Pediatric weight management, dietary restraint, dieting, and eating disorder risk: a systematic review

• Published in: Nutrition reviews Vol. 79; no. 10; pp. 1114 - 1133
• Main Authors: House, Eve T, Gow, Megan L, Lister, Natalie B, Baur, Louise A, Garnett, Sarah P, Paxton, Susan J, Jebeile, Hiba
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 01-10-2021
• Subjects: disordered eating; pediatrics; weight management; adolescent; dietary restraint; child; dieting
• ISSN: 0029-6643; 1753-4887
• DOI: 10.1093/nutrit/nuaa127

Abstract
Context
Whether dietary restraint and dieting are risk factors associated with eating disorders has not been explored in the context of pediatric weight management.
Objective
To review associations between dietary pediatric weight management, dietary restraint, dieting, and eating disorder risk.
Data sources, selection, and extraction
Four databases – MEDLINE, EMBASE, Cochrane Library, and PsycINFO – were searched to May 2020 to identify pediatric weight management interventions with a dietary component for children and adolescents with overweight or obesity. The review was limited to studies reporting dietary restraint and/or dieting at preintervention, postintervention, and/or follow-up. Screening and quality assessment were conducted in duplicate, and data extraction was completed by 1 reviewer and cross-checked for accuracy. Data extracted included study characteristics, dietary restraint/dieting, and eating disorder–related outcomes (including disordered eating, body image, self-esteem, depression, and anxiety).
Results
A total of 26 papers, representing 23 studies, were included. Of these, 20 studies reported on dietary restraint, which increased (10 postintervention, 6 follow-up) or remained unchanged (7 postintervention, 5 follow-up), and 5 studies reported on dieting, which increased (1 study), remained unchanged (2 studies) or decreased (2 studies) postintervention. All studies that reported on other eating disorder risk factors (eg, binge eating, body dissatisfaction, and depression) and weight-related outcomes found improvement or no change postintervention or at follow-up.
Conclusion
The results of this review suggest that current measures of dietary restraint and dieting are not associated with eating disorder risk within the context of pediatric weight management; however, long-term data is limited. In addition, those current measures may not be suitable risk markers. Concerns about dietary restraint and dieting leading to eating disorders should not prevent access to quality care for young people with obesity.
Systematic Review Registration
PROSPERO registration no. 2017 CRD42017069488.