Oral Presentation Australian and New Zealand Obesity Society Annual Scientific Conference 2024

Psychosocial outcomes following intermittent energy restriction during a randomised controlled trial in adolescents with obesity. (#104)

Natalie Lister 1 , Louise Baur 1 , Eve House 1 , Kaitlin Day 2 , Megan Gow 1 , Mary-Kate Inkster 3 , Cathy Kwok 1 , Sarah Lang 2 , Hiba Jebeile 1 , on behalf of the Fast Track to Health study team 4
  1. University of Sydney, Westmead, NSW, Australia
  2. Nutrition, Dietetics & Food, Monash University, Melbourne, VIC, Australia
  3. Department of Paediatric Endocrinology and Diabetes, Monash Children’s Hospital, Clayton, VIC, Australia
  4. The Children’s Hospital at Westmead, Westmead

INTRODUCTION: Behavioural weight management improves psychosocial health for most adolescents, however the effects of intensive dietary interventions is unknown.

METHODS: Fast Track to Health (ACTRN12617001630303), a multi-site 52-week RCT, recruited adolescents (13-17years) with obesity and ≥1 associated complication, was conducted 2018–2023. The intensive behavioural intervention, delivered by a multidisciplinary team, compared a very low energy diet (VLED) followed by intermittent (IER) or continuous energy restriction (CER). Anthropometry, eating behaviours (Dutch Eating Behaviour Questionnaire [DEBQ]), mental health (Depression Anxiety and Stress Scale [DASS]) self-esteem (Rosenberg Self-Esteem Scale [RSE]) and internalised weight bias (Weight Bias Internalization Scale [WBIS]) were assessed at baseline, weeks-4, -16, and -52. BMI-for-sex/age z score (BMIz) and BMI expressed as a percentage of the 95th percentile (BMI%95) were calculated. Analysis was intention to treat using linear mixed models to investigate changes over time between intervention groups.

RESULTS: 141 adolescents (70 female) were enrolled and 97 (48 female) completed the intervention. At 52 weeks both groups reduced BMIz and BMI%95 with no significant differences between groups (p>0.05).

After 52 weeks, both groups had reduced anxiety and stress (DASS p<0.001), weight bias internalisation (WBIS p<0.001) and increased self-esteem (RSE p<0.001). Depression reduced at week-4 and -16 in both groups, with no differences between baseline to week-52 (DASS, p=0.516). There were no group by time interactions for anxiety (DASS p=0.136), stress (DASS p=0.082), or weight bias internalisation (WBIS p<0.001), self-esteem (RSE p=0.229), dietary restraint (DEBQ p=0.317), or emotional eating (DEBQ p=0.54). External eating (DEBQ) was different between groups over time (p<0.001) with reductions occurring in the VLED phase for the IER group, but after VLED for the CER group. There were no differences between groups at week-52 (p=0.942).

CONCLUSION: Both IER and CER, delivered with intensive behavioural weight management, improve psychosocial health for adolescents with obesity associated complications.