Pediatric Obesity and Eating Disorders Symptoms: The Role of the Multidisciplinary Treatment. A Systematic Review

Abstract

The prevalence of obesity in children/adolescents has increased worldwide during the past 30 years, becoming a significant public health concern; prevention, and management of pediatric obesity onset is one of the most critical public health goals for both industrialized and developing countries. Pediatric obesity has been identified as a risk factor for various psychopathologies, including eating disorders (ED). Although it has been demonstrated that a comprehensive multidisciplinary treatment (MT), with small steps and practical approaches to lifestyle change, can be an effective treatment for children and adolescents with obesity, to the best of our knowledge, this is the first systematic review investigating the effect of MT on the development, progression or decrease of ED symptoms (EDS) in this target population. PubMed and Web of Science databases were searched (last search on 18 February 2019) according to a predetermined search strategy, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines and Statement. Original studies published in English examining the effect of MT on pediatric overweight/obesity, paying particularly attention at the development of EDS, were eligible for inclusion. Seven hundred and forty-four records have been identified; nine articles with study quality ranging from weak to moderate have been included. MTs were heterogeneous in nature including length, number, frequency and type of sessions, parent-involvement and use of technology, besides several psychometric questionnaires were used to screen for EDS, since there are no standardized criteria. In 3 studies there was a significant decrease in external and emotional eating and in four studies a significant increase in restraint eating post MT. Two studies found a significant decrease of binge eating symptoms and other two studies showed an improvement of self-perception, weight, and shape concern. A statistical significant decrease in BMI, BMIz, BMISDS, and adjusted BMI was observed after all MTs, except one. A narrative summary of the evidences reported highlighted the positive impact of MT on the EDS. Moreover, since weight loss post MTs was not necessarily related to EDS, clinicians should also look for the presence of EDS and treat them accordingly.

Impact of Strategies for Preventing Obesity and Risk Factors for Eating Disorders among Adolescents: A Systematic Review

“…Due to this stigmatization, obesity in youth has been shown to be a risk factor for psychopathology, which may manifest itself through body dissatisfaction, shape and weight concerns, and dieting and eating disorder behaviors, such as binge eating and purging [ 4 , 5 ]. Research has also shown that obesity in youth is associated with sneaking and hoarding food, eating when not hungry, and feelings of self-consciousness or embarrassment when eating in front of others [ 6 , 7 ]. Although disordered eating behaviors and eating disorders both encompass a broad array of dimensional maladaptive cognitions and behaviors relating to eating and weight, they differ in their diagnosis.…”

“…Prevention programs that include diet, physical activity (PA), and/or sedentary behavior components are currently the first line of prevention for obesity in adolescent youth [ 6 ]. However, focusing on diet and PA may increase the risk for eating disorders.…”

“…Thus, it is important to examine the implications of the aforementioned strategies and their impact on disordered eating risk factors and obesity prevention among adolescent youth in order to build a more sustainable approach through the integration of diet and PA components with psychosocial support. Previous systematic reviews and meta-analyses [ 6 , 18 ] have assessed the impact of obesity treatment on eating disorders in overweight or obese children and adolescents. However, there is a gap in the literature examining the impact of obesity prevention programs among youth on risk factors for disordered eating.…”

A response to the comments by Ms Adams on our paper “Treatment of obesity, with a dietary component, and eating disorder risk in children and adolescents: A systematic review with meta‐analysis”

“…It would not be uncommon for discrepancies to exist in the quality assessment of an intervention trial between tools. There are two studies in common between our review and that conducted by De Giuseppe et al which may be perceived as having a differing quality ratings, where we have allocated a “neutral” rating and De Giuseppe et al (2019) have allocated a “weak” rating.…”

Letter to the editor: Concerns regarding “Meta‐analysis on pediatric obesity treatments and eating disorder risk” of Jebeile et al

“…Interventions within the reviewed papers varied considerably, encompassing SMS support, a Jenny Craig program, and inpatient treatment. De Giuseppe et al also systematically reviewed the impact of pediatric obesity treatment on ED development and rejected meta‐analysis in favor of narrative summary due to significant study heterogeneity. Despite several studies in common, the quality ratings of papers across these two teams differed, with Jebeile et al consistently assessing studies more positively than De Giuseppe et al…”