ImportanceDepression and eating disorders are heightened for adolescents with obesity. Clinical reviews alongside self-report questionnaires are important to ensure appropriate intervention.ObjectiveTo evaluate changes in self-report symptoms of depression, eating disorders, and binge eating in adolescents with obesity during the Fast Track to Health trial.Design, Setting, and ParticipantsThis was a randomized clinical trial conducted from 2018 to 2023. It was a multisite trial conducted at children’s hospitals in Sydney, New South Wales, and Melbourne, Victoria, Australia, and included adolescents (13-17 years) with obesity (defined as adult equivalent body mass index ≥30; calculated as weight in kilograms divided by height in meters squared) and 1 or more related complications.InterventionsDuration was 52 weeks including a very low energy diet for 4 weeks followed by intermittent energy restriction (IER) or continuous energy restriction (CER).Main Outcomes and MeasuresSelf-report symptoms of depression (Center for Epidemiologic Studies Depression Scale–Revised 10-Item Version for Adolescents [CESDR-10]; scores 0-30), eating disorders (Eating Disorder Examination Questionnaire [EDE-Q]; scores 0-6), and binge eating (Binge Eating Scale [BES]; scores 0-46) were assessed. Adolescents were screened for depression and eating disorders (weeks 0, 4, 16, and 52) and monitored for the onset of new symptoms of disordered eating during dietetic consults.ResultsOf 141 adolescents (median [IQR] age, 14.8 [12.9-17.9] years; 71 male [50.4%]) enrolled, median baseline EDE-Q score was 2.28 (IQR, 1.43-3.14), median baseline CESDR-10 score was 9.00 (IQR, 4.00-14.50), and median baseline BES score was 11.00 (IQR, 5.00-17.00). There were no differences between groups for change in CESDR-10 (mean difference at week 52, 0.75; 95% CI, −1.86 to 3.37), EDE-Q (mean difference at week 52, 0.02; 95% CI, −0.41 to 0.45), or BES (mean difference at week 52, −2.91; 95% CI, −5.87 to 0.05). The within-group reductions at week 4 were maintained at week 52, for CESDR-10 and EDE-Q, indicating reduced symptoms of depression and eating disorders. Within-group reductions on the BES were maintained in the IER group only. Seventeen adolescents (12.1%) required support or referral for depression and/or disordered eating, including 7 (5%; 5 IER, 2 CER) adolescents who experienced the onset or reemergence of symptoms during the intervention.Conclusions and RelevanceResults suggest that many treatment-seeking adolescents with obesity self-reported symptoms of depression and eating disorders. Although symptoms reduced for most, some required additional support. Obesity treatment is an opportune time to screen and monitor for depression and disordered eating.Trial RegistrationAustralian New Zealand Clinical Trials Registry: ACTRN12617001630303

中文翻译：

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肥胖青少年的抑郁、饮食失调和暴饮暴食症状


重要性肥胖青少年的抑郁症和饮食失调症会加剧。临床审查和自我报告问卷对于确保适当的干预非常重要。目的评估快速健康试验期间肥胖青少年抑郁、饮食失调和暴饮暴食的自我报告症状的变化。设计、设置和参与者这是一项于 2018 年至 2023 年进行的随机临床试验。这是一项在新南威尔士州悉尼和澳大利亚维多利亚州墨尔本的儿童医院进行的多中心试验，纳入了患有肥胖症（定义为成人等效身体）的青少年（13-17 岁）质量指数≥30；计算方法为体重（千克）除以身高（米）平方）和 1 种或多种相关并发症。干预持续时间为 52 周，包括 4 周的极低能量饮食，然后进行间歇性能量限制（IER）或持续能量限制（ CER).主要结果和测量抑郁症的自我报告症状（流行病学研究中心抑郁量表 - 青少年修订版 10 项版本 [CESDR-10]；评估了饮食失调（得分 0-30）、饮食失调（饮食失调检查问卷 [EDE-Q]；得分 0-6）和暴食（暴食量表 [BES]；得分 0-46）。对青少年进行抑郁症和饮食失调筛查（第 0、4、16 和 52 周），并在饮食咨询期间监测饮食失调新症状的出现。结果 141 名青少年（中位 [IQR] 年龄，14.8 [12.9-17.9]）年；71 名男性 [50.4%]）入组，基线 EDE-Q 评分中位数为 2.28（IQR，1.43-3.14），基线 CESDR-10 评分中位数为 9.00（IQR，4.00-14.50），基线 BES 评分中位数为 11.00 （IQR，5.00-17.00）。 CESDR-10（第 52 周平均差异，0.75；95% CI，-1.86 至 3.37）、EDE-Q（第 52 周平均差异，0.02；95% CI，-0.41 至 3.37）组间变化无差异。 0.45），或 BES（第 52 周的平均差值，-2.91；95% CI，-5.87 至 0.05）。对于 CESDR-10 和 EDE-Q，第 4 周的组内减少在第 52 周得以维持，表明抑郁和饮食失调症状有所减轻。仅 IER 组维持了 BES 的组内降低。 17 名青少年 (12.1%) 因抑郁症和/或饮食失调需要支持或转诊，其中 7 名 (5%; 5 IER, 2 CER) 青少年在干预期间经历了症状的发作或再次出现。结论和相关性结果表明，许多治疗方法- 寻求肥胖青少年自我报告的抑郁和饮食失调症状。尽管大多数人的症状有所减轻，但有些人需要额外的支持。肥胖治疗是筛查和监测抑郁症和饮食失调的最佳时机。试验注册澳大利亚新西兰临床试验注册中心：ACTRN12617001630303