et al., 2007; Francis & Birch, 2005; Moens & Braet, 2007; Shunk & Birch, 2004). In contrast to binge and LOC eating, EAH can occur with or without a cognitive understanding by the child of how much the child ate, and can occur with or without distress in the child (Wolkoff et al., 2011).
