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.