Eating disorder risk in adolescents with obesity

Abstract

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.

Effect of a High-Intensity Dietary Intervention on Changes in Dietary Intake and Eating Pathology during a Multicomponent Adolescent Obesity Intervention

“…The current investigation adds to this literature by specifically examining the relationship between changes in the diet, rather than just participation in treatment, and eating pathology. Collectively, findings suggest that supervised dietary interventions within obesity treatment are not associated with increased eating pathology, which is in contrast to the observed relationships between unsupervised "dieting" and increased eating pathology among adolescents with obesity [25]. In this investigation, mean EDE-Q scores, both pre-and post-treatment, are well below the clinical cut-off score of >4 [26].…”

“…While the changes in dietary intake reflected the treatment goals, it is important to note that there was a large amount of variability in the response. This amount of variability to intervention response has been one of the major reasons why the focus on "precision medicine" has developed [25]. A component of this is precision nutrition, which is focused on identifying moderators to dietary treatment response.…”

Time-Limited Eating and Continuous Glucose Monitoring in Adolescents with Obesity: A Pilot Study

“…This finding is important given the concerns that TLE may lead to unhealthy eating behaviors and attitudes. Disordered eating behaviors are prevalent among adolescents with obesity; however, many studies have suggested that monitored intervention programs implemented by trained professionals may decrease eating behavior symptomatology [82][83][84]. The potential for unhealthy eating should be continuously monitored in future studies [73,83,85].…”

The Complicated Relationship between Dieting, Dietary Restraint, Caloric Restriction, and Eating Disorders: Is a Shift in Public Health Messaging Warranted?

“…Recent studies of obesity and ED treatment interventions in adolescents [ 89 , 90 ] have concluded that structured obesity treatment programs for adolescents reduce eating disorder prevalence, risk, and symptoms, [ 90 ] as well as reducing shape and weight concerns [ 91 ]. These findings also suggest that while these “supervised” interventions are not associated with increased eating pathology, unsupervised “dieting”, as a self-reported method to lose weight, e.g., fasting, skipping meals, and diet pill use, has been associated with increased eating pathology among adolescents [ 92 ]. Additionally, not all individuals at increased risk maybe adequately be identified in aggregate data [ 93 ].…”