Eating disorder risk during behavioral weight management in adults with overweight or obesity: A systematic review with meta-analysis.

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This systematic review examined change in eating disorder risk during weight management interventions. Four databases and clinical trials registries were searched in March and May 2022, respectively, to identify behavioral weight management intervention trials in adults with overweight/obesity measuring eating disorder symptoms at pre- and post-intervention or follow-up. Random effects meta-analyses were conducted examining within group change in risk. Of 12,023 screened, 49 were eligible (n = 6337, mean age range 22.1 to 59.9 years, mean (SD) 81(20.4)% female). Interventions ranged from 4 weeks to 18 months, with follow-up of 10 weeks to 36 months post-intervention. There was a within group reduction in global eating disorder scores (20 intervention arms; Hedges' g = -0.27; 95% CI -0.36, -0.17; I2 67.1%) and binge eating (49 intervention arms; -0.66; 95% CI -0.76, -0.56; I2 82.7%) post-intervention, both maintained at follow-up. Of 14 studies reporting prevalence or episodes of binge eating, all reported a reduction. Four studies reported eating disorder symptoms, not present at baseline, in a subset of participants (0%-6.5%). Overall, behavioral weight management interventions do not increase eating disorder symptoms for most adults; indeed, a modest reduction is seen post-intervention and follow-up. A small subset of participants may experience disordered eating; therefore, monitoring for the emergence of symptoms is important.

diet intervention, disordered eating, treatment, Adult, Female, Humans, Young Adult, Middle Aged, Male, Overweight, Obesity, Feeding and Eating Disorders, Behavior Therapy, Binge-Eating Disorder
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Obes Rev
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MRC (MC_UU_00006/6)
HJ is supported by the Sydney Medical School Foundation (University of Sydney) and NHMRC Leadership Investigator Grant (#2009035) awarded to LAB. ALA and RAJ are supported by the Medical Research Council (MRC) (Grant MC_UU_00006/6). DW is supported by the Scott Rudolph University Endowed Professorship at Washington University in St. Louis School of Medicine. ALS is in receipt of an NHMRC Emerging Leadership Investigator Grant (#2009432). LAB is in receipt of an NHMRC Leadership Investigator Grant (#2009035). NBL is a recipient of a NHMRC Peter Doherty Early Career Fellowship (GTN1145748).
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