Reducing eating disorder risk in adolescents with obesity

Joint research from The Children’s Hospital at Westmead and University of Sydney has identified that a small proportion of adolescents with obesity may have an undiagnosed eating disorder, and many more have risk factors.

The research, led by Dr Hiba Jebeile, Research Dietitian at The Children’s Hospital at Westmead and University of Sydney and published in Obesity Reviews, found that adolescents with obesity may have some of the common risk factors for eating disorders including poor body image or depression.

“Adolescents with obesity are vulnerable to the development of eating disorders and those who attempted to lose weight on their own often rely on unhealthy or extreme approaches like fasting, skipping meals, and taking diet pills or laxatives,” Dr Jebeile said.

“We know these extreme dieting behaviours are consistent with those in eating disorders like binge eating, bulimia nervosa and anorexia nervosa, which is why treatment needs to be managed carefully and why weight management intervention is so important,” Dr Jebeile said.

Kelly Cooper, 43, lived with obesity for most of her childhood through to her late 30’s and undertook a number of extreme diets throughout adolescence to try and self-manage her condition.

“I started my first diet when I was eleven-years-old to try and lose weight. Over the years, I went through various periods of not eating very much at all to skipping meals and not eating until mid-afternoon.”

“It was very much feast or famine, I would lose 30kgs then put the weight back on and start on the next extreme diet.”

Kelly’s condition was never formally diagnosed and her self-dieting continued through adulthood until she began studying nutrition and learnt how to properly manage her nutritional needs.

"I recall my adolescence being a time of heightened vulnerability and insecurity. A supervised, formal and evidence-based approach to weight management might have saved me from the decades of weight cycling and feeling like a failure when I couldn’t keep the excess weight off," Kelly said.

Weight management intervention for adolescents with obesity plays a vital role in managing adolescents with obesity, with research also finding showing that this helped to reduce some risk factors associated with eating disorders.

Symptoms of depression, anxiety, body image and self-esteem were all shown to have improved following behavioural weight management.

“Most adolescents with obesity who are enrolled in a supervised and professionally-developed weight management program actually have a reduction in eating disorder risk factors,” Dr Jebeile said.

“Through supervised weight management, adolescents are able to develop positive and healthy relationships, not only with food, but with care providers, family and other support networks. This plays a big role in helping them to form healthy habits.”

“This weight management process also gives us the opportunity to identify any warning signs of eating disorders and refer those who may have an undiagnosed eating disorder for appropriate treatment.”

Supervised weight management interventions include developing healthy eating and activity behaviour, encouraging strong family and social relationships and promoting the importance of physical and mental health – many of which are similar to those used in the treatment of eating disorders.

With rates of obesity predicted to increase by 2030, screening and monitoring for eating disorder risk factors and behaviours should form an important component in managing adolescent obesity for health professionals to ensure those at-risk are identified.

“Adolescents should not be encouraged to lose weight and diet on their own. Support from health professionals trained in obesity management is essential to ensure adolescents are learning to manage their weight properly without compromising other aspects of their health,” Dr Jebeile said.

“We also need to be taking a long-term risk management approach and consider eating disorder risk factors  when assessing young people and delivering weight management interventions to ensure those with undiagnosed eating disorders can receive the treatment and support they need.”

World Obesity Day falls on March 4 and is an opportunity to increase awareness, encourage advocacy, improve outcomes and share experiences for those living with the condition. To inspire this change, #EveryBodyNeedsEverybody.