Dietary change as part of family-based multicomponent approach is foundational to management of obesity during adolescence. However, dietary restraint and dieting behaviours are considered important risk factors for eating disorder development in community samples. Systematic reviews demonstrate that most adolescents, supervised obesity treatment improves risk scores related to eating disorders, and dietary restraint may not be a strong predictor of eating disorder risk in the context of paediatric obesity treatment. Yet some individuals have poor outcomes for eating disorders, and may subsequently develop an eating disorder following paediatric weight management. Those who have poorer eating disorder outcomes following weight management interventions may not be identified when studies report aggregate risk scores. Additionally, screening tools for the full spectrum of eating disorders in adolescents with overweight and obesity are limited. The challenges with screening and monitoring for eating disorders during weight management is an important research and practice gap. It is critical to determine whether individuals at risk of developing an eating disorder can be identified by baseline characteristics, and if interventions or components of interventions contribute to risk.