Key Takeaways
- A randomized clinical trial involving 166 adolescents and their parents found that adding emotional-skills training to family-based weight treatment helped teenagers maintain more of their initial weight loss.
- Both treatment groups achieved similar weight reductions during the six-month intervention. The difference emerged during the following 12 months, when adolescents receiving emotional-skills training regained less weight.
- At the 12-month follow-up, an estimated 22% of adolescents receiving the combined treatment maintained a clinically significant reduction in their BMI-for-age score, compared with 4% receiving standard family-based treatment.
- Participants receiving emotional-skills training also reported less emotional eating, although their scores on a broader measure of emotion regulation did not significantly improve compared with the control group.
Introduction
Emotional-skills training may help teenagers maintain weight-related improvements. A randomized trial involving 166 adolescents found less weight regain when emotional support strategies were added to family-based behavioral treatment.
Adding emotional-skills training to family-based behavioral treatment may help adolescents maintain weight-related improvements, according to a randomized clinical trial published October 22, 2026, in JAMA Network Open.
Researchers found that adolescents who received emotional-regulation training alongside conventional family-based weight treatment regained less weight during the year after treatment ended than those receiving standard treatment alone.
The difference was not apparent during the initial six months. Both groups lost similar amounts of weight while actively participating in their programs.
Instead, the additional emotional-skills training appeared to make a difference after structured treatment stopped.
The findings raise an important question about adolescent weight management: Could helping teenagers respond differently to stress, frustration, and difficult feelings make behavioral treatment more sustainable?
What the Study Examined
The randomized clinical trial by Boutelle et al. (2026) enrolled 166 adolescents between the ages of 13 and 16, each participating with a parent.
The adolescents had overweight or obesity, defined by a body mass index at or above the 85th percentile but below the 99.9th percentile for their age and sex.
Their average age was 14.3 years, and 57% were female.
The study was conducted at the University of California, San Diego, and the University of Minnesota. Participants were randomly assigned to one of two treatment approaches.
Eighty-two adolescent-parent pairs received standard family-based behavioral treatment, while 84 received the same treatment supplemented with emotional-regulation training.
Both programs lasted six months, followed by assessments extending through 12 months after treatment ended.
What Did the Two Treatments Involve?
Standard family-based behavioral treatment included nutrition education, physical activity guidance, behavioral strategies, and parenting skills.
Parents and adolescents participated in group sessions and behavioral coaching designed to support changes in everyday routines.
The experimental program retained these components but added strategies drawn from dialectical behavior therapy and emotion-focused therapy.
These approaches teach people to recognize difficult emotions, respond to distress more effectively, and develop alternatives to behaviors driven by emotional discomfort.
Parents also learned skills intended to help them recognize and respond constructively to their teenagers’ emotional experiences.
The researchers wanted to determine whether these additional skills would improve weight outcomes, reduce emotional eating, and strengthen emotion regulation.
Much of the treatment was delivered remotely because the study overlapped with the COVID-19 pandemic.
What Researchers Found
Both Groups Lost Similar Amounts of Weight During Treatment
At the end of the six-month intervention, adolescents in both groups had experienced reductions in standardized body mass index.
However, adding emotional-regulation training did not produce significantly greater weight loss during active treatment.
The difference between groups in BMI z score at the end of treatment was 0.03, with a 95% confidence interval ranging from -0.05 to 0.10.
Because this interval included zero, the result did not establish a statistically significant difference between the treatments at that point.
This distinction matters because the trial does not show that emotional-skills training makes teenagers lose weight faster or produces greater initial weight loss.
Its most notable finding concerns what happened afterward.
Teenagers Receiving Emotional-Skills Training Regained Less Weight
During the 12 months after treatment ended, adolescents in both groups experienced some weight regain.
However, those who had received emotional-regulation training regained significantly less.
At the 12-month follow-up, the difference between groups in BMI z score was -0.09, with a 95% confidence interval of -0.17 to -0.02.
The difference was statistically significant.
Researchers also examined BMI as a percentage of the 95th percentile, another measure used to evaluate weight status in children and adolescents.
This analysis showed a similar pattern, with a between-group difference of -4.81 percentage points at the final follow-up.
Together, these findings suggest that adding emotional-skills training to family-based behavioral treatment may help adolescents maintain weight-related improvements after structured treatment ends.
The trial did not establish that participants continued losing weight during follow-up, nor did it determine whether the benefits would persist beyond the study period.
More Adolescents Maintained a Clinically Significant Reduction in BMI
Researchers also examined how many adolescents achieved a reduction of at least 0.20 in BMI z score, a standardized measure that accounts for age and sex.
At the end of the six-month treatment period, the estimated proportions meeting this threshold were 26% in the combined-treatment group and 22% in the standard-treatment group.
By the 12-month follow-up, the estimated proportions were 22% and 4%, respectively.
These figures represent model-estimated proportions of adolescents meeting a defined BMI z-score threshold. They do not mean that participants lost 22% or 4% of their body weight.
The estimates also carried considerable uncertainty. At the final follow-up, the 95% confidence intervals were 8% to 48% for the combined-treatment group and 1% to 12% for the standard-treatment group.
Although these findings favor the addition of emotional-skills training, they should not be interpreted as predicting an individual teenager’s likelihood of maintaining weight loss.
The results are consistent with the trial’s overall finding that adolescents receiving the combined intervention experienced less weight regain after treatment ended.
Emotional Eating Decreased, but Overall Emotion-Regulation Scores Did Not Improve Significantly
Researchers also assessed emotional eating, which involves eating in response to feelings rather than primarily in response to physical hunger.
Adolescents receiving the combined treatment reported significantly lower emotional-eating scores than those receiving standard treatment.
At the 12-month follow-up, the difference between groups was -0.39 points on the Emotional Eating Scale, with a 95% confidence interval of -0.63 to -0.15.
However, the study produced a more complicated result when researchers examined broader emotional-regulation abilities.
Scores on the Difficulties in Emotion Regulation Scale did not differ significantly between treatment groups at the final follow-up.
This means the researchers could not demonstrate that the intervention improved general emotional-regulation capacity as measured by that questionnaire.
One possible explanation is that participants learned to respond differently to distress specifically when it came to eating, without experiencing measurable changes across all aspects of emotional regulation.
Another possibility is that the questionnaire was not sufficiently sensitive to detect the particular skills taught during treatment.
The trial could not determine which explanation was correct.
Why Might Emotional Skills Matter for Weight Maintenance?
Maintaining behavioral changes after a structured weight-management program can be challenging for adolescents. Stress, changing routines, social pressures, and increasing independence may all influence eating habits and physical activity.
Traditional family-based behavioral treatment addresses nutrition, physical activity, behavior change, and parental support. The experimental program in this trial added strategies intended to help teenagers recognize difficult emotions and develop alternative responses to distress.
These strategies included elements of dialectical behavior therapy and emotion-focused therapy. Parents also received guidance on recognizing and responding supportively to their children’s emotional experiences.
The adolescents receiving this additional training reported less emotional eating and regained less weight during follow-up. However, their scores on a broader measure of emotion regulation did not improve significantly compared with those receiving standard treatment.
This distinction is important. Although the results are consistent with a potential benefit from addressing emotional experiences, the trial did not establish that improvements in general emotion-regulation ability caused the difference in weight maintenance.
Researchers also could not determine which components of the combined intervention were responsible for the observed benefits.
How the Findings Compare With Earlier Research
Family-based behavioral treatment has an established role in pediatric weight management.
Previous research has shown that involving parents in structured behavioral programs can improve outcomes for children and adolescents, although treatment effectiveness and long-term maintenance vary.
A review of adolescent obesity treatment published in JAMA Pediatrics described family-based behavioral approaches as an important component of care while identifying the need for more effective and sustainable treatment strategies (Cardel et al., 2020).
The new trial extends that evidence by testing whether adding structured emotional-skills training improves outcomes beyond those achieved with conventional family-based treatment.
Its contribution is particularly relevant because adolescence presents challenges that may differ from those encountered in younger children.
Teenagers generally have greater independence over food choices, social activities, and daily routines. They may also experience emotional pressures that influence health behaviors.
The current findings indicate that addressing these emotional processes within an established treatment program may improve the durability of weight-related changes.
However, the trial does not show that emotional-regulation training alone would produce the same benefits.
What the Results May Mean for Parents and Healthcare Professionals
The study suggests that emotional and behavioral support may be valuable components of comprehensive adolescent weight-management care.
For parents, an important takeaway is that difficulties maintaining healthy routines may involve more than nutritional knowledge or motivation. Stress, frustration, and emotional discomfort can affect everyday behavior, including eating patterns.
Families concerned about a teenager’s weight or eating habits can discuss these issues with a pediatrician or another qualified healthcare professional. Depending on the teenager’s needs, care may involve nutritional guidance, behavioral support, and assessment of emotional well-being.
Parents can also support open conversations about stress and eating without criticism, shame, or pressure to achieve a particular body size.
However, the trial did not test emotional coping exercises as a standalone treatment. Its results came from a structured, professionally supervised program involving both adolescents and parents.
Weight management during adolescence also requires consideration of normal growth, body image, mental health, and the potential risks of restrictive dieting.
The findings therefore support a more comprehensive approach to adolescent care, not an expectation that teenagers should independently manage their weight by controlling their emotions.
Limitations
Several limitations affect how the results should be interpreted.
Specific age group. Participants were between 13 and 16 years old. The findings may not apply to younger children or older adolescents.
Treatment-seeking families. Participants were families who had actively sought weight-management treatment and agreed to participate in a structured program. Results may differ among families with less time, fewer resources, or different treatment preferences.
Changes caused by the pandemic. The COVID-19 pandemic required much of the intervention and some assessments to move online. Researchers could not determine how these changes influenced the findings.
Remote measurements. Some height and weight assessments were conducted remotely, potentially introducing measurement variability.
Combined intervention. Emotional-regulation training incorporated elements of dialectical behavior therapy and emotion-focused therapy. The trial could not establish which components contributed most to improved weight maintenance.
Self-reported emotional outcomes. Emotional eating and emotion regulation were measured using questionnaires. These provide useful information but may not fully capture actual behavior or changes in coping skills.
Limited evidence about longer-term outcomes. Participants were followed for 12 months after treatment, but the study did not establish whether the differences would persist for several years or affect long-term metabolic health.
The researchers also reported exploratory evidence that treatment effects differed by sex during follow-up. Those findings require confirmation before drawing conclusions about whether the approach works differently for boys and girls.
Final Thoughts
A randomized clinical trial suggests that incorporating emotional-skills training into family-based behavioral treatment may help adolescents maintain weight-related improvements after structured treatment ends.
The additional training did not produce greater initial weight loss, but adolescents receiving it experienced less weight regain and reported lower emotional eating during the following year.
These findings support further investigation into how emotional and behavioral support can be integrated into adolescent weight-management programs.
Larger studies with longer follow-up periods are needed to establish whether these benefits persist and to identify which elements of the intervention are most effective.
Funding and Disclosures
The study was supported by the National Institutes of Health through grant R01DK116616 and by the University of California San Diego Clinical and Translational Science Award UM1TR005449.
Kerri N. Boutelle, Dawn M. Eichen, and Carol B. Peterson reported receiving NIH grants during the study. The authors reported no other disclosures.
According to the published paper, the funding organizations had no role in the study design, data collection, analysis, manuscript preparation, or publication decision.
The trial was registered at ClinicalTrials.gov under NCT03674944.
References
Boutelle, K. N., Manzano, M. A., Pasquale, E. K., Strong, D. R., Bernard, R. S., Rhee, K. E., Eichen, D. M., Miller, A., & Peterson, C. B. (2026). Emotion-focused behavioral weight loss treatment for adolescents: A randomized clinical trial. JAMA Network Open, 9(10), e2639867. https://doi.org/10.1001/jamanetworkopen.2026.39867
Cardel, M. I., Atkinson, M. A., Taveras, E. M., Holm, J. C., & Kelly, A. S. (2020). Obesity treatment among adolescents: A review of current evidence and future directions. JAMA Pediatrics, 174(6), 609–617. https://doi.org/10.1001/jamapediatrics.2020.0085
