Do child weight programs raise eating disorder risk? A 2019 review

Why this study matters

Many parents and clinicians worry that putting a child or teen on a weight-management program could trigger disordered eating. It is a fair concern, because dieting on one's own has been linked to eating problems in young people. This review pulled together the research on structured programs run by health professionals to see whether that fear holds up. Canadian families who are offered a pediatric weight program may want to know what the evidence says about this specific risk.

Who was in the study

The review searched four research databases and screened 3078 articles. It included 36 articles, which the extracted data describe as representing 29 studies, with a combined 2589 participants. The children and teens had overweight or obesity, and the mean ages across studies ranged from 7.8 to 16.9 years. Treatment lasted from 1 week to 13 months, and follow-up ran from 6 months to 6 years after the start. The extracted data note that Canada was among the countries represented in the included studies.

What the researchers did

This is a systematic review with meta-analysis. A systematic review searches for every study on a question using set rules. A meta-analysis then combines the numbers from those studies into one overall estimate. To be included, a study had to test an obesity treatment with a dietary component in children or adolescents and measure eating disorder outcomes with validated tools both before and after the intervention. Most comparisons were pre/post, meaning the same children were measured before and after treatment; randomized comparisons were also reviewed where available. The combined results are reported as standardized mean differences (SMD). An SMD expresses a change in units of spread, so that different questionnaires can be pooled; a negative number here means symptoms went down.

What they found

Five studies reported the prevalence of eating disorders, and prevalence was lower after treatment in those studies (R32-C139).

Immediately after treatment, the pooled results showed reductions in several symptoms:

At later follow-up, reductions were also found in eating disorder risk (6 studies; SMD -0.313, standard error 0.13; P=0.012), emotional eating (5 studies; -0.259, 0.05; P less than 0.001), eating concern (3 studies; -0.501, 0.06; P less than 0.001), and drive for thinness (2 studies; -0.375, 0.07; P less than 0.001).

The authors concluded that structured and professionally run obesity treatment was associated with reduced eating disorder prevalence, risk and symptoms.

Side effects and people who stopped

The published summary we reviewed does not report adverse events or how many children left the programs. A review of eating disorder risk is itself a study of one possible harm, and on average that harm was not seen.

What this study does not tell you

• Most comparisons were before-and-after measurements in the same children, without a control group. That design cannot prove the program caused the improvement, because symptoms might have changed anyway.
• The studies used different questionnaires to measure symptoms, and many were small. Some pooled results rest on only two or three studies.
• These were supervised programs run by health professionals in research settings. The results may not apply to unsupervised dieting or to programs of lower quality.
• An average improvement does not rule out harm for some individual children. The review cannot say that every approach is safe for every child.
• The review covers behavioural and dietary programs. It does not cover weight-management medicines or surgery in young people.
• The summary we reviewed does not state the funding source. The authors declared no conflicts of interest.

What it means in Canada

Canadian families are sometimes offered structured pediatric weight programs through hospitals or community clinics. This review suggests that, on average, such programs did not raise eating disorder symptoms in research settings, while leaving open the need to watch each child closely. It does not address medicines used in adolescents; separate trial pages on this site cover those. For general information, see semaglutide in Canada and public drug coverage by province.

Related reading

Other studies in this library that bear on the same question.

Source