Components of Adolescent Behavioural Interventions With Eating Disorder Outcomes: Systematic Review With Intervention Mapping

Objective: To understand delivery features and intervention strategies of adolescent weight management interventions which may influence eating disorder risk. Methods: Systematic searches in four databases and two trial registries to identify randomised controlled trials in adolescents with overweight/obesity measuring eating disorder risk pre- and post-intervention. Delivery features and intervention strategies were coded from published descriptions using a project-specific codebook, validated by trial investigators and narratively synthesised. Results: Of 11 860 records screened, 23 trials, with 54 intervention arms, were included in the analysis. Most interventions focused on weight loss and maintenance (54%) and were informed by a cognitive behavioural framework (43%). Interventions commonly targeted an individual with a support person (70%). Median intervention duration was 26 weeks, with weekly (35%) or staged (e.g., weekly, then monthly) visit (41%) frequency. Interventions had a mean (SD) of 30 (16.1) intervention strategies. Most included healthy eating education (89%), physical activity education (89%) and problem-solving barriers to dietary change (80%). Few included mental health strategies (17%). Interventions included ‘dietary prescription’ (65%), and 78% promoted ‘healthful/helpful eating behaviours’. Conclusion: Weight management interventions are complex and vary in delivery approach and strategies used to change behaviors. Characterising interventions is a critical first step to understanding how weight management interventions' influence eating disorder risk.