Identifying eating disorders in adolescents and adults with overweight or obesity: A systematic review of screening questionnaires.

OBJECTIVE: This review aimed to examine the validity of self-report screening questionnaires for identifying eating disorder (ED) risk in adults and adolescents with overweight/obesity. METHOD: Five databases were searched from inception to September 2020 for studies assessing validation of self-report ED screening questionnaires against diagnostic interviews in adolescents and adults with overweight/obesity. The review was registered with PROSPERO (https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=220013). RESULTS: Twenty-seven papers examining 15 questionnaires were included. Most studies validated questionnaires for adults (22 of 27 studies), and most questionnaires (12 of 15) screened for binge eating or binge-eating disorder (BED). The Eating Disorder Examination Questionnaire (sensitivity = .16-.88, specificity = .62-1.0) and Questionnaire on Eating and Weight Patterns (sensitivity = .07-1.0, specificity = .0-1.0) were most frequently validated (six studies each). Five studies of three questionnaires were in adolescents, with the Adolescent Binge-Eating Disorder Questionnaire having highest sensitivity (1.0) but lower specificity (.27). Questionnaires designed to screen for BED generally had higher diagnostic accuracy than those screening for EDs in general. DISCUSSION: Questionnaires have been well validated to identify BED in adults with overweight/obesity. Validated screening tools to identify other EDs in adults and any ED in adolescents with overweight/obesity are lacking. Thus, clinical assessment should inform the identification of patients with co-morbid EDs and overweight/obesity. PUBLIC SIGNIFICANCE: Individuals with overweight/obesity are at increased risk of EDs. This review highlights literature gaps regarding screening for ED risk in this vulnerable group. This work presents possibilities for improving care of individuals with overweight/obesity by reinventing ED screening tools to be better suited to diverse populations.

OBJETIVO: Esta revisión tuvo como objetivo examinar la validez de los cuestionarios de detección de autorreporte para identificar el riesgo de trastorno de la conducta alimentaria (TCA) en adultos y adolescentes con sobrepeso/obesidad. MÉTODO: Se realizaron búsquedas en cinco bases de datos desde su inicio hasta septiembre de 2020 para obtener estudios que evaluaran la validación de los cuestionarios de autorreporte de detección de TCA frente a entrevistas diagnósticas en adolescentes y adultos con sobrepeso/obesidad. La revisión se registró en PROSPERO (https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=220013). RESULTADOS: Se incluyeron veintisiete artículos que examinaron 15 cuestionarios. La mayoría de los estudios validaron cuestionarios para adultos (22 de 27 estudios) y la mayoría de los cuestionarios (12 de 15) detectaban atracones o trastorno por atracón (BED, en sus siglas en inglés). El Cuestionario de Examen de Trastornos alimentarios (Eating Disorder Examination Questionnaire) (sensibilidad = 0.16-0.88, especificidad = 0.62-1.0) y el Cuestionario sobre patrones de alimentación y peso (Questionnaire on Eating and Weight Patterns) (sensibilidad = 0.07-1.0, especificidad = 0.0-1.0) se validaron con mayor frecuencia (seis estudios cada uno). Cinco estudios de tres cuestionarios fueron en adolescentes, y el Cuestionario de Trastorno por Atracón en Adolescentes (Adolescent Binge-eating Disorder Questionnaire) tuvo la mayor sensibilidad (1,0) pero una menor especificidad (0,27). Los cuestionarios diseñados para detectar BED generalmente tuvieron una mayor precisión diagnóstica que los que detectaron TCA en general. DISCUSIÓN: Los cuestionarios han sido bien validados para identificar BED en adultos con sobrepeso/obesidad. Faltan herramientas de detección validadas para identificar otros TCA en adultos y cualquier tipo de trastorno de la conducta alimentaria en adolescentes con sobrepeso / obesidad. Por lo tanto, la evaluación clínica debe informar la identificación de pacientes con comorbilidad de TCA y sobrepeso/obesidad.

Intermittent Energy Restriction for Adolescents With Obesity: The Fast Track to Health Randomized Clinical Trial.

Importance: Adolescent obesity requires effective and accessible treatment. Intensive dietary interventions have the potential to be used as adjunctive therapy for behavioral weight management. Objective: To examine the effectiveness of 2 diet therapies, delivered as part of an intensive behavioral weight management intervention, in adolescents with metabolic complications associated with obesity. Design, Setting, and Participants: This multisite, 52-week randomized clinical trial was conducted from January 31, 2018, to March 31, 2023, at 2 tertiary pediatric centers in Australia. Adolescents (aged 13-17 years) with obesity and 1 or more associated complications were included. Interventions: Intensive behavioral interventions, delivered by a multidisciplinary team, comparing intermittent energy restriction (IER) or continuous energy restriction (CER), with 3 phases: very low-energy diet (weeks 0-4), intensive intervention (weeks 5-16), and continued intervention and/or maintenance (weeks 17-52). Main Outcomes and Measures: The primary outcome was body mass index (BMI) z score at 52 weeks in the IER vs CER group. Anthropometry, body composition, and cardiometabolic health were assessed at baseline and 52 weeks. The BMI z score and percentiles were determined using Centers for Disease Control and Prevention growth charts. Insulin resistance, dyslipidemia, and elevated hepatic function were assessed. Results: A total of 141 adolescents (median [IQR] age, 14.8 [12.9-17.9] years; 71 male [50.4%]) were enrolled, 71 in the IER group and 70 in the CER group, and 97 (68.8%) completed the intervention, 43 in the IER group and 54 in the CER group. At week 52, both groups had reduced BMI z scores (estimated marginal mean change, -0.28 [95% CI, -0.37 to -0.20] for IER and -0.28 [95% CI, -0.36 to -0.20] for CER) and reduced BMI expressed as a percentage of the 95th percentile (estimated marginal mean change, -9.56 [95% CI, -12.36 to -6.83] for IER and -9.23 [95% CI, -11.82 to -6.64] for CER). No differences were found in body composition or cardiometabolic outcomes between the groups. Both groups had a reduction in the occurrence of insulin resistance (from 52 of 68 [76.5%] to 32 of 56 [57.1%] in the IER group and from 59 of 68 [86.8%] to 31 of 60 [57.1%] in the CER group) at week 16; however, at week 52, this effect was observed in the CER group only (from 59 of 68 [86.7%] to 30 of 49 [61.2%]). The occurrence of dyslipidemia was unchanged between baseline and week 52 (60 of 137 [42.6%] and 37 of 87 [42.5%], respectively), with a small improvement in occurrence of impaired hepatic function tests (37 of 139 [27.0%] and 15 of 87 [17.2%], respectively). No differences were found in dyslipidemia or hepatic function between groups. Conclusions and Relevance: These findings suggest that for adolescents with obesity-associated complications, IER can be incorporated into a behavioral weight management program, providing an option in addition to CER and offering participants more choice. Trial Registration: http://anzctr.org.au Identifier: ACTRN12617001630303.

Symptoms of Depression, Eating Disorders, and Binge Eating in Adolescents With Obesity: The Fast Track to Health Randomized Clinical Trial.

Importance: Depression and eating disorders are heightened for adolescents with obesity. Clinical reviews alongside self-report questionnaires are important to ensure appropriate intervention. Objective: To evaluate changes in self-report symptoms of depression, eating disorders, and binge eating in adolescents with obesity during the Fast Track to Health trial. Design, Setting, and Participants: This was a randomized clinical trial conducted from 2018 to 2023. It was a multisite trial conducted at children's hospitals in Sydney, New South Wales, and Melbourne, Victoria, Australia, and included adolescents (13-17 years) with obesity (defined as adult equivalent body mass index ≥30; calculated as weight in kilograms divided by height in meters squared) and 1 or more related complications. Interventions: Duration was 52 weeks including a very low energy diet for 4 weeks followed by intermittent energy restriction (IER) or continuous energy restriction (CER). Main Outcomes and Measures: Self-report symptoms of depression (Center for Epidemiologic Studies Depression Scale-Revised 10-Item Version for Adolescents [CESDR-10]; scores 0-30), eating disorders (Eating Disorder Examination Questionnaire [EDE-Q]; scores 0-6), and binge eating (Binge Eating Scale [BES]; scores 0-46) were assessed. Adolescents were screened for depression and eating disorders (weeks 0, 4, 16, and 52) and monitored for the onset of new symptoms of disordered eating during dietetic consults. Results: Of 141 adolescents (median [IQR] age, 14.8 [12.9-17.9] years; 71 male [50.4%]) enrolled, median baseline EDE-Q score was 2.28 (IQR, 1.43-3.14), median baseline CESDR-10 score was 9.00 (IQR, 4.00-14.50), and median baseline BES score was 11.00 (IQR, 5.00-17.00). There were no differences between groups for change in CESDR-10 (mean difference at week 52, 0.75; 95% CI, -1.86 to 3.37), EDE-Q (mean difference at week 52, 0.02; 95% CI, -0.41 to 0.45), or BES (mean difference at week 52, -2.91; 95% CI, -5.87 to 0.05). The within-group reductions at week 4 were maintained at week 52, for CESDR-10 and EDE-Q, indicating reduced symptoms of depression and eating disorders. Within-group reductions on the BES were maintained in the IER group only. Seventeen adolescents (12.1%) required support or referral for depression and/or disordered eating, including 7 (5%; 5 IER, 2 CER) adolescents who experienced the onset or reemergence of symptoms during the intervention. Conclusions and Relevance: Results suggest that many treatment-seeking adolescents with obesity self-reported symptoms of depression and eating disorders. Although symptoms reduced for most, some required additional support. Obesity treatment is an opportune time to screen and monitor for depression and disordered eating. Trial Registration: Australian New Zealand Clinical Trials Registry: ACTRN12617001630303.

Pediatric weight management, dietary restraint, dieting, and eating disorder risk: a systematic review.

CONTEXT: Whether dietary restraint and dieting are risk factors associated with eating disorders has not been explored in the context of pediatric weight management. OBJECTIVE: To review associations between dietary pediatric weight management, dietary restraint, dieting, and eating disorder risk. DATA SOURCES, SELECTION, AND EXTRACTION: Four databases - MEDLINE, EMBASE, Cochrane Library, and PsycINFO - were searched to May 2020 to identify pediatric weight management interventions with a dietary component for children and adolescents with overweight or obesity. The review was limited to studies reporting dietary restraint and/or dieting at preintervention, postintervention, and/or follow-up. Screening and quality assessment were conducted in duplicate, and data extraction was completed by 1 reviewer and cross-checked for accuracy. Data extracted included study characteristics, dietary restraint/dieting, and eating disorder-related outcomes (including disordered eating, body image, self-esteem, depression, and anxiety). RESULTS: A total of 26 papers, representing 23 studies, were included. Of these, 20 studies reported on dietary restraint, which increased (10 postintervention, 6 follow-up) or remained unchanged (7 postintervention, 5 follow-up), and 5 studies reported on dieting, which increased (1 study), remained unchanged (2 studies) or decreased (2 studies) postintervention. All studies that reported on other eating disorder risk factors (eg, binge eating, body dissatisfaction, and depression) and weight-related outcomes found improvement or no change postintervention or at follow-up. CONCLUSION: The results of this review suggest that current measures of dietary restraint and dieting are not associated with eating disorder risk within the context of pediatric weight management; however, long-term data is limited. In addition, those current measures may not be suitable risk markers. Concerns about dietary restraint and dieting leading to eating disorders should not prevent access to quality care for young people with obesity. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration no. 2017 CRD42017069488.