{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T15:46:42Z","timestamp":1792684002559,"version":"4.5.0"},"reference-count":37,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Family-based behavioral treatment (FBT) efficacy decreases in adolescence, a developmental period of gradual maturation and increasing autonomy during which emotion regulation skills develop.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate the feasibility and efficacy of FBT alone compared with FBT plus emotion regulation across 6 months of treatment and 12 months of follow-up on adolescent weight change, emotion regulation, emotional eating, and parent weight change.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This parallel-group randomized clinical trial of adolescents 13 to 16 years of age with body mass index (BMI) in the 85th percentile or higher but less than the 99.9th percentile was conducted from August 29, 2019, to January 4, 2024, at 2 university clinics. Central randomization was completed by a statistician, and outcome assessors were blinded to treatment condition. The majority of treatments and assessments were delivered remotely via video conference due to the COVID-19 pandemic.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n FBT plus emotion regulation vs traditional FBT skills alone for weight loss. FBT included nutrition and physical activity education, behavior change strategies, and parenting skills. Both treatments had 6 months of adolescent and parent groups and behavior coaching sessions. The combined group included FBT skills and added dialectical behavior therapy and emotion-focused therapy.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n \n The main outcomes were adolescent weight (body mass index [BMI]\n z<\/jats:italic>\n score (BMIz) and BMI as a percentage of the 95th BMI percentile [%BMIp95]), emotion regulation skills (measured by Difficulties in Emotion Regulation Scale [DERS] scores), emotional eating behaviors (measured by Emotional Eating Scale [EES] scores), parent weight, and feasibility and acceptability of treatment. Primary outcome analyses used an intention-to-treat approach.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total of 166 (FBT plus emotion regulation\u2009=\u200984; FBT\u2009=\u200982) dyads (adolescents: mean [SD] age, 14.3 [1.2] years; 95 [57%] female; mean [SD] BMIz, 2.2 [0.6]; mean [SD] %BMIp95, 120.4 [21.4]; parents: mean [SD] age, 45.3 [6.5] years; 141 [85%] female; mean [SD] BMI, 32.6 [7.0]) were assessed at baseline, midtreatment, posttreatment, and 6- and 12-month follow-up visits. There were no statistically significant differences in posttreatment weight loss among adolescents receiving FBT plus emotion regulation compared with FBT (difference in BMIz, 0.03 [95% CI, \u22120.05 to 0.10]). However, adolescents in FBT plus emotion regulation did not regain as much weight at the 12-month follow-up (difference in BMIz, \u22120.09 [95% CI, \u22120.17 to \u22120.02]). At the 12-month follow-up, 4% (95% CI, 1%-12%) of adolescents in FBT and 22% (95% CI, 8%-48%) of adolescents in FBT plus emotion regulation lost a clinically significant amount of weight (\u22650.20 BMIz). At 12 months\u2019 follow-up, parent weight (difference in BMI, 0.51 [95% CI, \u22120.03 to 1.05]) and adolescent emotion regulation (difference in DERS scores, \u22120.06 [95% CI, \u22120.25 to 0.50]) did not differ by treatment. By contrast, the FBT plus emotion regulation group had lower scores than the FBT group on emotional eating (difference in EES scores, \u22120.39 [95% CI, \u22120.63 to \u22120.15]).<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this randomized clinical trial of 166 parent-adolescent dyads, adding emotion regulation skills to FBT did not improve weight loss during treatment but was associated with less weight regain and lower emotional eating through the 12-month follow-up. These findings suggest that adding emotion regulation skills to an FBT program may attenuate weight regain and decrease emotional eating among adolescents.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT03674944<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.39867","type":"journal-article","created":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T15:30:43Z","timestamp":1792683043000},"page":"e2639867","source":"Crossref","is-referenced-by-count":0,"title":["Emotion-Focused Behavioral Weight Loss Treatment for Adolescents"],"prefix":"10.1001","volume":"9","author":[{"given":"Kerri N.","family":"Boutelle","sequence":"first","affiliation":[{"name":"Department of Pediatrics, University of California, San Diego, La Jolla"},{"name":"Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla"},{"name":"Department of Psychiatry, University of California, San Diego"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael A.","family":"Manzano","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of California, San Diego"},{"name":"San Diego State University\/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellen K.","family":"Pasquale","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of California, San Diego"},{"name":"San Diego State University\/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David R.","family":"Strong","sequence":"additional","affiliation":[{"name":"Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca S.","family":"Bernard","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of California, San Diego, La Jolla"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyung E.","family":"Rhee","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of California, San Diego, La Jolla"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dawn M.","family":"Eichen","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of California, San Diego, La Jolla"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alec","family":"Miller","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Albert Einstein College of Medicine, White Plains, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carol B.","family":"Peterson","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2026,10,22]]},"reference":[{"issue":"6","key":"zoi261080r2","doi-asserted-by":"publisher","first-page":"609","DOI":"10.1001\/jamapediatrics.2020.0085","article-title":"Obesity treatment among adolescents: a review of current evidence and future directions.","volume":"174","author":"Cardel","year":"2020","journal-title":"JAMA Pediatr"},{"issue":"4","key":"zoi261080r3","doi-asserted-by":"publisher","first-page":"521","DOI":"10.1080\/15374416.2014.963854","article-title":"Evidence update on the treatment of overweight and obesity in children and adolescents.","volume":"44","author":"Altman","year":"2015","journal-title":"J Clin Child Adolesc Psychol"},{"issue":"4","key":"zoi261080r4","doi-asserted-by":"publisher","first-page":"1310","DOI":"10.1111\/j.1467-8624.2011.01587.x","article-title":"Desire for increased autonomy and adolescents\u2019 perceptions of peer autonomy: \u201ceveryone else can; why can\u2019t I?\u201d.","volume":"82","author":"Daddis","year":"2011","journal-title":"Child Dev"},{"key":"zoi261080r5","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1016\/j.dcn.2015.07.006","article-title":"Neurocognitive bases of emotion regulation development in adolescence.","volume":"15","author":"Ahmed","year":"2015","journal-title":"Dev Cogn Neurosci"},{"issue":"4","key":"zoi261080r6","doi-asserted-by":"publisher","first-page":"1227","DOI":"10.1111\/sode.12684","article-title":"The development of emotion regulation in adolescence: what do we know and where to go next?","volume":"32","author":"Fombouchet","year":"2023","journal-title":"Soc Dev"},{"issue":"1","key":"zoi261080r7","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1017\/S0954422415000153","article-title":"The role of emotion regulation in childhood obesity: implications for prevention and treatment.","volume":"29","author":"Aparicio","year":"2016","journal-title":"Nutr Res Rev"},{"key":"zoi261080r8","doi-asserted-by":"publisher","first-page":"12896","DOI":"10.1007\/s12144-021-02536-3","article-title":"Emotion regulation difficulties, perceived parenting and personality as predictors of health-risk behaviours among adolescents.","volume":"42","author":"Singh","year":"2023","journal-title":"Curr Psychol"},{"issue":"8","key":"zoi261080r9","doi-asserted-by":"publisher","first-page":"909","DOI":"10.1007\/s00787-017-0952-8","article-title":"Emotion regulation across childhood and adolescence: evidence for a maladaptive shift in adolescence.","volume":"26","author":"Cracco","year":"2017","journal-title":"Eur Child Adolesc Psychiatry"},{"key":"zoi261080r10","doi-asserted-by":"publisher","first-page":"258","DOI":"10.1016\/j.copsyc.2021.09.023","article-title":"Adolescence as a pivotal period for emotion regulation development.","volume":"44","author":"Silvers","year":"2022","journal-title":"Curr Opin Psychol"},{"issue":"3","key":"zoi261080r11","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1080\/10640260902848543","article-title":"Psychological determinants of emotional eating in adolescence.","volume":"17","author":"Nguyen-Rodriguez","year":"2009","journal-title":"Eat Disord"},{"issue":"2","key":"zoi261080r12","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1176\/appi.psychotherapy.2015.69.2.97","article-title":"The course and evolution of dialectical behavior therapy.","volume":"69","author":"Linehan","year":"2015","journal-title":"Am J Psychother"},{"issue":"2","key":"zoi261080r13","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1111\/camh.12112","article-title":"Dialectical behavior therapy for nonsuicidal self-injury and depression among adolescents: preliminary meta-analytic evidence.","volume":"21","author":"Cook","year":"2016","journal-title":"Child Adolesc Ment Health"},{"issue":"1","key":"zoi261080r14","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1186\/s40337-021-00461-1","article-title":"A systematic review of cognitive behavior therapy and dialectical behavior therapy for adolescent eating disorders.","volume":"9","author":"Vogel","year":"2021","journal-title":"J Eat Disord"},{"issue":"1","key":"zoi261080r15","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1037\/prj0000106","article-title":"The efficacy of two adolescent substance abuse treatments and the impact of comorbid depression: results of a small randomized controlled trial.","volume":"38","author":"Santisteban","year":"2015","journal-title":"Psychiatr Rehabil J"},{"issue":"6","key":"zoi261080r16","doi-asserted-by":"publisher","first-page":"1061","DOI":"10.1037\/0022-006X.69.6.1061","article-title":"Dialectical behavior therapy for binge eating disorder.","volume":"69","author":"Telch","year":"2001","journal-title":"J Consult Clin Psychol"},{"issue":"11","key":"zoi261080r17","doi-asserted-by":"publisher","first-page":"723","DOI":"10.1016\/j.brat.2013.08.001","article-title":"A randomized wait-list controlled pilot study of dialectical behaviour therapy guided self-help for binge eating disorder.","volume":"51","author":"Masson","year":"2013","journal-title":"Behav Res Ther"},{"issue":"1","key":"zoi261080r18","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1016\/j.beth.2009.01.006","article-title":"Outcome from a randomized controlled trial of group therapy for binge eating disorder: comparing dialectical behavior therapy adapted for binge eating to an active comparison group therapy.","volume":"41","author":"Safer","year":"2010","journal-title":"Behav Ther"},{"issue":"4","key":"zoi261080r19","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1080\/10640266.2015.1044352","article-title":"Parent coaching model for adolescents with emotional eating.","volume":"23","author":"Knatz","year":"2015","journal-title":"Eat Disord"},{"issue":"1","key":"zoi261080r20","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1080\/10640266.2018.1418252","article-title":"An open trial targeting emotional eating among adolescents with overweight or obesity.","volume":"26","author":"Boutelle","year":"2018","journal-title":"Eat Disord"},{"issue":"22","key":"zoi261080r21","doi-asserted-by":"publisher","first-page":"1998","DOI":"10.1001\/jama.2025.4347","article-title":"CONSORT 2025 Statement: updated guideline for reporting randomized trials.","volume":"333","author":"Hopewell","year":"2025","journal-title":"JAMA"},{"key":"zoi261080r22","doi-asserted-by":"publisher","DOI":"10.1016\/j.cct.2024.107640","article-title":"Design of the FRESH-teen study: a randomized controlled trial evaluating an adapted emotion regulation weight loss program for adolescents with overweight or obesity and their parent.","volume":"145","author":"Boutelle","year":"2024","journal-title":"Contemp Clin Trials"},{"issue":"246","key":"zoi261080r24","first-page":"1","article-title":"2000 CDC growth charts for the United States: methods and development.","volume":"246","author":"Kuczmarski","year":"2002","journal-title":"Vital Health Stat 11"},{"issue":"2","key":"zoi261080r26","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1093\/ajcn\/51.2.241","article-title":"A new predictive equation for resting energy expenditure in healthy individuals.","volume":"51","author":"Mifflin","year":"1990","journal-title":"Am J Clin Nutr"},{"issue":"6","key":"zoi261080r27","doi-asserted-by":"publisher","first-page":"1136","DOI":"10.1542\/peds.2012-0596","article-title":"Clinical tracking of severely obese children: a new growth chart.","volume":"130","author":"Gulati","year":"2012","journal-title":"Pediatrics"},{"key":"zoi261080r28","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1023\/B:JOBA.0000007455.08539.94","article-title":"Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the difficulties in emotion regulation scale.","volume":"26","author":"Gratz","year":"2004","journal-title":"J Psychopathol Behav Assess"},{"issue":"1","key":"zoi261080r29","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1002\/1098-108X(199507)18:1<79::AID-EAT2260180109>3.0.CO;2-V","article-title":"The emotional eating scale: the development of a measure to assess coping with negative affect by eating.","volume":"18","author":"Arnow","year":"1995","journal-title":"Int J Eat Disord"},{"issue":"3","key":"zoi261080r30","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1002\/eat.20362","article-title":"Validation of the emotional eating scale adapted for use in children and adolescents (EES-C).","volume":"40","author":"Tanofsky-Kraff","year":"2007","journal-title":"Int J Eat Disord"},{"issue":"6","key":"zoi261080r31","first-page":"36","article-title":"Godin leisure-time exercise questionnaire.","volume":"29","author":"Godin","year":"1997","journal-title":"Med Sci Sports Exerc"},{"issue":"23","key":"zoi261080r32","doi-asserted-by":"crossref","first-page":"2417","DOI":"10.1001\/jama.2017.6803","article-title":"Screening for obesity in children and adolescents: US Preventive Services Task Force recommendation statement.","volume":"317","author":"Grossman","year":"2017","journal-title":"JAMA"},{"issue":"1","key":"zoi261080r36","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1146\/annurev-clinpsy-081423-022321","article-title":"Sex differences in affective disorders: a developmental neuroscience framework on the role of puberty.","volume":"22","author":"Ladouceur","year":"2026","journal-title":"Annu Rev Clin Psychol"},{"issue":"12","key":"zoi261080r37","doi-asserted-by":"crossref","first-page":"2673","DOI":"10.3390\/nu15122673","article-title":"Loss of control over eating, inhibitory control, and reward sensitivity in children and adolescents: a systematic review.","volume":"15","author":"Ramalho","year":"2023","journal-title":"Nutrients"},{"key":"zoi261080r1","volume-title":"NCHS Health E Stats","author":"Noiman","year":"2024"},{"key":"zoi261080r23","unstructured":"Snow? G. Blockrand: Randomization for Block Random Clinical Trials. R package version 1.5. CRAN; 2020. Accessed May 1, 2020. https:\/\/CRAN.R-project.org\/package=blockrand"},{"key":"zoi261080r25","unstructured":"US Department of Agriculture. MyPlate: based on the dietary guidelines for Americans, 2020-2025. May 1, 2020. https:\/\/www.myplate.gov\/"},{"key":"zoi261080r33","unstructured":"Quartagno? M, Carpenter? J. Jomo: Multilevel Joint Modelling Multiple Imputation [R Package]. CRAN; 2023. Accessed January 31, 2025. https:\/\/cran.r-project.org\/web\/packages\/jomo\/index.html"},{"key":"zoi261080r34","unstructured":"R Core Team. R: A Language and Environment for Statistical Computing [Computer Program]. R Foundation for Statistical Computing; 2023. Accessed January 31, 2025. https:\/\/www.R-project.org\/"},{"key":"zoi261080r35","doi-asserted-by":"crossref","unstructured":"Bojanowski? M. Lspline: Linear Splines With Convenient Parametrisations [R Package]. CRAN; 2017. Accessed January 31, 2025. https:\/\/cran.r-project.org\/web\/packages\/lspline\/index.html","DOI":"10.32614\/CRAN.package.lspline"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2855701\/boutelle_2026_oi_261080_1792081185.4278.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T15:30:46Z","timestamp":1792683046000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2855701"}},"subtitle":["A Randomized Clinical Trial"],"short-title":[],"issued":{"date-parts":[[2026,10,22]]},"references-count":37,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2026.39867","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,22]]}}}