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New research from the Nuffield Department of Primary Care Health Sciences and Department of Psychiatry provides reassurance that weight loss programmes do not worsen disordered eating symptoms and may lead to improvements in people who already exhibit symptoms of disordered eating.

Mum makes healthy lunch in front of daughter © World Obesity Federation

New research from the Nuffield Department of Primary Care Health Sciences and Department of Psychiatry provides reassurance that weight loss programmes do not worsen disordered eating symptoms and may lead to improvements in people who already exhibit symptoms of disordered eating. 

Published in eClinicalMedicine, the systematic review and meta-analysis examined 38 studies involving more than 3,000 participants across ten countries. The research examined various types of weight loss interventions, including behavioural weight loss programmes alone, or with pharmacotherapy and/or psychological support. The researchers found that weight loss interventions were consistently associated with improvements in disordered eating symptoms, regardless of the type of programme used. 

The findings come at an important time, as there has been significant increase in both eating disorders and obesity. Eating disorders have one of the highest mortality rates among psychiatric disorders, while obesity, affects an estimated 250 billion adults worldwide and increases risk for numerous health conditions. 

People living with obesity are more likely to experience eating disorders, particularly binge eating, than those at a healthy weight. While this could be due to shared genetic and psychological factors, some people have worried that attempting to lose weight might trigger a worsening of disordered eating in vulnerable individuals - with dietary restrictions potentially leading to a cycle of guilt, low self-esteem, and binge eating. 

Having worked as a dietitian with people living with an eating disorder, I am well aware of how difficult they are to manage and what an impact they have on patients and their families,said Elena Tsompanaki, registered dietitian and DPhil candidate who is the lead author of the paper. At the same time, living with obesity increases the risk for type 2 diabetes, heart disease and some cancers. 

After following a weight loss programme, disordered eating symptoms improved. These improvements were seen regardless of the type of the weight loss programme People with disordered eating at baseline had larger improvements. On average, participants lost about 5kg during the programmes.  

These findings have important implications for healthcare delivery. Currently, there are calls to screen patients for eating disorders before referring them to weight loss programmes. However, such screening would add significant costs and delays to treatment. This research suggests that universal screening may not be necessary. 

There is now good evidence that there are effective interventions to treat obesity, yet there are outstanding concerns that these treatments may increase the risk of disordered eating or worsen existing symptoms.  This discourages healthcare professionals offering these programmes or patients making use of them, Tsompanaki explained. This study provides important new evidence to help patients and healthcare professionals to navigate these decisions. 

The findings provide reassurance to healthcare professionals who may have been hesitant to recommend weight loss interventions due to concerns about potential negative psychological impacts. They also offer confidence to people living with excess weight that weight loss programmes do not worsen disordered eating – instead, they may improve it. 

Read the full paper, 'The impact of weight loss interventions on disordered eating symptoms in people with overweight and obesity: a systematic review & meta-analysis' in eClinicalMedicine.

 

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