Childhood obesity is a significant public health concern, impacting health and quality of life. In Germany, approximately 15% of children and adolescents are affected. Diet plays a crucial role in childhood obesity, contributing to energy imbalance through overeating. Acquired eating behaviors significantly influence food choices, often overriding internal hunger and satiety cues. Three key obesogenic eating behaviors are: external eating (susceptibility to external food cues), emotional eating (using food to cope with emotions), and dietary restraint (cognitive regulation of eating for weight control). These behaviors have been linked to overweight and obesity in children and adolescents. The transition to adolescence is particularly important, marked by dietary shifts from parental control to increased autonomy, peer influence, and body image concerns. Previous research on the association between eating behaviors and diet in children and adolescents has yielded mixed results, often focusing on single aspects or limited food groups. This study aims to comprehensively describe the prevalence of external eating, emotional eating, and dietary restraint in late childhood and adolescence and examine their cross-sectional association with usual dietary intake in a large, population-based German birth cohort.

Existing research on the relationship between obesogenic eating behaviors and dietary intake in children and adolescents presents a mixed picture. Some studies have reported associations between emotional eating and increased consumption of sweets, sugary drinks, and energy-dense foods. Others have found links between dietary restraint and healthier food choices, such as increased fruit and vegetable intake, while simultaneously reporting reduced overall energy intake and potentially lower nutrient intake. The inconsistency in findings may be attributable to variations in study design, age groups, methodologies, and cultural contexts. Furthermore, many studies have focused on specific aspects of eating behavior or limited dietary components, making it challenging to draw comprehensive conclusions about the interplay between these factors.

This study utilized data from the 10- and 15-year follow-ups of the GINIplus and LISA birth cohort studies. Participants (N10 = 2257; N15 = 1880) completed self-report questionnaires assessing eating behaviors using the Eating Behavior and Weight Problems Inventory for Children (EWI-C) and dietary intake using a validated food frequency questionnaire (FFQ). The EWI-C subscales for external eating, emotional eating, and dietary restraint (at age 15 only) were analyzed. Dietary intake was categorized into 17 food groups, macronutrients, and total energy. Sex-stratified, cross-sectional associations were assessed using multinomial logistic or multiple linear regression, adjusting for covariates (age, BMI, pubertal status, etc.) and correcting for multiple testing. Sensitivity analyses were performed to account for potential confounding factors, such as vegetarian/vegan diets and extreme BMI values. Interactions between eating behaviors and BMI were also explored. Statistical analysis was performed using R version 4.0.3.

The study revealed generally low levels of obesogenic eating behaviors in both 10- and 15-year-olds. External eating scores were higher than those for emotional eating and dietary restraint at both ages. At age 10, males exhibited higher external eating scores than females, while at age 15, females displayed higher scores across all three eating behaviors. Significant associations between eating behaviors and dietary intake were primarily observed in 15-year-old females. Specifically: * **External eating** in 15-year-old females was linked to higher total energy intake. * **Emotional eating** in 10-year-old females was associated with medium vegetable intake. * **Dietary restraint** in 15-year-old females was associated with higher fruit and whole grain intake and lower total energy and omega-3 fatty acid intake. Sensitivity analyses, which excluded vegetarians/vegans and participants with extreme BMI values, modified some associations, suggesting a potential effect modification by BMI. Interactions between BMI and eating behaviors were observed for dietary restraint (with whole grain, oils, and sugar-sweetened foods) and emotional eating (with dairy).

The findings of this study indicate that while levels of obesogenic eating behaviors are generally low in this predominantly high socioeconomic status population, certain associations exist, particularly among adolescent females. The positive association between external eating and total energy intake in 15-year-old females suggests that external cues may drive overall energy consumption, irrespective of specific food types. The association between emotional eating and vegetable intake in 10-year-old females is intriguing and could potentially reflect parental attempts to counteract emotional eating with healthier food choices. The association between dietary restraint and both healthy food choices and reduced energy intake in 15-year-old females warrants further investigation. The effect modification by BMI highlights the complexity of the relationships between eating behaviors, dietary intake, and body weight, suggesting the need for further research that stratifies analyses by BMI.

This study demonstrates generally low reported levels of obesogenic eating behaviors among German children and adolescents from a high socioeconomic status population. Few significant associations were found between these behaviors and specific dietary components, mostly limited to adolescent females. BMI emerged as a significant effect modifier, suggesting the need for future studies to explore the interplay between eating behaviors, diet, and BMI more thoroughly across different BMI strata. Further research should investigate the longitudinal effects of these eating behaviors on long-term dietary habits and health outcomes, potentially using larger samples representing a wider range of socioeconomic backgrounds.

The study's generalizability might be limited due to the overrepresentation of children from higher socioeconomic backgrounds with a lower prevalence of overweight and obesity in the GINIplus and LISA cohorts. The cross-sectional design prevents causal inferences, and reverse causality is possible. The use of self-reported data for both eating behaviors and dietary intake introduces potential recall bias. The study was limited to three subscales of the EWI-C, which may have influenced the findings. Finally, the lack of dietary restraint assessment at age 10 limits comparisons across developmental stages.