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Randomized Controlled Trial
. 2024 Oct 1;178(10):996-1005.
doi: 10.1001/jamapediatrics.2024.2851.

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

Hiba Jebeile  1   2 , Louise A Baur  1   3 , Cathy Kwok  1   3 , Shirley Alexander  3 , Justin Brown  4   5 , Clare E Collins  6   7 , Christopher T Cowell  1   8 , Kaitlin Day  9   10 , Sarah P Garnett  1   8 , Megan L Gow  1 , Alicia M Grunseit  11 , Maddison Henderson  2 , Eve T House  1   2 , Mary-Kate Inkster  4   9 , Sarah Lang  9 , Susan J Paxton  12 , Helen Truby  13   14 , Krista A Varady  15 , Natalie B Lister  1   2
Affiliations
Randomized Controlled Trial

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

Hiba Jebeile et al. JAMA Pediatr. .

Abstract

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.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Jebeile reported receiving grants from National Health and Medical Research Council during the conduct of the study. Dr Baur reported receiving grants from National Health and Medical Research Council; serving as sponsor/investigator of the Novo Nordisk ACTION Teens study; receiving advisory board fees from Eli Lilly; and receiving speaker fees from Novo Nordisk. Ms Kwok reported receiving the University of Sydney Postgraduate Awards scholarship from the University of Sydney during the conduct of the study; support from Novo Nordisk to attend and present the ACTION Teens study outside the submitted work. Dr Collins reported receiving grants from the National Health and Medical Research Council of Australia during the conduct of the study; being an inventor of the online dietary assessment questionnaire, the Australian Eating Survey, from which her institution receives income. Dr Day reported receiving personal fees from Nu-Mega Ingredients outside the submitted work. Dr Garnett reported receiving grants from the National Health and Medical Research Council during the conduct of the study. Dr Gow reported receiving grants from the National Health and Medical Research Council of Australia, Early Career Fellowship during the conduct of the study. Dr Truby reported receiving grants from National Health and Medical Research Council, the Commonwealth Department of Health and Aged Care, the Medical Research Future Fund–Preventive and Public Health Research Initiative–Maternal Health and Healthy Lifestyles Initiative, and from the National Health and Medical Research Council Ideas grant outside the submitted work. Dr Varady reported receiving grants from the National Institutes of Health and publishing fees from Pan MacMillan Publishing for the book The Fastest Diet outside the submitted work. Dr Lister reported receiving grants from National Health and Medical Research Council during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Depression and Eating Disorder Screening and Monitoring Protocol
CESDR-10 indicates Center for Epidemiologic Studies Depression Scale–Revised 10-Item Version for Adolescents; EDE-Q, Eating Disorder Examination Questionnaire.
Figure 2.
Figure 2.. Change in Symptoms of Depression Between Baseline and Week 52
Total number of participants analyzed was 141. Values are estimated marginal means (95% CI). Shaded area represents the 4-week very low energy diet phase of the trial. CER indicates continuous energy restriction; CESDR-10, Center for Epidemiologic Studies Depression Scale–Revised 10-Item Version for Adolescents; EMM, estimated marginal means; IER, intermittent energy restriction.
Figure 3.
Figure 3.. Change in Symptoms of Eating Disorders and Binge Eating Between Baseline and Week 52
A, Eating disorders between baseline and week 52. B, Binge eating between baseline and week 52. Values are estimated marginal means (95% CI). Shaded area represents the 4-week very low energy diet phase of the trial. Total number of participants was 141 for the Eating Disorder Examination Questionnaire (EDE-Q) and 139 for the Binge Eating Scale (BES). CER indicates continuous energy restriction; EMM, estimated marginal means; IER, intermittent energy restriction.
Figure 4.
Figure 4.. Change in Shape Concern, Weight Concern, Eating Concerns, and Dietary Restraint Subscales of the Eating Disorder Examination Questionnaire (EDE-Q) Between Baseline and Week 52
A, Shape concern. B, Weight concern. C, Eating concern. D, Dietary restraint. Values are estimated marginal means (95% CI). Shaded area represents the 4-week very low energy diet phase of the trial (total participants, n = 141). CER indicates continuous energy restriction; EMM, estimated marginal means; IER, intermittent energy restriction.
See this image and copyright information in PMC

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