Mental Health Among Adolescents With Obesity: Daily Dose

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On August 28, 2024, we reported on a study published in JAMA Pediatrics that examined changes in self-reported symptoms of depression, eating disorders, and binge eating in adolescents with obesity.

The study

Researchers conducted the randomized clinical trial between 2018 and 2023 among adolescents aged 13 to 17 years with obesity and 1 or more cardiometabolic conditions (eg, insulin resistance, hypertension). For the purpose of the study, obesity was defined as the adult equivalent BMI of ≥30 kg/m². The trial included 3 phases, with the first being from baseline to week 4, then weeks 5 to 16, and weeks 17 to 52.

During the first phase, participants received very low energy diets (VLEDs) consisting of approximately 800 kcal per day, then they transitioned to intermittent energy restriction (IER) or continuous energy restriction (CER) during phase 2, and then either continued intervention and/or maintenance with reduced support during phase 3.

The IER intervention consisted of 3 energy-restricted days per week (approximately 600-700 kcal/day), and 4 days per week of healthy eating without energy restriction. The CER intervention involved tailored energy prescription based on age (eg, those aged 13-14 years received 1430-1670 kcal/day and those aged 15-17 years received 1670-1900 kcal/day).

Investigators screened participants for depression and eating disorders using self-reported questionnaires at baseline and week 4, 16, and 52. Symptoms of depression were measured using the Center for Epidemiologic Studies Depression Scale–Revised 10-Item Version for Adolescents (CESDR-10; scores 0-30). Eating disorder symptoms were evaluated using the Eating Disorder Examination Questionnaire (EDE-Q; scores 0-6), where a score of 2.7 indicates risk. Binge eating symptoms were measured via the Binge-Eating Scale (BES; scores 0-46), with a score of ≥27 indicates severe binge eating.

The findings

At week 52, there were no differences between groups for change in CESDR-10 (mean difference 0.75, 95% CI −1.86 to 3.37), EDE-Q (mean difference 0.02, 95% CI −0.41 to 0.45), or BES (mean difference −2.91, 95% CI −5.87 to 0.05).

The within-group decreases at week 4 were maintained at week 52 for CESDR-10 (IER, −2.70, 95% CI −4.95 to −0.45; CER, −3.87, 95% CI −5.98 to −1.77) and EDE-Q (IER, −0.63, 95% CI −0.97 to −0.26; CER, −0.56, 95% CI −0.89 to −0.22), “indicating reduced symptoms of depression and eating disorders,” investigators stated. They added that within-group reductions on the BES were maintained in the IER group at week 52 (−3.72, 95% CI −6.20 to −1.24), but not CER (−0.38, 95% CI −2.71 to 1.96).

Despite these reductions in symptoms, 12.1% of participants (n=17) required additional support or referral for depression and/or disordered eating during the study, including 7 adolescents who experienced the onset or re-emergence of symptoms.

Authors' comment

"Results suggest that obesity treatment interventions may have a dual role of improving physiological and psychosocial health; screening and monitoring for depression and disordered eating are important to facilitate early intervention."

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