Treatment Of Adolescent Obesity Research Articles

Tailored mobile phone text messages as an adjunct to obesity treatment for adolescents

We examined the use of tailored messages sent to the mobile phones of obese adolescents enrolled in a weight-management programme, as a means of increasing adherence. The feasibility study was conducted in three phases: (1) a library of 90 messages was developed about five weight-related behaviours; (2) a computer application was developed to tailor these messages to participants' characteristics; the SMS messages (text and images) were sent to mobile phones daily; (3) a three-month trial of the intervention was performed with 20 adolescents. Semi-structured interviews were conducted to assess the participants' perceptions of the intervention and the participants', providers' and computer consultants' reports about technology performance. These interviews revealed that participants were enthusiastic about the intervention and most found the messages to be personally relevant. The favourite messages were meal suggestions and recipe ideas. The computer tailoring application performed faultlessly and messages were delivered on schedule and in the desired sequence. Computerized tailored text messaging is a feasible adjunct to multidisciplinary obesity treatment and is acceptable to adolescents as an enjoyable means of improving their adherence to healthy lifestyle practices.

Expert Recommendations for the Treatment of Childhood and Adolescent Obesity: Advantages of the Seven Step Model and Immersion Treatments

This paper provides a review of three sets of recent expert recommendations on the treatment of childhood and adolescent obesity: 2007 Healthcare Organizations’ Four Stage Model; 2009 Seven Step Model; and 2010 US Preventive Task Force Recommendations. A consensus emerged from this analysis. All three groups viewed the evidence as supporting intensive (>25 contact hours) dietary, physical activity and cognitive-behavioral counseling and two of the three groups discouraged reliance on educational interventions alone. A case is made for the advantages of the Seven Steps model and immersion treatments.

Application of psychological theories, principles and strategies in the treatment of obesity in adolescents

Application of psychological theories, principles and strategies in the treatment of obesity in adolescents

Sex dimorphisms in inflammatory markers and adiposity in African-American youth

There are demonstrated sex differences in the association between adiposity and inflammation in adults. Our aim was to determine sex differences in inflammatory markers and in the association between adiposity and inflammation in a sample of African-American adolescents. Adiposity variables including body mass index (BMI), waist circumference, weight, total fat, trunk fat, and inflammatory markers including interleukin-6 (IL-6), leptin, monocyte chemotactic protein 1 (MCP1), C-reactive Protein (CRP), adiponectin were examined in 166 (53% female) African-American adolescents, aged 14-19 years. Total fat and trunk fat were measured using Dual-Energy X-ray Absorptiometry (DXA). Results revealed males had higher weight (p=0.01); females had higher BMI, trunk fat, and total fat (p's <0.01). With inflammation, males had higher MCP1 (p=0.024); females had higher leptin (p<0.001), adiponectin (p=0.006), and IL-6 (p=0.026). Partial correlations in males indicated associations of adiposity variables with leptin, adiponectin (all p's <0.01), and CRP (p<0.05); in females, leptin, CRP, and IL-6 were associated with adiposity variables (all p's <0.05). multiple regression analyses revealed female adiposity variables predicted CRP, (R(2)=0.254), IL-6 (R(2)=0.167), and MCP1 (R(2)=0.220). Adiposity variables in males predicted lower adiponectin (R(2)=0245). For both, leptin was predicted by adiposity (males R(2)=0.420 and females R(2)=0.410). Data indicate clear sex dimorphisms in the associations between inflammatory markers and adiposity in African-American adolescents, suggesting that preventive measures and treatments for adolescent obesity may need to be sex-specific.

Analysis of Metformin Treatment for Adolescent Obesity at 48 Rather Than 24 Weeks After Treatment Cessation

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Analysis of Metformin Treatment for Adolescent Obesity at 48 Rather Than 24 Weeks After Treatment Cessation—Reply

Analysis of Metformin Treatment for Adolescent Obesity at 48 Rather Than 24 Weeks After Treatment Cessation—Reply

The impact of child and adolescent obesity treatment interventions on physical activity: a systematic review

Efforts to treat obesity in childhood and adolescence would benefit from a greater understanding of evidence-based strategies to modify physical activity behaviour. A systematic review was conducted to examine the impact of child and adolescent obesity treatment interventions on physical activity. Studies included were randomized controlled trials or controlled trials, with overweight and obese youth (aged < 18 years), which reported statistical analysis of free-living physical activity at pretreatment and post-treatment. Two independent reviewers assessed each study for methodological quality. Seventeen child and three adolescent studies were retrieved, half of which were conducted in the USA. Studies were characterized by small samples of limited cultural and economic diversity. Fifteen studies reported an increase in at least one physical activity outcome at post-test or follow-up. Overall, study quality was rated as low (child median score = 3/10, range = 0-9; adolescent median score = 3/10, range = 2-5) with three child studies classified as high quality (>or=6/10). Research evaluating the effect of child and adolescent obesity treatment trials on physical activity is limited in both quantity and quality. Studies testing innovative, theoretically driven treatment approaches that use robust methodologies are required to better understand generalizable approaches for promoting physical activity participation among obese youth.

Financial Disclosure Clarification in: Surgical Treatment of Obesity in Adolescence

Financial Disclosure Clarification in: Surgical Treatment of Obesity in Adolescence

Metformin treatment for adolescent obesity has limited long-term benefits

Metformin treatment for adolescent obesity has limited long-term benefits

Treatment of Obese Adolescents: The Influence of Periodization Models and ACE Genotype

The aims of the present study were to compare the effects of two periodization models on metabolic syndrome risk factors in obese adolescents and verify whether the angiotensin-converting enzyme (ACE) genotype is important in establishing these effects. A total of 32 postpuberty obese adolescents were submitted to aerobic training (AT) and resistance training (RT) for 14 weeks. The subjects were divided into linear periodization (LP, n = 16) or daily undulating periodization (DUP, n = 16). Body composition, visceral and subcutaneous fat, glycemia, insulinemia, homeostasis model assessment of insulin resistance (HOMA-IR), lipid profiles, blood pressure, maximal oxygen consumption (VO(2max)), resting metabolic rate (RMR), muscular endurance were analyzed at baseline and after intervention. Both groups demonstrated a significant reduction in body mass, BMI, body fat, visceral and subcutaneous fat, total and low-density lipoprotein cholesterol, blood pressure and an increase in fat-free mass, VO(2max), and muscular endurance. However, only DUP promoted a reduction in insulin concentrations and HOMA-IR. It is important to emphasize that there was no statics difference between LP and DUP groups; however, it appears that there may be bigger changes in the DUP than LP group in some of the metabolic syndrome risk factors in obese adolescents with regard to the effect size (ES). Both periodization models presented a large effect on muscular endurance. Despite the limitation of sample size, our results suggested that the ACE genotype may influence the functional and metabolic characteristics of obese adolescents and may be considered in the future strategies for massive obesity control.

Surgical Treatment of Obesity in Adolescence

ADOLESCENT OBESITY IS A VEXING PROBLEM FOR WHICH there are few good solutions. Obese children develop metabolic syndrome. Because the cardiovascular complications of metabolic syndrome result from many years of exposure to hyperglycemia, diabetes, hyperlipidemia, and hypertension, early onset of these problems portends significant disease later in life. For these reasons, treating adolescent obesity is important. How can sustained weight loss be achieved in children and adolescents? As with adults, effective treatments are lacking. Bariatric surgery has been proposed for children but remains controversial. Evidence in support of these operations is based on small-scale studies that have mostly emanated from single institutions reporting outcomes from small numbers of patients with inadequate follow-up. Most studies have investigated gastric bypass–type procedures. Because these operations permanently alter the stomach, most clinicians are reluctant to advise these operations for children or adolescents except in the most compelling circumstances. Laparoscopic adjustable banding operations have become popular in recent years because these procedures can result in reasonable weight loss with relatively few complications and substantial potential for reversibility. As with adult bariatric surgery, the literature supporting the use of bariatric procedures is incomplete, causing policy makers to be hesitant in recommending this procedure for treatment of adolescent obesity. In this issue of JAMA, O’Brien and colleagues report their findings regarding the use of the laparoscopic banding procedure in adolescents. This study is important not only in providing difficult-to-come-by level 1 evidence in support of bariatric surgery but also because the work demonstrates that randomized controlled trials can and should be conducted to evaluate surgical technologies. The investigators randomized 50 obese adolescents to either receive a laparoscopic band or enroll in a medically supervised weight loss program. All participants received free care and those involved in the medical care group were offered an unusually intense program that included the provision of a personal trainer for 6 weeks. At 2 years of followup, there was substantial heterogeneity in weight loss outcomes for both groups with greater average weight loss for those receiving laparoscopic banding procedures. Even though weight loss was modest in the medical weight loss group, there was substantial improvement in hypertension, hyperlipidemia, and insulin resistance, demonstrating that lifestyle interventions are worthwhile even though they did not result in the amount of weight loss achievable with surgery. Although adverse events were common in both groups, 8 reoperations were required among 7 of the 24 patients who had received laparoscopic banding. This finding is particularly important because O’Brien et al are among the most experienced group in the world with these operations, suggesting that these complication rates will probably be higher in actual community practice. This randomized controlled trial demonstrates that the decision to offer laparoscopic banding procedures to adolescents is not straightforward. Patients enrolled in this trial were obese but did not have particularly severe complications of their obesity. Medical intervention was successful at improving many of the metabolic complications of obesity, but improvements in the surgical group were greater and included a higher degree of quality of life. Surgery was also associated with greater weight loss, but that benefit was possibly offset by the high complication rate associated with the laparoscopic banding devices. Even though this study by O’Brien et al raises many questions, it does answer some important ones. Laparoscopic banding procedures appear to be a feasible means for treating obesity in adolescents. The operation is known to require more patient compliance than Rouxen-Y gastric bypass (RYGB) surgery, and concerns have existed about the ability of teenagers to comply with the rigorous follow-up required to lose weight after laparoscopic banding placement. Because laparoscopically placed adjustable bands have fewer complications and are reversible, they represent a better alternative than RYGB

Associations between being overweight, variability in heart rate, and well-being in the young men

Abnormalities of the autonomic nervous system have been repeatedly shown in hypertension. We studied the associations between being overweight, blood pressure, cardiac vagal tone as measured by variability in heart rate, and well-being in a large cohort of young men. We hypothesised an inverse correlation between body mass index and the variability in heart rate. Further, we assessed systolic and diastolic blood pressure as traditional indicators of cardiovascular risk. Exclusion criteria were the use of drugs or pharmaceuticals. The following data from 786 men with a mean age of 19.4 years (standard deviation = 1.4, with a range from 16 to 24 years) were analysed in a cross-sectional study: body mass index, sleep duration, sporting activities, psychological well-being, blood pressure, heart rate, and variability in heart rate. Despite the young age of the men in this study, increased values for the body mass index were already associated with a shift in sympathovagal balance trending towards sympathetic dominance. There was also a significant positive correlation between body mass index and systolic and diastolic blood pressure. A multiple stepwise regression analysis showed that significant factors, which were associated with variability in heart rate, were body mass index and sporting activities. In addition, sporting activity and sleep duration had a significant positive impact on psychological well-being. Even in young men, being overweight is associated with increased cardiovascular risk, especially an increased sympathetic and/or lowered cardiovascular tone and increased blood pressure. Our study gives additional motivation for the early prevention and treatment of obesity in childhood and adolescence.

Annual Review of the Treatment of Childhood and Adolescent Obesity 2009: Rationale and Introduction to Special Focus Section

© Mary Ann Liebert, Inc. February 2010 Obesity and Weight Management 25 Introduction Of the tens of millions of overweight and obese children in the world, what percent are currently actively engaged, with their families, in evidence-based and concerted efforts to change their weight status? No one knows the precise answer to this key question at the moment, but an educated guess is less than 1%. Parents usually underestimate their children’s weight status1,2; healthcare providers usually fail to formally diagnosis this disease2; and scientifically grounded, professionally conducted programs are not universally

Metformin Extended Release Treatment of Adolescent Obesity

Metformin has been proffered as a therapy for adolescent obesity, although long-term controlled studies have not been reported. To test the hypothesis that 48 weeks of daily metformin hydrochloride extended release (XR) therapy will reduce body mass index (BMI) in obese adolescents, as compared with placebo. Multicenter, randomized, double-blind, placebo-controlled clinical trial. The 6 centers of the Glaser Pediatric Research Network from October 2003 to August 2007. Obese (BMI > or = 95th percentile) adolescents (aged 13-18 years) were randomly assigned to the intervention (n = 39) or placebo groups. Intervention Following a 1-month run-in period, subjects following a lifestyle intervention program were randomized 1:1 to 48 weeks' treatment with metformin hydrochloride XR, 2000 mg once daily, or an identical placebo. Subjects were monitored for an additional 48 weeks. Main Outcome Measure Change in BMI, adjusted for site, sex, race, ethnicity, and age and metformin vs placebo. After 48 weeks, mean (SE) adjusted BMI increased 0.2 (0.5) in the placebo group and decreased 0.9 (0.5) in the metformin XR group (P = .03). This difference persisted for 12 to 24 weeks after cessation of treatment. No significant effects of metformin on body composition, abdominal fat, or insulin indices were observed. Metformin XR caused a small but statistically significant decrease in BMI when added to a lifestyle intervention program. clinicaltrials.gov Identifiers: NCT00209482 and NCT00120146.

Applying Practice Recommendations for the Prevention and Treatment of Obesity in Children and Adolescents

To describe pediatric clinicians' adherence to practice recommendations for obesity prevention and treatment, we conducted a cross-sectional analysis of 227 medical records of 3- to 18-year-old patients (seen from September 2003 to April 2004) and a longitudinal analysis of data from 632 overweight and obese patients (followed through March 2006). The cross-sectional analysis showed that early practice adopters (n = 3) more frequently recorded BMI (91% of patients), a diagnosis (89%), and counseling (82%) compared with late adopters (n = 9; 34%, 51%, and 48% of patients, respectively; P < .001). The longitudinal analysis showed that among overweight and obese patients, documentation of BMI dropped from 96% at the first clinic visit to 27% by the fifth visit; documentation of individual risk behaviors fell from >or=72% at the first visit to <or=23% at the fifth visit. Despite initial adoption of screening and assessment practices, clinicians' attention to weight management diminished over time.

Maintenance of Weight Loss in Adolescents: Current Status and Future Directions

There is a dearth of research on the long-term efficacy and safety of treatments for adolescent obesity. This narrative review examined several approaches to treatment, focusing on long-term effectiveness data in adolescents, as well as relevant findings from studies of adults. The available research suggests that lifestyle modification has promise in obese adolescents, although it is not clear that any particular dietary or physical activity approach is more effective than another. Meal replacements are quite effective in adults and deserve further research in adolescents. Extending the length of treatment to teach weight loss maintenance skills is likely to improve long-term outcomes in adolescents, and delivering treatment via the Internet or telephone is a novel way of doing so. Treatment that combines lifestyle modification with the medication orlistat generally appears to be safe but only marginally superior to lifestyle modification alone. More research is needed on the management of adolescent obesity, which has been overlooked when compared with research on the treatment of obesity in children and adults.

Cochrane review: Interventions for treating obesity in children

AbstractBackgroundChild and adolescent obesity is increasingly prevalent, and can be associated with significant short‐ and long‐term health consequences.ObjectivesTo assess the efficacy of lifestyle, drug and surgical interventions for treating obesity in childhood.Search strategyWe searched CENTRAL on The Cochrane Library Issue 2 2008, MEDLINE, EMBASE, CINAHL, PsycINFO, ISI Web of Science, DARE and NHS EED. Searches were undertaken from 1985 to May 2008. References were checked. No language restrictions were applied.Selection criteriaWe selected randomised controlled trials (RCTs) of lifestyle (i.e. dietary, physical activity and/or behavioural therapy), drug and surgical interventions for treating obesity in children (mean age under 18 years) with or without the support of family members, with a minimum of six months follow up (three months for actual drug therapy). Interventions that specifically dealt with the treatment of eating disorders or type 2 diabetes, or included participants with a secondary or syndromic cause of obesity were excluded.Data collection and analysisTwo reviewers independently assessed trial quality and extracted data following the Cochrane Handbook. Where necessary authors were contacted for additional information.Main resultsWe included 64 RCTs (5230 participants). Lifestyle interventions focused on physical activity and sedentary behaviour in 12 studies, diet in 6 studies, and 36 concentrated on behaviorally orientated treatment programs. Three types of drug interventions (metformin, orlistat and sibutramine) were found in 10 studies. No surgical intervention was eligible for inclusion. The studies included varied greatly in intervention design, outcome measurements and methodological quality.Meta‐analyses indicated a reduction in overweight at 6 and 12 months follow up in: i) lifestyle interventions involving children; and ii) lifestyle interventions in adolescents with or without the addition of orlistat or sibutramine. A range of adverse effects was noted in drug RCTs.Authors' conclusionsWhile there is limited quality data to recommend one treatment program to be favoured over another, this review shows that combined behavioural lifestyle interventions compared to standard care or self‐help can produce a significant and clinically meaningful reduction in overweight in children and adolescents. In obese adolescents, consideration should be given to the use of either orlistat or sibutramine, as an adjunct to lifestyle interventions, although this approach needs to be carefully weighed up against the potential for adverse effects. Furthermore, high quality research that considers psychosocial determinants for behaviour change, strategies to improve clinician‐family interaction, and cost‐effective programs for primary and community care is required.Plain Language SummaryTreating obesity in childrenChildhood obesity affects both the physical and psychosocial health of children and may put them at risk of ill health as adults. More information is needed about the best way to treat obesity in children and adolescents. In this review, 64 studies were examined including 54 studies on lifestyle treatments (with a focus on diet, physical activity or behaviour change) and 10 studies on drug treatment to help overweight and obese children and their families with weight control. No surgical treatment studies were suitable to include in this review. This review showed that lifestyle programs can reduce the level of overweight in child and adolescent obesity 6 and 12 months after the beginning of the program. In moderate to severely obese adolescents, a reduction in overweight was found when either the drug orlistat, or the drug sibutramine were given in addition to a lifestyle program, although a range of adverse effects was also noted. Information on the long‐term outcome of obesity treatment in children and adolescents was limited and needs to be examined in some high quality studies.

Adolescent Nutrition

Adolescent Nutrition

The Health and Obesity: Prevention and Education (HOPE) Curriculum Project—Curriculum Development

The Health and Obesity: Prevention and Education (HOPE) project is a multidisciplinary, healthy living counseling curriculum to educate pediatric clinicians in training on how to recognize children who are at risk for obesity and its comorbidities and how to promote healthy weight among children and their families. Curriculum topics were selected by experts of nutrition, medicine, dentistry, behavioral counseling, and education and incorporate the recent 2007 Expert Committee recommendations regarding the prevention, assessment, and treatment of childhood and adolescent obesity. The HOPE curriculum instructs medical and dental clinicians on the health consequences of childhood obesity and screening techniques to identify children and families at risk, reviews the current evidence for health intervention recommendations, and teaches trainees regarding the theoretical rationale and art of constructive and culturally sensitive weight counseling for behavioral change. Although designed and tailored specifically for and currently available medical and dental trainees, the HOPE curriculum is Web-based and will also be made available to currently practicing clinicians across the United States beginning in winter 2009. This educational tool, grounded in understanding of relevant sciences, literature, and research methods, provides clinicians with the skills necessary to identify and counsel patients who are at risk to promote healthy weight among youth. This article discusses the approach and methods used for curriculum development. Future publications will discuss HOPE project implementation and outcomes.

A Cognitive Behavioural Intervention for Overweight and Obese Adolescents Illustrated by Four Case Studies

AbstractThis article reports four case studies illustrating the implementation of the ChooseHealthProgram, a cognitive behavioural lifestyle intervention for overweight and obese adolescents. Participants were an overweight (12 years) and obese (15 years) female, and an overweight (14 years) and obese (12 years) male. The program was delivered by provisional psychologists with program specific training and supervision. All participants demonstrated improvements in body composition, and maintained or improved dietary quality and psychosocial wellbeing. The program had variable effects on physical activity and minimal effect on cardiovascular fitness for three of the four participants. While parents and adolescents required considerable assistance to develop and monitor long term program goals, these goals were a useful clinical tool to support the adolescent and parent to recognise the improvements they had made. Identification and monitoring of specific, measurable, and realistic behaviour change strategies was particularly important in assisting adolescents and their parents to translate session information into improved health behaviours. Results indicate that an adolescent overweight and obesity treatment program that promotes adolescent responsibility and autonomy, and emphasises the importance of parent support and family change is both effective and highly acceptable to both adolescents and parents.