Ostracism, cortisol reactivity, and motivation for high-calorie food in children and adolescents with obesity.

Abstract

Objective: Experiencing ostracism (i.e., social exclusion) may impact self-regulatory eating behaviors, particularly in youths with excess weight. Yet, research in pediatric patients with obesity is lacking. Hence, we examined the effect of Virtual Reality(VR)-based ostracism on motivation for food in children and adolescents with BMI ≥97^th percentile.

Methods: In a randomized experimental between-subject design, forty-one patients (M_age = 13.37 years, 46% female) with a diagnosis of obesity (ICD-10: E66) were randomized to a social exclusion or inclusion condition in a VR-Cyberball-paradigm. Patients' salivary cortisol, heart rate and heart rate variability were assessed. Furthermore, we measured patients' motivation to consume high-calorie food, their prosocial behavior, their self-reported urge to eat and subjective stress.

Results: Results indicate that the experience of social exclusion in youths with obesity leads to a blunted salivary cortisol response; in contrast, no effects of social exclusion on the sympathetic nervous system were observed. Social exclusion was associated with an increased perceived threat to fundamental social needs. Similarly, ostracized participants demonstrated heightened self-regulatory behaviors regarding their motivation for high-calorie food intake, selecting fewer grams of sweets following social exclusion. Furthermore, ostracism tended to increase helping behavior post-exclusion, although this effect was not significant. Self-reported urge to eat and stress levels during the experiment showed no significant effect.

Conclusion: Ostracism-induced reduction of motivation for food suggests that affiliative behaviors like increasing compliance regarding eating behaviors may play a role in youths with obesity with BMI ≥97^th percentile in the context of social stress. Future research should explore the broader social context, including family and friends, to better understand the dynamics between social stress, physiological reactivity, and self-regulatory behaviors in treating obesity.

Clinical trial registration: As this study does not constitute a clinical trial, the study design and analyses plans were not preregistered.