A randomized clinical trial involving 141 adolescents with obesity assessed changes in depression, eating disorders, and binge eating during a 52-week intervention using a very low energy diet, followed by intermittent energy restriction or continuous energy restriction. The Fast Track to Health trial, conducted in Australia from 2018 to 2023, aimed to evaluate the psychosocial effects of obesity treatment.
The study participants, with a median age of 14.8 years (interquartile range [IQR], 12.9 to 17.9 years), included 50.4% males (71 males). Participants were screened for depression, eating disorders, and binge eating at baseline, weeks 4, 16, and 52, using the Center for Epidemiologic Studies Depression Scale (CESDR-10), Eating Disorder Examination Questionnaire (EDE-Q), and Binge Eating Scale (BES).
At baseline, the median EDE-Q score was 2.28 (IQR, 1.43 to 3.14), the CESDR-10 median score was 9.00 (IQR, 4.00 to 14.50), and the BES median score was 11.00 (IQR, 5.00 to 17.00). After a 4-week very low energy diet (VLED) phase, participants showed reductions in depression, eating disorder, and binge eating symptoms. These improvements were sustained at 52 weeks for depression and eating disorder symptoms.
By week 4, depression symptoms, as measured by the CESDR-10, showed reductions that persisted through week 52 (week 52 mean difference: 0.75; 95% confidence interval [CI], −1.86 to 3.37). Similarly, eating disorder symptoms, assessed with the EDE-Q, decreased significantly by week 4 and were maintained at week 52 (week 52 mean difference: 0.02; 95% CI, −0.41 to 0.45). Binge eating symptoms, measured by the BES, were significantly reduced by week 4. However, these reductions continued in the intermittent energy restriction (IER) group at week 52 but not in the continuous energy restriction (CER) group (week 52 mean difference: −2.91; 95% CI, −5.87 to 0.05).
There were no significant between-group differences in changes to depression or eating disorder symptoms. However, adolescents in the IER group experienced sustained reductions in binge eating compared with the CER group.
At the start of the study, published in JAMA Pediatrics, 22% of participants (31 adolescents) were identified as having a possible, probable, or major depressive episode. By week 52, this percentage decreased to 9%, with 65% of participants reporting no symptoms of depression. Despite these improvements, 12.1% of adolescents required additional support for depression and/or disordered eating. Seven adolescents experienced new or reemerging symptoms of disordered eating during the trial, indicating the need for continued mental health monitoring during obesity treatment.
The researchers noted that obesity treatment interventions could support improvements in both physical and psychological health outcomes. The study highlighted the importance of screening and monitoring for depression and disordered eating in adolescents receiving obesity treatment.
Full disclosures can be found in the published study.