A randomized, comparative pilot trial of family‐based interpersonal psychotherapy for reducing psychosocial symptoms, disordered‐eating, and excess weight gain in at‐risk preadolescents with loss‐of‐control‐eating

Abstract

Objective Preadolescent loss-of-control-eating (LOC-eating) is a risk factor for excess weight gain and binge-eating-disorder. We evaluated feasibility and acceptability of a preventive family-based interpersonal psychotherapy (FB-IPT) program. FB-IPT was compared to family-based health education (FB-HE) to evaluate changes in children’s psychosocial functioning, LOC-eating, and body mass. Method A randomized, controlled pilot trial was conducted with 29 children, 8 to 13 years who had overweight/obesity and LOC-eating. Youth-parent dyads were randomized to 12-week FB-IPT (n=15) or FB-HE (n=14) and evaluated at post-treatment, six-months, and one-year. Changes in child psychosocial functioning, LOC-eating, BMI, and adiposity by dual-energy-X-ray-absorptiometry were assessed. Missing follow-up data were multiply imputed. Results FB-IPT feasibility and acceptability were indicated by good attendance (83%) and perceived benefits to social interactions and eating. Follow-up assessments were completed by 73% FB-IPT and 86% FB-HE at post-treatment, 60% and 64% at six-months, and 47% and 57% at one-year. At post-treatment, children in FB-IPT reported greater decreases in depression (95% CI −7.23, −2.01, Cohen’s d=1.23) and anxiety (95% CI −6.08, −0.70, Cohen’s d=.79) and less odds of LOC-eating (95% CI −3.93, −0.03, Cohen’s d=.38) than FB-HE. At six-months, children in FB-IPT had greater reductions in disordered-eating attitudes (95% CI −0.72, −0.05, Cohen’s d=.66) and at one-year, tended to have greater decreases in depressive symptoms (95% CI −8.82, 0.44, Cohen’s d=.69) than FB-HE. There was no difference in BMI gain between the groups. Discussion Family-based approaches that address interpersonal and emotional underpinnings of LOC-eating in preadolescents with overweight/obesity show preliminary promise, particularly for reducing internalizing symptoms. Whether observed psychological benefits translate into sustained prevention of disordered-eating or excess weight gain requires further study.

Treatment of obesity, with a dietary component, and eating disorder risk in children and adolescents: A systematic review with meta‐analysis

“…Items assessing abnormal eating behaviors and attitudes (food preoccupation, anorexia, or bulimia) were not changed significantly during treatment . Four studies reported follow‐up data only, reporting no change or a significant reduction in ED risk …”

“…Meta‐analysis of the intervention arms from nine studies, with a combined sample of 491 participants, found no change in ED risk post‐intervention (Figure A; SMD [SE], −0.10 [0.10], P = 0.317, I 2 86%). A follow‐up measure of up to 4.6 years from baseline was reported in six studies, with a combined effect of −0.31 [0.13], P = 0.012, I 2 88% (Figure B) representing a reduction in ED risk. Funnel plots appeared symmetrical, and the classic fail‐safe N statistic estimated that 91 unpublished studies would be required for P > 0.05 at follow‐up, and therefore, publication bias is unlikely.…”

“…In brief, 18 articles reported on noncontrolled trials (pre-post), [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] 17 on randomized controlled trials, [37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53] and one on a nonrandomized controlled trial. 54 Studies were conducted in the United States, 19,32,33,42,[44][45][46][47]52,53 Belgium, [20][21][22]35,36,…”

“…54 Studies were conducted in the United States, 19,32,33,42,[44][45][46][47]52,53 Belgium, [20][21][22]35,36,38 Brazil, [23][24][25][26][27] Australia, 37,39,48,49 the United Kingdom, 29,34,41 the Netherlands, 31,43,50 Canada, 40 Iran, 51 Israel, 30 Romania, 54 and Spain. 28 Interventions were conducted in tertiary hospital outpatient 19,[23][24][25][26][27][28][29]32,40,[43][44][45][47]…”

Disordered Eating Attitudes and Behaviors in Youth with Overweight and Obesity: Implications for Treatment

“…Strategies are also taught for parenting around topics related to disordered eating attitudes and behaviors, such as encouraging discussion of media images, praising their child for non-appearance related characteristics, and avoiding discussions of their own or other’s bodies in front of their child. Improving communication, increasing support, and reducing conflict within the family through interpersonal psychotherapy has been shown to be helpful for children with overweight/obesity and LOC eating by reducing LOC eating episodes and disordered eating attitudes [79]. As such, FBT elements focusing on communication within the parent-child relationship may be one mechanism through which to reduce disordered eating.…”