Emotion regulation skills curb weight regain in teen weight management

Teaching adolescents with overweight or obesity and their parents emotion regulation skills alongside standard family-based behavioral treatment (FBT) did not increase weight loss during treatment, but it was associated with less weight regain and lower emotional eating over the following year, according to a randomized clinical trial published October 22, 2026, in JAMA Network Open.¹

At 12 months after treatment ended, 22% of adolescents who received the emotion-focused program had maintained clinically meaningful weight loss, compared with 4% of those who received FBT alone.¹ "Weight loss is only part of the story," said Kerri Boutelle, PhD, professor of pediatrics and psychiatry at UC San Diego School of Medicine and the UC San Diego Herbert Wertheim School of Public Health and Human Longevity Science, who led the study.² “Our goal is to develop treatments that give adolescents and families skills they can continue to use after a structured program ends. Understanding how emotions influence eating may help us build interventions that are more sustainable for youth over the long term.”

FRESH-Teen trial design and emotion regulation intervention for adolescents

The FRESH-Teen trial randomized 166 parent-adolescent dyads at UC San Diego and the University of Minnesota to 6 months of FBT alone (n = 82) or FBT plus emotion regulation (n = 84).¹ Adolescents were aged 13 to 16 years (mean, 14.3 years; 57% female) with a BMI at or above the 85th percentile but below the 99.9th percentile, and outcome assessors were blinded to group assignment.¹

Both arms included 20 concurrent 60-minute parent and adolescent group sessions plus 18 30-minute behavioral coaching sessions.¹ The enhanced arm kept core FBT content but replaced some peripheral content with dialectical behavior therapy (DBT) skills in mindfulness, emotion regulation, and distress tolerance.¹ Parents in that arm also learned emotion-focused therapy (EFT) strategies centered on validating their adolescent's emotions before problem-solving.¹,⁴

Weight regain and emotional eating outcomes at 12-month follow-up

Both groups lost weight during treatment, with no between-group difference at posttreatment (difference in BMI z score [BMIz], 0.03; 95% CI, −0.05 to 0.10).¹ At 12 months posttreatment, adolescents in the enhanced arm had regained less weight (difference in BMIz, −0.09; 95% CI, −0.17 to −0.02; P = .01; difference in percentage of the 95th BMI percentile, −4.81; 95% CI, −7.26 to −2.05; P = .001).¹ The proportion achieving a clinically meaningful BMIz reduction of at least 0.20 was 26% vs 22% at posttreatment and 22% (95% CI, 8%-48%) vs 4% (95% CI, 1%-12%) at 12 months.¹

Emotional eating scores were lower in the enhanced arm at posttreatment and at both follow-up visits (12-month difference, −0.39; 95% CI, −0.63 to −0.15; P = .001).¹ Scores on the Difficulties in Emotion Regulation Scale, however, did not differ between groups at any time point, and parent BMI changes were similar.¹

“The fact that we saw less emotional eating and better weight maintenance, without a measurable change in overall emotion management, raises an important question about what is actually driving the benefit,” Boutelle said. “We need to understand which parts of the intervention are most important and whether helping adolescents respond differently to difficult emotions is the key.”

Why adolescents may need adapted family-based obesity treatment

Approximately 43% of US adolescents have overweight or obesity, and FBT, the most efficacious behavioral approach for youth, appears to lose efficacy as children get older, possibly reflecting adolescents' push for autonomy and still-developing emotion regulation.¹ The American Academy of Pediatrics' 2023 clinical practice guideline recommends intensive health behavior and lifestyle treatment, ideally 26 or more hours of face-to-face, family-based, multicomponent care over 3 to 12 months.³ Weight regain after such programs end remains a major challenge.¹

Interpreting emotional eating findings and FRESH-Teen study limitations

The investigators suggested the intervention may have weakened the link between distress and eating rather than improving global emotion regulation, while acknowledging the scale may have been insensitive to change.¹ Boutelle noted that the team still needs to pinpoint which components drive the benefit.² The enhanced program also appeared more effective for boys than girls during follow-up, a difference the measured variables did not explain.¹

Limitations include the pandemic-driven shift to virtual delivery with partly remote anthropometric measurement, enrollment of treatment-seeking families, and exclusion of adolescents with BMI at or above the 99.9th percentile.¹ Whether the adolescent DBT skills, the parent EFT training, or both account for the effect remains unclear.¹ No participants were taking glucagon-like peptide-1 receptor agonists at baseline, so how emotion-focused skills might complement pharmacotherapy, which the AAP guideline supports as an adjunct for adolescents aged 12 years and older, is untested.¹,³

References

1. 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

2. Adding emotion management skills to family weight treatment may help teens maintain weight loss. News release. University of California San Diego. October 22, 2026. Accessed October 23, 2026. https://www.newswise.com/articles/adding-emotion-management-skills-to-family-weight-treatment-may-help-teens-maintain-weight-loss

3. Hampl SE, Hassink SG, Skinner AC, et al. Clinical practice guideline for the evaluation and treatment of children and adolescents with obesity. Pediatrics. 2023;151(2):e2022060640. doi:10.1542/peds.2022-060640

4. Boutelle KN, Manzano MA, Pasquale EK, et al. 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. Contemp Clin Trials. 2024;145:107640. doi:10.1016/j.cct.2024.107640