Identifying eating behaviour phenotype cut-off scores for childhood obesity: an individual participant data meta-analysis using the Child Eating Behaviour Questionnaire (CEBQ)

Background

Weight management interventions targeting appetitive traits show promise in treating childhood obesity, yet a tool to identify appetitive phenotypes for personalised treatment is missing. The Child Eating Behaviour Questionnaire (CEBQ) is a widely used measure of eight parent-reported appetitive traits associated with childhood obesity. We aimed to explore the utility of the CEBQ for phenotyping childhood obesity and derive cut-off scores to support clinical decision-making.

Methods

This individual participant data meta-analysis combined cross-sectional data from 17 international studies (N = 15,273) on CEBQ scores and Body Mass Index Standard Deviation Scores from children (2–18 years). The potential of CEBQ subscales (Food Responsiveness, Enjoyment of Food, Emotional Over-eating, Desire to Drink, Satiety Responsiveness, Slowness in Eating, Emotional Under-eating, Food Fussiness) to discriminate weight status was explored in random-effect meta-analyses of Area Under the Curve (AUC) metrics. We explored heterogeneity across studies and age- and sex- specific subgroups. Cut-off scores were derived within subgroups using (a) the Youden’s Index and (b) the point maximising specificity after a minimum sensitivity of 60%. We meta-analysed study-specific performance with the selected cut-offs to describe heterogeneity across studies.

Results

AUCs for CEBQ subscales ranged from 0.60 to 0.71. The magnitude and shape of associations between CEBQ scores and obesity varied by age and sex. Cut-off performance was generally better in middle- than early childhood. The best performing cut-off score of 2.6 was observed for females aged 7–12 years for Food Responsiveness (Sensitivity: 0.81 [95%CI 0.77, 0.85]; Specificity: 0.85 [95%CI 0.82, 0.88]). High heterogeneity in cut-off performance across studies and wide prediction intervals suggest the need to further investigate external validity.

Conclusions

We provide the first empirically derived CEBQ subscale cut-offs to phenotype children with obesity based on weight-related eating behaviours. Cut-offs could support personalised treatment in clinical and research contexts.

Funding

MC_UU_00006/6 and MC_UU_00006/5.