Summary This review aimed to investigate the impact of obesity treatment, with a dietary component, on eating disorder (ED) prevalence, ED risk, and related symptoms in children and adolescents with overweight or obesity. Four databases were searched to identify pediatric obesity treatment interventions, with a dietary component, and validated pre‐post intervention assessment of related outcomes. Of 3078 articles screened, 36 met inclusion criteria, with a combined sample of 2589 participants aged 7.8 to 16.9 years. Intervention duration ranged from 1 week to 13 months, with follow‐up of 6 months to 6 years from baseline. Prevalence of ED was reported in five studies and was reduced post‐intervention. Meta‐analyses showed a reduction in bulimic symptoms (eight studies, standardized mean difference [SE], −0.326 [0.09], P < 0.001), emotional eating (six studies, −0.149 [0.06], P = 0.008), binge eating (three studies, −0.588 [0.10], P < 0.001), and drive for thinness (three studies, −0.167 [0.06], P = 0.005) post‐intervention. At follow‐up, a reduction in ED risk (six studies, −0.313 [0.13], P = 0.012), emotional eating (five studies, −0.259 [0.05], P < 0.001), eating concern (three studies, −0.501 [0.06], P < 0.001), and drive for thinness (two studies, −0.375 [0.07], P < 0.001) was found. Structured and professionally run obesity treatment was associated with reduced ED prevalence, ED risk, and symptoms.
Summary Background Pediatric obesity impacts on multiple domains of psychological health, including self‐esteem and body image. Objective To determine the effect of multicomponent pediatric obesity treatment interventions on self‐esteem and body image. Methods A systematic search of published literature up to June 2019 was undertaken using electronic databases MEDLINE, EMBASE, Cochrane Library, and PsychINFO. Eligible studies implemented an obesity treatment intervention, including a dietary and physical activity component with/without a behavioral component, in children and adolescents with overweight/obesity, and assessed self‐esteem and/or body image. Data were extracted by one reviewer and cross‐checked. Meta‐analysis was used to combine outcome data and moderator analysis conducted to identify intervention characteristics influencing outcomes. Results 64 studies were identified. Meta‐analysis of 49 studies (n = 10471) indicated that pediatric obesity treatment results in increased self‐esteem postintervention (standardized mean difference, [SE] 0.34 [0.03], P < .001, I2 87%), maintained at follow‐up (0.35 [0.05] P < .001, I2 79%, 17 studies). Similarly, meta‐analysis of 40 studies (n = 2729) indicated improvements in body image postintervention (0.40 [0.03], P < .001, I2 73%), maintained at follow‐up (0.41 [0.08], P < .001, I2 89%, 16 studies). Conclusions Pediatric obesity treatment improves self‐esteem and body image in the short and medium term. These findings may underpin improvements in other psychological outcomes.
Summary This scoping review describes current guidelines for the dietary management of pediatric obesity and severe obesity. Guidelines were identified via electronic searches of six databases, grey literature, and reference lists and included international clinical practice guidelines (n = 21), position papers (n = 5), and scientific/consensus statements (n = 2) produced by professional bodies and/or expert panels. All recommend multicomponent lifestyle interventions including diet, physical activity, and behavior modification as first‐line treatment. Most guidelines (n = 21) recommend weight loss as a treatment goal for children and adolescents with obesity and associated comorbidities or severe obesity; 15 recommend using dietary approaches. Fourteen of 28 guidelines refer to the management of severe obesity, 10 refer to dietary approaches, and seven recommend using intensive dietary approaches. Dietary approaches to weight loss focus on caloric restriction (n = 14) with some guidelines recommending very low‐energy diet (n = 4), protein‐sparing modified fast (n = 2), and very low‐carbohydrate/ketogenic diets (n = 2). A stronger evidence base is required for dietary management of pediatric obesity and severe obesity to improve consistency in future guidelines. Guidance on the use of dietary approaches, beyond caloric restriction, and in line with the growing evidence base on novel dietary approaches is required to facilitate personalized care and optimal patient outcomes.
IMPORTANCEChildren and adolescents with obesity are at higher risk of developing depression and anxiety, and adolescent dieting is a risk factor for the development of depression. Therefore, determining the psychological effect of obesity treatment interventions is important to consider. OBJECTIVE To investigate the association between obesity treatment interventions, with a dietary component, and the change in symptoms of depression and anxiety in children and adolescents with overweight/obesity. DATA SOURCES Searches of MEDLINE, Embase, Cochrane Library, and PsychINFO were conducted from inception to August 2018. Hand searching of references was conducted to identify missing studies. STUDY SELECTION Obesity treatment interventions, with a dietary component, conducted in children and adolescents (age <18 years) with overweight/obesity, and validated assessment of depression and/or anxiety were included.DATA EXTRACTION AND SYNTHESIS Data were independently extracted by 1 reviewer and checked for accuracy. Meta-analysis, using a random-effects model, was used to combine outcome data and moderator analysis conducted to identify intervention characteristics that may influence change in depression and anxiety. The meta-analyses were finalized in May 2019. MAIN OUTCOMES AND MEASURESChange in symptoms of depression and anxiety postintervention and at the latest follow-up. RESULTSOf 3078 articles screened, 44 studies met inclusion criteria with a combined sample of 3702 participants (age range, 5.6 to 16.6 years) and intervention duration of 2 weeks to 15 months. Studies reported either no change or a statistically significant reduction in symptoms of depression or anxiety. Meta-analyses of 36 studies found a reduction in depressive symptoms postintervention (standardized mean difference [SE], −0.31 [0.04]; P < .001), maintained at follow-up in 11 studies at 6 to 16 months from baseline (standardized mean difference [SE], −0.25 [0.07]; P < .001). Anxiety was reduced postintervention (10 studies; standardized mean difference [SE], −0.38 [0.10]; P < .001) and at follow-up (4 studies; standardized mean difference [SE], −0.32 [0.15]; P = .03). Longer intervention duration was associated with a greater reduction in anxiety (R 2 = 0.82; P < .001). Higher body mass index z score at baseline was associated with a greater reduction in depression (R 2 = 0.19; P = .03).CONCLUSIONS AND RELEVANCE Structured, professionally run pediatric obesity treatment is not associated with an increased risk of depression or anxiety and may result in a mild reduction in symptoms. Treatment of weight concerns should be considered within the treatment plan for young people with depression and obesity.
Despite rapid physiologic weight gain, women report little or no change in energy intake during pregnancy. Current recommendations to increase energy intake by ∼ 1000 kJ/day may, therefore, encourage excessive weight gain and adverse pregnancy outcomes.
Summary The intersection between adolescent obesity and eating disorder risk is one that requires urgent attention. This review aimed to synthesize the literature on the risk of clinical eating disorders in adolescents with obesity, discuss challenges with assessing risk, and examine implications for clinical practice and future research. Obesity and eating disorders can coexist resulting in exacerbated physical and psychological health issues. Recognized eating disorder risk factors, including body dissatisfaction, poor self‐esteem, depression, and engaging in dieting behaviors, are elevated and frequently reported in adolescents with obesity, highlighting a vulnerability to the development of eating disorders. Unsupervised dieting to manage weight may exacerbate eating disorder risk, while structured and supervised weight management is likely to reduce eating disorder risk for most adolescents. However, some adolescents may present to an obesity service with an undiagnosed eating disorder or may develop an eating disorder during or following treatment. We conclude that a risk management approach, with screening or monitoring for eating disorder‐related risk factors and behaviors, should be utilized to identify those at risk. Future research to identify eating disorder risk factors specific to adolescents with obesity is required to inform screening and monitoring protocols, patient care, and address current knowledge gaps.
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