Dietary interventions and psychological risk in adolescents with obesity

Abstract

The management of adolescent obesity is a global priority. Evidence for a range of treatment approaches are required for use across the care continuum and to allow adaptation to individual adolescents. There is also increasing recognition of the psychosocial complications associated with obesity, and the importance of recognising these as treatment outcomes. In particular, to ensure obesity treatment does not lead to improved physiology at the expense of psychological health. The aims of this thesis were to: 1. Investigate the feasibility, effectiveness and acceptability of intermittent energy restriction as a novel dietary approach in adolescents with obesity. 2. Assess the association of dietary obesity treatment on depression, anxiety and eating disorder risk in children and adolescents with overweight or obesity. 3. Assess the prevalence of symptoms of depression and eating disorders in a treatment-seeking sample of adolescents with obesity. Findings from this thesis indicate that intermittent energy restriction is a feasible, acceptable and effective novel dietary approach for the treatment of adolescent obesity. Although a large proportion of young people may present to obesity treatment with abnormal psychopathology, systematic reviews with meta-analyses found that for most young people the prevalence and symptoms of depression, anxiety and eating disorders reduce following obesity treatment. These findings address an important safety concern relating to the use of dietary interventions in paediatric populations as part of obesity treatment. Recommendations arising from this thesis include: 1) the need for a larger evidence base on the use of novel dietary approaches; 2) the importance of identifying risk factors for the development of worsening psychopathology during obesity treatment so young people at risk can be identified; and 3) the need to develop an eating disorder assessment tool targeted to the profile and needs of young people with obesity.