Abstract
BackgroundMany adolescents with obesity do not meet recommendations for nutrition, physical and sedentary activities, and sleep habits, all of which can influence weight management.ObjectiveTo explore barriers and enablers that influenced the adoption of lifestyle behavior changes among adolescents receiving multidisciplinary clinical care for pediatric weight management.MethodsIn this multi-centre, qualitative description study, we used purposeful sampling to recruit 13–17 year olds (body mass index ≥85th percentile) enrolled in one of two pediatric weight management clinics in Edmonton and Ottawa, Canada. Adolescents participated in one-on-one, in-person, semi-structured interviews in English or French. Interviews lasted 30–60 minutes, were audio-recorded, transcribed verbatim, and managed using NVivo 11. Data were triangulated using transcripts, field notes, and memos and analyzed by two independent researchers using inductive, semantic thematic analysis.ResultsIn total, 19 adolescents (12 Anglophone and 7 Francophone; 15.1±1.7 years old; 3.5±0.6 BMI z-score; n = 11 female; n = 13 Caucasian) participated. Adolescents reported diverse barriers to and enablers of healthy nutrition, physical and sedentary activities, and sleep habits, which we organized into the following themes: physiological mechanisms and physical health status, self-regulation for behavior change, controllability and competence beliefs, social relationships and interactions, and accessibility to and availability of opportunities for lifestyle enhancement. Across these themes and lifestyle areas, we identified three shared barriers and/or enablers, including the degree of controllability, the impact of mental health, and social pressures related to weight management.ConclusionsThis research provides evidence that can be used to tailor interventions and health services delivery, including a focus on psychosocial well-being, to support adolescents with obesity in making and maintaining healthy lifestyle behavior changes.
Highlights
Recent international data point to a ten-fold increase in the prevalence of pediatric obesity over the last four decades [1]
In Canada, a number of weight management programs exist [12] in which multidisciplinary teams deliver lifestyle and behavioral therapeutic interventions using a variety of behavioral change techniques
In our multi-centre, qualitative study, adolescents receiving multidisciplinary clinical care for pediatric weight management identified numerous barriers to and enablers of adopting lifestyle behavior changes related to nutrition, physical and sedentary activities, and sleep
Summary
Recent international data point to a ten-fold increase in the prevalence of pediatric obesity over the last four decades [1]. Adolescent obesity is concerning because it is associated with a higher risk of developing longterm adverse health consequences such as type 2 diabetes and cardiovascular disease [6] and is likely to be maintained in adulthood [7]. Adolescents can derive health benefits from making healthy lifestyle and behavioral changes to prevent and manage obesity [8]. To help achieve these outcomes, adolescent-specific lifestyle recommendations have been developed, which include 6 to 8 daily servings of fruits and vegetables [9], 60 minutes of daily moderate-to-vigorous physical activity (MVPA) [10], no more than 2 hours of daily leisure-time sedentary activity [11], and 8 to 10 hours of sleep per night [11]. Many adolescents with obesity do not meet recommendations for nutrition, physical and sedentary activities, and sleep habits, all of which can influence weight management
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