Phenotype Tailored Lifestyle Intervention for Weight Management in Individuals with Emotional Eating: A Secondary Analysis of the PHENO-Diet Trial

Background In a proof-of-concept trial, a phenotype tailored lifestyle intervention (PLI) led to greater weight loss than a standardized lifestyle intervention (SLI). This secondary analysis evaluated the effect of the PLI for individuals with an emotional eating phenotype (EE) on weight loss outcomes, eating behaviors and mood. Methods This original clinical research article is a secondary analysis of a 12-week, non-randomized, date-of-treatment trial in which adults with obesity underwent phenotyping and were assigned sequentially to either a PLI (N=84) or a SLI (N=81). The EE phenotype was defined as a HADS-A (Hospital Anxiety and Depression Scale for Anxiety) score ≥ 7. Weight loss outcome and changes in eating behaviors and mood were evaluated among participants with EE assigned to an SLI (n=19) or a PLI (n=26). Results Participants with EE assigned to the PLI achieved greater weight loss at 12-weeks compared with those assigned to the SLI (-5.9% ± 4.4 vs. -2.6% ± 4.8; p= 0.02). Participants with EE assigned to the PLI demonstrated reduced HADS-A and HADS-D scores, and the Three-Factor Eating Questionnaire Emotional Eating subscale (TFEQ-EE), while those assigned to the SLI had minimal or no improvements after 12-weeks. Among participants with EE assigned to the PLI, Higher HADS-A scores and lower scores in the Weight Efficacy Lifestyle questionnaire (WEL) negative emotions subscale and TFEQ-EE at baseline were associated with greater weight loss at 12-weeks. (NCT04073394). Conclusion These findings support tailoring behavioral weight-loss interventions for adults with obesity and EE. Larger randomized studies with longer follow-up are needed to further refine phenotype-based approaches.