Food Addictive and Selective Eating Traits in Autism and Their Health and Behavioral Consequences

Background:

Obesity is a prevalent issue in those with Autism Spectrum Disorder ([ASD]; Curtin et al., 2014). People with ASD are more likely to develop high blood pressure, diabetes, cardiovascular disease/stroke, etc. when compared to the general population (Croen et al., 2015). The mechanisms driving these adverse health outcomes are unclear. There is some evidence for increased overeating in individuals with ASD (Hess, Matson, & Dixon, 2010); however, this evidence is limited. Food addiction [FA] is a set of traits used to explain the drive to eat due to the rewarding nature of food, despite the potential accompanying negative health consequences. To date, neither FA traits, nor their health-related correlates have been examined in individuals with ASD. Furthermore, the overlap between FA traits and food selectivity has yet to be examined and may be associated with further negative health outcomes.

Objectives:

Characterize food addictive and selective eating traits in children with ASD and their associations with body mass index [BMI].

Methods:

Participants consisted of parents of children with ASD (n=153;M age=8.9,109 males) and parents of typically developing [TD] children (n=78;M age=8.3,36 males) who completed psychometrically sound and well-established questionnaires assessing FA traits and picky eating behavior. FA was assessed using The Yale Food Addiction Scale for Children (Gearhardt et al., 2013; Burrows et al., 2017). Food selectivity (i.e., picky eating) was assessed using a portion of the Eating Habits Survey (Wilde et al., 2012). Lastly, parents were asked to report their child’s biological sex, chronological age, height, and weight in order to calculate BMI and categorize overweight/obesity status using Center for Disease Control norms.

Results:

Children with ASD were more likely to be rated as picky eaters than TD children(ASD:55.6%,TD:29.5%;χ2 =14.1,p<.001). Additionally, parents rated children with ASD as having more FA traits than TD children(t=4.15,p<.001), and significantly more children with ASD than TD children surpassed the threshold for elevated FA traits(ASD:23.8%,TD:8.5%;χ2=7.40,p<.01). Of the children with ASD surpassing the threshold for elevated FA traits, 68.6% were also rated as being picky in their eating, which was significantly higher than among the non-picky eaters(50.9%,p<.05). Finally, among the children with ASD, BMI was found to be lower for picky eaters compared to non-picky eaters(t=3.84,p<.001), but positively correlated with FA traits(r=.20,p<.05). Furthermore, those who have elevated FA traits alone and those who exhibit both elevated FA traits and picky eating have higher BMI than those who are picky eaters only(F=18.05,p<.001).

Conclusions:

This study indicates that not only food avoidant behaviors, but also FA traits, are overrepresented in children with ASD. Moreover, there appears to be an overlap between selective eating and FA traits in ASD, suggestive of a ‘selective overeating’ phenotype. Finally, picky eating (lower) and FA (higher) exert opposing influences on BMI in the context of ASD. This study informs our understanding of appetitive traits and eating behaviors in ASD that could serve as behavioral risk factors for overweight/obesity. In turn, these behaviors might represent viable intervention targets, around which to design effective treatments to optimize health outcomes in individuals with ASD.