Youth with severe obesity do not demonstrate increased eating disorder symptoms following family-based behavioral obesity treatment

Abstract Purpose To investigate eating disorder symptoms before and after family-based behavioral treatment for severe obesity in youth. Methods Eating disorder symptoms were measured pre- and posttreatment in 74 youth (age: 10–18 years; 58% female; mean body mass index standard deviation score BMI SDS: 3.11) enrolled in a 17–session treatment for severe obesity. Symptoms were assessed using the Youth-Eating Disorder Examination Questionnaire (Y-EDE-Q), including a global score and sub-scales for dietary restraint, eating-, weight- and shape concerns. Robust linear mixed models and generalized mixed models were utilized to measure change over time. Results There was no significant change in global eating disorder score over time (mean (SD) pre 1.82(1.07) and post 1.67(1.08); beta = − 0.16, p = 0.69). Before treatment, 20.3% of the youth scored above the clinical cut-off for eating disorder risk (> 2.5) on the Y-EDE-Q, compared to 13.5% after treatment (beta = − 0.81, p = 0.25). However, no one received a clinical eating disorder diagnosis at any time point. Before treatment, 4 youth reported ≥ 1 objective binge episode per week, compared to no one post-treatment. A significant reduction in shape concern was observed (beta = − 0.29, p = 0.036). No changes were found for dietary restraint, eating- or weight concerns. Global eating disorder- and dietary restraint scores pre-treatment did not predict changes in BMI SDS from pre- to post-treatment. Conclusion There was no evidence of an increase in eating disorder symptoms in the sample overall during family-based behavioral treatment for severe obesity, and improvements were seen for shape concerns. Level of evidence Level IV: Evidence obtained from multiple time series with intervention.