A randomised trial of 166 parent and teenager pairs, published in JAMA Network Open, found that adding emotion-regulation skills to a standard family-based weight programme made no difference to how much weight adolescents lost during six months of treatment. The difference appeared afterwards: a year after the programme ended, teenagers who had been taught the extra skills had regained less weight and reported less emotional eating. The result suggests that the hardest part of behavioural treatment, keeping weight off once sessions stop, may respond to work on emotions rather than on food and activity alone.
What the trial tested
The FRESH-Teen trial enrolled adolescents aged 13 to 16 whose body mass index was at or above the 85th percentile for their age and sex, each with a parent, at the University of California San Diego and the University of Minnesota between 2019 and 2022. Both groups received six months of family-based behavioural treatment (FBT): 20 parallel parent and teen group sessions plus 18 coaching sessions, covering nutrition, physical activity, self-monitoring and parenting skills. The second group also learned skills drawn from dialectical behaviour therapy and emotion-focused therapy, and logged their emotions around eating episodes. The staff who measured outcomes did not know which group a family was in.
At the end of treatment the groups were level. The difference in BMI z score, a measure of BMI relative to peers of the same age and sex, was 0.03 (95% CI −0.05 to 0.10), an interval that includes zero. Twelve months after treatment ended the gap had opened to −0.09 (95% CI −0.17 to −0.02) in favour of the emotion-regulation group, meaning that group had regained less; measured as a percentage of the 95th BMI percentile, the gap was 4.8 points. The estimated share of teenagers still holding a clinically meaningful loss, a fall of at least 0.20 in BMI z score, was 22% with the added skills against 4% without. Emotional-eating scores were lower in the emotion-regulation group (difference −0.39, 95% CI −0.63 to −0.15). Parent weight and a general emotion-regulation questionnaire did not differ between groups.
Where this fits
Family-based behavioural treatment is the most effective behavioural weight programme studied in young people, the authors write, but its effect weakens as children reach adolescence. Regain after treatment ends is a familiar problem across behavioural programmes, and this trial shows the same pattern: both groups lost weight during treatment and both regained during follow-up. What differed was how fast they regained.
The trial lands at a time when the treatment of adolescents with obesity is changing. GLP-1 medicines such as semaglutide are now approved for teenagers, and the evidence on them is collected in this site’s GLP-1 research hub. No participant in FRESH-Teen was taking a GLP-1 medicine at baseline, so the trial says nothing about how emotion-focused skills combine with drug treatment. What it does add is evidence that the content of a behavioural programme matters, and that follow-up length can change the conclusion: judged at six months, this trial would have reported no benefit at all.
The authors also report that the added skills appeared to help boys more than girls during follow-up. That came from a secondary moderator analysis, and the emotional-eating and emotion-regulation measures did not explain it.
What is not yet known. This is one trial of 166 families, and its 12-month estimates are imprecise: the 22% figure has a 95% confidence interval running from 8% to 48%. Follow-up thinned out, with weight data at the final visit for 53 of 84 teenagers in the emotion-regulation group and 58 of 82 in the comparison group, and the analysis filled the gaps by multiple imputation. The trial ran through the COVID-19 pandemic, so most sessions moved to video calls and some measurements were taken remotely. Participants were treatment-seeking families receiving intensive, clinician-led sessions that few ordinary programmes provide. Because the general emotion-regulation measure did not change, how the added skills worked remains unclear. Three of the authors reported National Institutes of Health grants during the conduct of the study.
Sources: Boutelle KN, Manzano MA, Pasquale EK, et al. Emotion-Focused Behavioral Weight Loss Treatment for Adolescents: A Randomized Clinical Trial. JAMA Network Open, October 2026; 9(10):e2639867 (PubMed 42911592). Trial registration NCT03674944.
