Managing Emotions Key to Sustaining Weight Loss in Adolescents With Obesity, Trial Finds

Key Takeaways: 

• Adolescents with obesity who received emotion regulation training alongside family-based behavioural treatment were far more likely to maintain a clinically meaningful reduction in BMI z-score after treatment ended (22% vs 4%).
  
• Both groups lost similar amounts of weight during the 6-month programme, but the added skills were linked to better weight maintenance and significantly less emotional eating at follow-up.
  
• Experts caution that obesity is not primarily psychological or a matter of self-control, but emotion regulation may be a useful component of care for some young people.
  
  
  

Emotional eating skills linked to longer-lasting results

A year after completing treatment for obesity, adolescents who were trained to regulate their emotions were significantly more likely to sustain their weight loss than peers who received standard behavioural therapy alone, according to a randomised clinical trial published in JAMA Network Open.

Participants who learnt the add-on skills also reported significantly less emotional eating at follow-up than those who completed only the diet and exercise programme.

“Emotional eating is one of the triggers for overeating and binge eating for many – over time, the goal is for teens to see food as one of many ways to feel better, but not the only one,” said Kerri Boutelle, PhD, professor of paediatrics and psychiatry at the Herbert Wertheim School of Public Health and Human Longevity Science at the University of California, San Diego, who led the study.

The current picture of adolescent obesity care

According to the US Centers for Disease Control and Prevention (CDC), about 22.9% of adolescents aged 12–19 years in the US have obesity.

Current guidance recommends intensive health behaviour and lifestyle treatment, with the most effective programmes providing at least 26 hours of family-based, multicomponent treatment over 3–12 months.

According to the American Academy of Pediatrics, medications such as GLP-1s can be offered as an adjunct to treatment for adolescents aged 12 years or older with obesity, while adolescents aged 13 years or older with severe obesity should be offered referral for evaluation for bariatric surgery.

How the study was designed

To find out whether adding training to regulate emotions related to eating could improve weight loss, Boutelle and colleagues conducted a study involving 166 adolescents aged 13–16 years with a BMI at or above the 85th percentile, along with their parents. The parents had a mean age of 45.3 years, and 85% were women.

Participants were randomly assigned to 6 months of standard family-based behavioural treatment, or to the same treatment with additional emotion regulation training. The standard programme included education on nutrition, physical activity, behaviour change and parenting, in addition to coaching sessions.

Learning to “ride the urge”

The add-on training taught adolescents to notice and name their feelings, and to consider whether they were physically hungry or were instead feeling stressed, sad or bored.

They were then taught to “ride the urge to eat like a wave” before choosing a response that better matched the emotion, Boutelle said. This might have included walking or slow breathing when stressed, texting a friend when lonely, or finding an engaging activity when bored.

Approaches like these sit at the heart of family-centred care for young people living with obesity – an area explored in depth in the College of Contemporary Health’s Childhood Obesity Essentials course, which supports healthcare professionals working with children, adolescents and their families.

Similar weight loss, very different maintenance

Both groups lost similar amounts of weight at 6 months.

However, at 6 and 12 months after treatment ended, 22% of participants who had been taught the added skills had maintained a clinically meaningful reduction in their BMI z-score, compared with 4% of those who received standard family-based treatment alone.

Boutelle said she was surprised that the additional training did not lead to greater weight loss during the programme compared with standard care. The later maintenance benefit was less surprising, she said, as regulating emotions may have become more important once the programme had ended.

“One thought is that once the support was removed, the skills became more pertinent,” she said.

What this means for clinicians

The differences in weight maintenance after the trial ended were “substantial,” said Sarah Barlow, MD, MPH, director of an integrated childhood obesity programme at Children’s Health in Dallas. Barlow helped author the American Academy of Pediatrics’ clinical practice guidelines for childhood obesity but was not involved in the current research.

The findings may give paediatricians another reason to ask whether stress, boredom or other emotions affect a patient’s eating. However, clinicians should also offer resources to help, Barlow said, which might include dialectical behaviour therapy workbooks for parents and adolescents.

Not a question of self-control

Barlow stressed that the findings should not be interpreted to mean that obesity is primarily psychological or a matter of self-control.

“We need to be careful about making everything too black and white,” Barlow said, noting that biological, genetic, environmental and social factors can all affect a person’s weight. “This is not going to be the answer to anybody, but it may be a component for some patients.”

Study disclosures

Boutelle and other authors reported receiving grants from the National Institutes of Health during the conduct of the study. No other disclosures were reported.

CCH insight

Supporting young people living with obesity means looking beyond diet and activity alone to the emotional, family and social factors that shape eating behaviour. The College of Contemporary Health’s Childhood Obesity Essentials course equips healthcare professionals with the knowledge and confidence to deliver compassionate, evidence-based care for children, adolescents and their families.

Explore Childhood Obesity Essentials →

Source: JAMA Network Open