Summary: This review aimed to investigate the impact of obesity treatment, with a dietary component, on eating disorder (ED) prevalence, ED risk, and related symptoms in children and adolescents with overweight or obesity. Four databases were searched to identify pediatric obesity treatment interventions, with a dietary component, and validated pre‐post intervention assessment of related outcomes. Of 3078 articles screened, 36 met inclusion criteria, with a combined sample of 2589 participants aged 7.8 to 16.9 years. Intervention duration ranged from 1 week to 13 months, with follow‐up of 6 months to 6 years from baseline. Prevalence of ED was reported in five studies and was reduced post‐intervention. Meta‐analyses showed a reduction in bulimic symptoms (eight studies, standardized mean difference [SE], −0.326 [0.09], P < 0.001), emotional eating (six studies, −0.149 [0.06], P = 0.008), binge eating (three studies, −0.588 [0.10], P < 0.001), and drive for thinness (three studies, −0.167 [0.06], P = 0.005) post‐intervention. At follow‐up, a reduction in ED risk (six studies, −0.313 [0.13], P = 0.012), emotional eating (five studies, −0.259 [0.05], P < 0.001), eating concern (three studies, −0.501 [0.06], P < 0.001), and drive for thinness (two studies, −0.375 [0.07], P < 0.001) was found. Structured and professionally run obesity treatment was associated with reduced ED prevalence, ED risk, and symptoms.

Obesity affects 158 million youth worldwide and is associated with psychosocial comorbidity. This review describes weight management options utilized by adolescents, including both self‐directed weight loss and medically supervised obesity treatment interventions, and associated psychosocial impacts. A majority of adolescents with obesity attempt to manage weight on their own, primarily through attempting weight loss, sometimes with supplement use. Approaches such as these are associated with a degree of risk, disordered eating behaviors, and further weight gain. In contrast, medically supervised multicomponent interventions are associated with improved psychosocial health, including quality of life, self‐esteem, and body image, and reduced symptoms of depression, anxiety, and eating disorders. Few studies utilizing antiobesity pharmacotherapy have reported psychosocial outcomes, and trials of bariatric surgery show some early improvements with a need for sustained psychological support following surgery. Greater access to medically supervised treatment services is required to facilitate obesity care for adolescents. Early data on psychosocial health and obesity treatment offer promising outcomes; however, larger randomized controlled trials and longer‐term data are needed. Future research should include both physiological and psychosocial outcomes to assess impact of interventions on the holistic health of adolescents with obesity.

Importance Children and adolescents with obesity are at higher risk of developing depression and anxiety, and adolescent dieting is a risk factor for the development of depression. Therefore, determining the psychological effect of obesity treatment interventions is important to consider. Objective To investigate the association between obesity treatment interventions, with a dietary component, and the change in symptoms of depression and anxiety in children and adolescents with overweight/obesity. Data Sources Searches of MEDLINE, Embase, Cochrane Library, and PsychINFO were conducted from inception to August 2018. Hand searching of references was conducted to identify missing studies. Study Selection Obesity treatment interventions, with a dietary component, conducted in children and adolescents (age <18 years) with overweight/obesity, and validated assessment of depression and/or anxiety were included. Data Extraction and Synthesis Data were independently extracted by 1 reviewer and checked for accuracy. Meta-analysis, using a random-effects model, was used to combine outcome data and moderator analysis conducted to identify intervention characteristics that may influence change in depression and anxiety. The meta-analyses were finalized in May 2019. Main Outcomes and Measures Change in symptoms of depression and anxiety postintervention and at the latest follow-up. Results Of 3078 articles screened, 44 studies met inclusion criteria with a combined sample of 3702 participants (age range, 5.6 to 16.6 years) and intervention duration of 2 weeks to 15 months. Studies reported either no change or a statistically significant reduction in symptoms of depression or anxiety. Meta-analyses of 36 studies found a reduction in depressive symptoms postintervention (standardized mean difference [SE], −0.31 [0.04];P < .001), maintained at follow-up in 11 studies at 6 to 16 months from baseline (standardized mean difference [SE], −0.25 [0.07];P < .001). Anxiety was reduced postintervention (10 studies; standardized mean difference [SE], −0.38 [0.10];P < .001) and at follow-up (4 studies; standardized mean difference [SE], −0.32 [0.15];P = .03). Longer intervention duration was associated with a greater reduction in anxiety (R2 = 0.82;P < .001). Higher body mass indexz score at baseline was associated with a greater reduction in depression (R2 = 0.19;P = .03). Conclusions and Relevance Structured, professionally run pediatric obesity treatment is not associated with an increased risk of depression or anxiety and may result in a mild reduction in symptoms. Treatment of weight concerns should be considered within the treatment plan for young people with depression and obesity.