The Promise of Early Childhood Self-Regulation for Obesity Prevention

We live in an obesity-promoting environment, with ubiquitous highly palatable, energy-dense foods and easy access to reinforcing sedentary activities. To navigate through the environment unscathed by these dual threats, children need adult supervision and guidance and an ability to control temptations. The latter can be a challenge for young children, who have fully developed brain reward systems combined with still-emerging executive functions that facilitate resisting immediate temptations and focusing on longer-term goals. There is a burgeoning literature on how poor self-control in young children predicts excess growth and overweight/obesity in later childhood and into adulthood,^1–3 with causal pathways supported by obesity treatment studies with older children⁴ and the demonstration of self-regulation–related interventions’ collateral benefits on weight.^5,6 Early childhood is a sensitive period for the development of self-regulation,⁷ highlighting an opportunity for obesity prevention research.

To date, the literature had not addressed the potential of enhancing self-regulation skills in young children with the specific goal of preventing excess weight gain. Thus, the study by Lumeng et al,⁸ in this issue of Pediatrics, implemented in Head Start centers is a valuable addition to the literature. The authors used an additive design to assess whether the Preschool Obesity Prevention Series (POPS), designed to provide obesity prevention messages to preschoolers and their parents, improved obesity prevention beyond Head Start, and whether the Incredible Years intervention (IYS), with previous demonstrated effects on self-regulation, was effective beyond POPS. The authors used the teacher-reported Social Competence and Behavior Evaluation measure to assess changes in self-regulation.

The results showed significant improvements in self-regulation for the IYS condition compared with Head Start or Head Start + POPS. However, no group differences were observed on weight outcomes within the academic year. The authors suggest that maybe the intervention wasn’t intense or long enough, or the assessment was not conducted over enough time, because intervention effects on weight may appear at later time points rather than directly after intervention. Numerous studies support links between self-regulation in early childhood and weight outcomes years later.^1,3,5,6,9 Additionally, IYS is designed with a parental component, so low parental involvement may have contributed to the lack of effect. Young children may need parental support to strengthen skills they are learning in school.

Although the current study did not show that improving preschoolers’ self-regulation impacted weight outcomes, it is premature to consider this inquiry closed. Given the extant literature linking self-regulation and later obesity, it is worthwhile to consider ways to strengthen future tests of self-regulation as a method to prevent childhood obesity.

One of the challenges in developing a self-regulation intervention is that there are many aspects of self-regulation that can be studied from different perspectives (eg, temperament, executive functioning). In addition, assessments of self-regulation can focus on integration across aspects¹⁰ or on individual component parts, including emotion regulation and aspects of inhibitory control like delay of gratification. To explore which aspects of self-regulation may hold potential for obesity prevention, future studies should include objective measures where assessors are blind to study condition, which was not the case in the current study, and should explore overall self-regulation as well as specific self-regulation skills, such as delay of gratification. Early childhood delay of gratification is related to subsequent obesity,^1,2 can be measured by using a simple behavioral task, and has demonstrated malleability as investigators have studied ways to improve it.^11–13 Additionally, Diamond and Lee¹⁴ have shown that various interventions involving repeated practice and progressive challenges can improve executive functions in children. These interventions could be leveraged to examine subsequent effects on obesity.

Self-regulation interventions may not influence all children equally. Numerous studies show greater effects among those with the lowest self-regulation at baseline who need these programs the most.^14–17 Additionally, emerging research suggests that the expression of self-regulation is sensitive to context. Children may be more likely to exhibit regulatory behaviors like delay of gratification when their environments are predictable and reliable.^18,19 These moderators may provide ideas for whom and under what circumstances self-regulation training is likely to be most effective.

Taken together, additional research is needed to elucidate whether and how early self-regulation promotion might affect weight outcomes. This research offers the potential for collateral benefits, given that self-regulation is linked with multiple aspects of well-being over time. Mischel et al²⁰ showed that young children who delayed gratification excelled in many domains, ranging from academic achievement to social competence, with similar evidence in other samples.^21,22 It is worth continuing to explore the relationship between self-regulation and obesity, knowing that self-regulation interventions may have powerful benefits for individuals and society. Pursuing research on early childhood self-regulation is an investment with the potential for widespread payoff.

Glossary

IYS

Incredible Years intervention

POPS

Preschool Obesity Prevention Series