Introduction: Prior research suggests behavioural interventions tend to reduce or not change eating disorder risk. However, behavioural interventions are complex, and may differ greatly from each other (1,2). This study aimed to examine change in eating disorder risk and binge eating during behavioural weight management compared with no-treatment control and based on intervention intensity.
Methods: We conducted a systematic review and individual participant data (IPD) meta-analyses. Four databases and clinical trial registries were searched to March and May 2022, respectively. Randomised-controlled trials of behavioural weight management interventions conducted in adolescents (10 to <19 years) or adults (≥19 years) with overweight or obesity and assessing eating disorder risk were included. We conducted two analyses each to assess change in global eating disorder risk and binge eating between baseline and latest follow-up timepoint: 1) intention-to-treat, two-stage, random effects pair-wise meta-analysis to examine effects of any weight management intervention compared to control; 2) two-stage, random effects contrast-based network meta-analysis based on low, medium or high intervention intensity.
Results: IPD from 36 trials (k; n=4,455) were included. Compared to control, pairwise meta-analyses found a reduction in ED symptoms (k=2, n=108; standardised mean difference [95%CI] -0·18 [-0·25, -0·12], tau=0.00, moderate certainty) and no change in binge eating (k=2, n=458, -0·15 [-0·42, 0·13], tau=0·15, moderate certainty). Network meta-analyses (k=9, n=961) found no differences between no-treatment control and low (-0·23 [-0·57, 0·12]) and medium-intensity (-0·23 [-0·52, 0·07]) and a reduction for high-intensity interventions (-0·34 [-0·66, -0·02]) for ED symptoms, and no differences for binge eating.
Conclusion: Behavioural weight management interventions did not increase, and may reduce, eating disorder symptoms in adolescents and adults. Higher intensity interventions showed a greater reduction. Community access to supported weight management interventions that align with clinical research is important, combined with individual assessment and monitoring of eating disorder symptoms.