Jebeile Hiba, Gow Megan L, Baur Louise A, Garnett Sarah P, Paxton Susan J, Lister Natalie B
The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia.
Institute of Endocrinology and Diabetes and Weight Management Services, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.
JAMA Pediatr. 2019 Nov 1;173(11):e192841. doi: 10.1001/jamapediatrics.2019.2841. Epub 2019 Nov 4.
Children and adolescents with obesity are at higher risk of developing depression and anxiety, and adolescent dieting is a risk factor for the development of depression. Therefore, determining the psychological effect of obesity treatment interventions is important to consider.
To investigate the association between obesity treatment interventions, with a dietary component, and the change in symptoms of depression and anxiety in children and adolescents with overweight/obesity.
Searches of MEDLINE, Embase, Cochrane Library, and PsychINFO were conducted from inception to August 2018. Hand searching of references was conducted to identify missing studies.
Obesity treatment interventions, with a dietary component, conducted in children and adolescents (age <18 years) with overweight/obesity, and validated assessment of depression and/or anxiety were included.
Data were independently extracted by 1 reviewer and checked for accuracy. Meta-analysis, using a random-effects model, was used to combine outcome data and moderator analysis conducted to identify intervention characteristics that may influence change in depression and anxiety. The meta-analyses were finalized in May 2019.
Change in symptoms of depression and anxiety postintervention and at the latest follow-up.
Of 3078 articles screened, 44 studies met inclusion criteria with a combined sample of 3702 participants (age range, 5.6 to 16.6 years) and intervention duration of 2 weeks to 15 months. Studies reported either no change or a statistically significant reduction in symptoms of depression or anxiety. Meta-analyses of 36 studies found a reduction in depressive symptoms postintervention (standardized mean difference [SE], -0.31 [0.04]; P < .001), maintained at follow-up in 11 studies at 6 to 16 months from baseline (standardized mean difference [SE], -0.25 [0.07]; P < .001). Anxiety was reduced postintervention (10 studies; standardized mean difference [SE], -0.38 [0.10]; P < .001) and at follow-up (4 studies; standardized mean difference [SE], -0.32 [0.15]; P = .03). Longer intervention duration was associated with a greater reduction in anxiety (R2 = 0.82; P < .001). Higher body mass index z score at baseline was associated with a greater reduction in depression (R2 = 0.19; P = .03).
Structured, professionally run pediatric obesity treatment is not associated with an increased risk of depression or anxiety and may result in a mild reduction in symptoms. Treatment of weight concerns should be considered within the treatment plan for young people with depression and obesity.
肥胖的儿童和青少年患抑郁症和焦虑症的风险更高，而青少年节食是抑郁症发病的一个风险因素。因此，确定肥胖治疗干预措施的心理影响很重要。
探讨包含饮食成分的肥胖治疗干预措施与超重/肥胖儿童及青少年抑郁和焦虑症状变化之间的关联。
对MEDLINE、Embase、Cochrane图书馆和PsychINFO进行了从创刊至2018年8月的检索。通过手工检索参考文献来识别遗漏的研究。
纳入了对超重/肥胖的儿童和青少年（年龄<18岁）实施的包含饮食成分的肥胖治疗干预措施，以及对抑郁和/或焦虑的有效评估。
由1名评审员独立提取数据并检查准确性。采用随机效应模型进行荟萃分析，以合并结果数据，并进行调节分析以确定可能影响抑郁和焦虑变化的干预特征。荟萃分析于2019年5月完成。
干预后及最新随访时抑郁和焦虑症状的变化。
在筛选的3078篇文章中，44项研究符合纳入标准，合并样本量为3702名参与者（年龄范围5.6至16.6岁），干预持续时间为2周至15个月。研究报告抑郁或焦虑症状无变化或有统计学显著降低。对36项研究的荟萃分析发现干预后抑郁症状有所减轻（标准化均数差[标准误]，-0.31[0.04]；P<0.001），在11项研究中，从基线起6至16个月的随访中仍保持这一结果（标准化均数差[标准误]，-0.25[0.07]；P<0.001）。干预后焦虑有所减轻（10项研究；标准化均数差[标准误]，-0.38[0.10]；P<0.001），随访时也有减轻（4项研究；标准化均数差[标准误]，-0.32[0.15]；P=0.03）。干预持续时间越长，焦虑减轻越明显（R2=0.82；P<0.001）。基线时较高的体重指数z评分与抑郁减轻更明显相关（R2=0.19；P=0.03）。
结构化的、由专业人员实施的儿童肥胖治疗与抑郁或焦虑风险增加无关，且可能导致症状轻度减轻。对于患有抑郁症和肥胖症的年轻人，应在治疗计划中考虑对体重问题的治疗。
