Study examines connections between weight loss programs and depression and anxiety in adolescents

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This is another in the series of research breakdowns I completed as part of a project with Weight Inclusive Nutrition and Dietetics (WIND) to create a comprehensive response to the horrible AAP guidelines.

The study is Association of pediatric ob*sity* treatment, including a dietary component, with change in depression and anxiety: a systematic review and meta-analysis by Jebeile H, Gow ML, Baur LA, Garnett SP, Paxton SJ, Lister NB.

General issues:

This study does do not examine eating disorder symptoms, they look at changes in depression and anxiety for participants in “professionally run” pediatric ob*sity treatment programs.

They find that “structured, professionally run pediatric ob*sity treatment is not associated with an increased risk of depression or anxiety and may result in a mild reduction in symptoms.”

First, note that their use of “may result,” is far from a clear conclusion.

There are troubling issues with weight stigma that aren’t truly covered here. If depression and anxiety in this population is driven by weight stigma, then the study recommendations are tantamount to telling stigmatized people that they should change themselves to suit their oppressors to impact their depression. This would be troubling under any guise, but is especially problematic given the fact that weight loss is almost never maintained.

Beyond this, the studies included only offer follow-up between 2 weeks to 15 months. We know that weight regain typically starts around the 12-month mark, but this study fails to address (or even consider) what will happen to depression and anxiety symptoms during/after (highly likely) weight regain.

Author concerns and conflicts:

These study authors were also authors of the Fast Track to Health trial which put higher-weight teens on extreme caloric and food restriction including, in some cases, alternate day fasting. Louise Adams created a website in response to this horrifying trial here. So this is already a group of people who believe that prescribing behaviors characteristic of eating disorders to higher-weight adolescents is a good idea.

Most of these authors are part of the “EDIT (Eating Disorders In weight-related Therapy) Collaboration” which is a group of people who predominantly have profit interest/career investment in “weight management” and “anti-ob*sity” work who are using pretty questionable research practices in an attempt to create research that (they can claim) shows that “weight management” and anti-ob*sity programs do not increase eating disorders and/or can decrease them.

This Study’s Claims

They included 44 studies with a total of 3702 participants from 5.6 to 16.6 years old and intervention durations from 2 weeks to 15 months.

36 studies found a reduction in depressive symptoms postintervention, but only 11 showed that reduction maintained at follow-up of 6 to 16 months from baseline.

10 of the studies found that anxiety was reduced postintervention, but only 4 showed that the reduction was maintained at follow-up.

Note that the “follow-up” period typically included the entire duration of the study (including the intervention time,) meaning that the actual post-intervention follow-up was actually less (sometimes far less) than 6-16 months.

There was considerable attrition of effect between the end of the study and the end of the (relatively short) follow-up period, we do not know if that attrition continued.

They concluded only that:

“Pediatric ob*sity treatment is not associated with an increased risk of depression or anxiety over a 16-month follow-up.” Treatment of weight concerns should be considered within the treatment plan for young people with depression and ob*sity.

This is a low bar (the treatment was not associated with an increased risk of depression or anxiety) and, again 16 months is not long enough to capture the long-term impacts of weight cycling or disordered relationships with eating. Seven of the studies did not show a weight difference between the intervention and control group. Among the studies that showed weight loss it was a small amount of weight loss and those that had additional follow up showed weight regain even in that short time. For all of these reasons, I don’t believe their recommendation is supported by their findings.

They are also (at least a little) honest that:

A small number of participants may experience a worsening in symptoms of depression and anxiety, and these outliers are not well represented in sample means.

This is a significant issue since they don’t offer specific ways to identify these participants and the outcomes for them could be catastrophic.

Overall, the AAP guidelines attempt to use this study to back up their dubious-at-best claim that the weight loss interventions they recommend don’t increase eating disorders/ eating disorder symptoms and this study, quite simply, does not do that.

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More research and resources:
https://haeshealthsheets.com/resources/

*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings Fearing the Black Body – the Racial Origins of Fat Phobia and Da’Shaun Harrison Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.