Emotion Regulation Training Helps Adolescents Sustain Weight Loss after obesity treatment: JAMA

To test the feasibility and comparative effectiveness of standard behavioral therapy as opposed to emotion-based interventions, a parallel-group randomized control trial was performed with 166 dyads of parents and adolescents enrolled at two university clinical sites between August 2019 and January 2024. The sample population included adolescents aged 13-16 years with body mass index (BMI) in the 85th to 99.9th percentile (mean age 14.3 ± 1.2 years; 95 female [57%]; mean baseline BMI z score [BMIz] 2.2 ± 0.6; mean baseline percentage of 95th percentile [%BMIp95] 120.4 ± 21.4%) and their parents (mean age 45.3 ± 6.5 years; 141 female [85%]; mean baseline BMI 32.6 ± 7.0).

The dyads were assigned to receive either 6 months of standard FBT treatment (n = 82) or FBT supplemented with emotion regulation skills based on dialectical behavior therapy (DBT) and emotion focused therapy (n = 84), mainly via video conferences during the pandemic period of the coronavirus disease 2019. Assessments were done at baseline, mid-treatment, post-treatment and six months and one year follow up after treatment visits for adolescent BMIz, %BMIp95, Difficulties in Emotion Regulation Scale (DERS) scores, Emotional Eating Scale (EES) scores, and parental weight trajectory.

Key findings:

• Comprehensive evaluation across the 166 parent-adolescent dyads demonstrated equivalent acute posttreatment weight loss but distinct long-term maintenance benefits.
• At the immediate 6-month posttreatment visit, adolescent weight loss showed no statistically significant difference between FBT plus emotion regulation and traditional FBT (difference in BMIz, 0.03; 95% CI, −0.05 to 0.10).
• However, at the 12-month follow-up, adolescents in the emotion regulation group experienced significantly less weight regain (difference in BMIz, −0.09; 95% CI, −0.17 to −0.02).
• At the immediate 6-month posttreatment visit, adolescent weight loss showed no statistically significant difference between FBT plus emotion regulation and traditional FBT (difference in BMIz, 0.03; 95% CI, −0.05 to 0.10).
• However, at the 12-month follow-up, adolescents in the emotion regulation group experienced significantly less weight regain (difference in BMIz, −0.09; 95% CI, −0.17 to −0.02).
• The combination group demonstrated significantly lower emotional eating scores at 12 months than the standard FBT group (difference in EES scores, −0.39; 95% CI, −0.63 to −0.15).
• Conversely, general adolescent emotion regulation scores (difference in DERS scores, −0.06; 95% CI, −0.25 to 0.50) and parent body weight trajectories (difference in BMI, 0.51; 95% CI, −0.03 to 1.05) did not differ significantly between treatment arms at 12 months.

To summarize, the one-year follow-up results from this randomised clinical study have revealed that the introduction of emotion regulation skills into family based behavioral therapy helps decrease weight regain as well as emotional eating among adolescents. It can be seen from the findings of the study that while the effectiveness of weight loss is the same in different behavioral approaches, emotional skills help prevent weight gain.

Reference:

Boutelle KN, Manzano MA, Pasquale EK, et al. Emotion-Focused Behavioral Weight Loss Treatment for Adolescents: A Randomized Clinical Trial. JAMA Netw Open. 2026;9(10):e2639867. doi:10.1001/jamanetworkopen.2026.39867