Treatment Of Adolescent Obesity Research Articles

The Role of Social Support vs. Modeling on Adolescents' Diet and Physical Activity: Findings from a School-based Weight Management Trial

Objective: Social influences play an important role in shaping adolescents’ dietary and physical activity behaviors. We examined the role of perceived modeling and perceived social support from family and friends on diet and physical activity behaviors among overweight and obese adolescents participating in a weight management trial. Methods: Six high schools were randomized to a school-nurse delivered behavioral weight management intervention or an information attention-control. Data on perceived support and modeling of healthy eating and physical activity from family and friends and dietary and physical activity behaviors were obtained from participants (N=82) at baseline and 2- and 6-months follow-up. Results: Linear mixed models were used to examine associations between social factors at baseline and diet and physical behaviors at 6 months. Friend support was correlated with increased fruit and vegetable consumption (0.4 servings/day) and decreased added sugar intake (-14.2 grams/day) (p’s<0.05). Family support for physical activity, friend support for physical activity, and family modeling of physical activity were associated with increased number of days/week active for ≥ 60 minutes/day (0.7 days/week; 0.6 days/week; and 0.4 days/week, respectively, p’s<0.05). Conclusions: Among overweight and obese high school adolescents, support from family and friends was associated with a greater number of improvements in diet and physical activity at follow-up than modeling. Strategies to solicit support may maximize efficacy of adolescent obesity intervention efforts.

Quality of life in overweight and obese children and adolescents: a literature review

The purpose of the study is to present a literature review on quality-of-life (QOL) assessment in overweight or obese children and adolescents in order to identify the most affected dimensions and better understand associated factors. The ERIC, FRANCIS, MEDLINE, PsycARTICLES, PsycINFO, and Academic Search Premier databases were searched for articles reporting cross-sectional QOL studies in obese children and adolescents published in English before January 2013. The reference lists of retained articles were also screened. Among the 34 articles retained for the analysis, only three did not report lower QOL among obese youth. Clinical populations appeared to be more affected than the general population. Several variables were associated with QOL such as self-image, bullying, bodily pain, quality of food intake, physical activity, screen time, parents' educational level, and weight status. Identifying variables associated with lower QOL in obese children and adolescents offers new perspectives for prevention and care. Further research is needed to better elucidate these findings. Better understanding QOL is a key element essential for the treatment for childhood and adolescent obesity.

Severe Obesity in Children and Adolescents: Identification, Associated Health Risks, and Treatment Approaches

Severe obesity afflicts between 4% and 6% of all youth in the United States, and the prevalence is increasing. Despite the serious immediate and long-term cardiovascular, metabolic, and other health consequences of severe pediatric obesity, current treatments are limited in effectiveness and lack widespread availability. Lifestyle modification/behavior-based treatment interventions in youth with severe obesity have demonstrated modest improvement in body mass index status, but participants have generally remained severely obese and often regained weight after the conclusion of the treatment programs. The role of medical management is minimal, because only 1 medication is currently approved for the treatment of obesity in adolescents. Bariatric surgery has generally been effective in reducing body mass index and improving cardiovascular and metabolic risk factors; however, reports of long-term outcomes are few, many youth with severe obesity do not qualify for surgery, and access is limited by lack of insurance coverage. To begin to address these challenges, the purposes of this scientific statement are to (1) provide justification for and recommend a standardized definition of severe obesity in children and adolescents; (2) raise awareness of this serious and growing problem by summarizing the current literature in this area in terms of the epidemiology and trends, associated health risks (immediate and long-term), and challenges and shortcomings of currently available treatment options; and (3) highlight areas in need of future research. Innovative behavior-based treatment, minimally invasive procedures, and medications currently under development all need to be evaluated for their efficacy and safety in this group of patients with high medical and psychosocial risks.

Best practice dietetic management of overweight and obese children and adolescents: a 2010 update of a systematic review

Background It is imperative that the prevention, treatment and management of overweight and obesity in children and adolescents are effective and clinicians have access to current best practice management guidelines. Since the previous review in 2003 many studies have been published investigating the effects of dietary interventions on weight outcomes in overweight children but these have not been reviewed systematically. Objectives To examine the impact of randomized controlled interventions, which include a dietary component, on weight change in overweight/obese children. Inclusion criteria Types of participants Participants who were overweight/obese subjects under 18 years of age. Types of intervention(s)/phenomena of interest Included interventions compared lifestyle interventions to no treatment/wait-list control, usual care or written education materials. Types of studies Included study designs were randomized controlled trials (RCTs) only. Types of outcomes Anthropometry, including body mass index (BMI), BMI percentile, percentage of overweight for age, waist measurement and skinfolds. Body composition, including percentage of body fat and lean body mass. Dietary measures, including energy intake, macronutrient composition and core food groups. Behavior modification, including eating behavior checklists and short-fat questionnaire. Cost. Search strategy English language articles from 2003 to 2010 available from seven databases were included in the search strategy. Methodological quality Study quality was critically appraised by two reviewers using established criteria. Data collection Two independent reviewers extracted outcome data using standardised forms. Data synthesis The findings have been presented in narrative summary, grouped by intervention characteristics. Information extracted included population demographics, method of dietary data collection, and key results on anthropometry and dietary intake. Results One hundred articles representing 70 RCTs were included. All interventions had a focus on dietary change either alone or in combination with physical activity or behavior modification including cognitive behavioral therapy (CBT). Conclusions It appears from the available evidence that a combination of lifestyle changes or a lifestyle intervention approach which incorporates a dietary component should be recommended for both future studies and clinical practice for the management of childhood and adolescent obesity. However, the quality of RCTs needs improvement, particularly with reference to bias reporting, retention rates, follow-up periods and dietary intervention reporting. The involvement of the dietician in the planning stages of pediatric weight loss trials also needs to be advocated in future studies. Further research is needed to determine the optimal length, intensity and long-term effectiveness of lifestyle interventions for pediatric obesity management.

Impact of annual body mass index gain on obesity development in Japanese 6‐year‐old non‐obese children

Effective timing of preventive intervention for adolescent obesity in non-obese school-aged children remains unclear. The aim of this study was to examine the impact of annual body mass index (BMI) gain on the development of adolescent obesity in 6-year-old non-obese Japanese children. Longitudinal weight and height data were collected annually from 9723 children aged 6-14 years, and individual per-year BMI gains were calculated. The BMI ≥ the 95th percentile for each age and sex defined obesity. In 6-year-old non-obese children, logistic regression analyses were applied to correlate the annual BMI gain at each age with obesity at a final survey. The 6-year-old non-obese children who became obese at a final survey showed larger annual BMI gains at any age compared with their peers with respect to baseline BMI. Increases in annual BMI gain, even in early school age, raised the risk of adolescent obesity. Categorical analysis also showed that children aged 6-7 years with higher annual BMI gains than 1-SD above the mean had a significant risk for adolescent obesity (OR: 4.39 [95%CI: 2.98-6.46] in boys and 3.83 [95%CI: 2.60-5.63] in girls, respectively). A larger annual BMI gain at any school age is a risk for adolescent obesity in 6-year-old non-obese children with no critical period. This suggests the need for earlier and continuous school-based surveillance using annual BMI gain for preventive intervention of adolescent obesity development.

Five Recent Expert Recommendations on the Treatment of Childhood and Adolescent Obesity: Toward an Emerging Consensus—A Stepped Care Approach

Various organizations published five sets of expert recommendations recently: 2007 Healthcare Organizations' Four Stage Model; 2006 Canadian Clinical Practice Guidelines; 2008 The Endocrine Society Recommendations; 2009 Seven Step Model; and 2010 US Preventive Task Force Recommendations. We compared the recommendations' approaches and conclusions pertaining to four treatments (self-help groups, outpatient cognitive-behavior therapy [CBT], immersion CBT, and surgery). All of the expert committees supported using intensive dietary, physical activity, and cognitive-behavioral counseling; two of the five groups discouraged reliance on educational interventions alone, and two of the groups explicitly promoted a stepped-care approach. Greatest benefits may accrue by encouraging healthcare providers and parents to view medical management and education as foundations to change, but to pursue increasingly intensive viable options until overweight and obese children make clinically significant progress toward improved health and happiness.

Reasons for non-adherence to obesity treatment in children and adolescents.

OBJECTIVE To analyze the reasons for non-adherence to follow-up at a specialized outpatient clinic for obese children and adolescents. METHODS Descriptive study of 41 patients, including information from medical records and phone recorded questionnaires which included two open questions and eight closed ones: reason for abandonment, financial and structural difficulties (distance and transport costs), relationship with professionals, obesity evolution, treatment continuity, knowledge of difficulties and obesity complications. RESULTS Among the interviewees, 29.3% reported that adherence to the program spent too much time and it was difficult to adjust consultations to patientsâ€(tm) and parentsâ€(tm) schedules. Other reasons were: childrenâ€(tm)s refusal to follow treatment (29.3%), dissatisfaction with the result (17.0%), treatment in another health service (12.2%), difficulty in schedule return (7.3%) and delay in attendance (4.9%). All denied any relationship problems with professionals. Among the respondents, 85.4% said they are still overweight. They reported hurdles to appropriate nutrition and physical activity (financial difficulty, lack of parentsâ€(tm) time, physical limitation and insecure neighborhood). Among the 33 respondents that reported difficulties with obesity, 78.8% had emotional disorders such as bullying, anxiety and irritability; 24.2% presented fatigue, 15.1% had difficulty in dressing up and 15.1% referred pain. The knowledge of the following complications prevailed: cardicac (97.6%), aesthetic (90.2%), psychological (90.2%), presence of obesity in adulthood (90.2%), diabetes (85.4%) and cancer (31.4%). CONCLUSIONS According to the results, it is possible to create weight control public programs that are easier to access, encouraging appropriate nutrition and physical activities in order to achieve obesity prevention.

Registered Dietitians Provided Valued Nutrition Expertise in an Adolescent Obesity Intervention

Registered Dietitians Provided Valued Nutrition Expertise in an Adolescent Obesity Intervention

Metformin Treatment for Obesity in Children and Adolescents: A Meta-analysis and Review of Literature

Metformin Treatment for Obesity in Children and Adolescents: A Meta-analysis and Review of Literature

Effects of Different Physical Exercises on Leptin Concentration in Obese Adolescents

In order to compare the effects of leisure physical activity (LPA), aerobic training (AT) and aerobic plus resistance training (AT + RT) as part of a 6-month interdisciplinary therapy in body composition, insulin resistance and leptin concentrations in obese adolescents, 72 volunteers (n = 24 in each group) ages 15-19 years were evaluated. Delta (Δ) body mass (kg) and Δ BMI (kg/m(2)) was different between AT and LPA groups and in AT + RT group compared to both LPA and AT groups; Δ body fat mass (kg and %) was different only in AT + RT group compared to both LPA and AT; Δ body lean mass (%) was different only in AT + RT group; Δ body lean mass (kg) was negative only in AT and positive and different from AT in AT + RT group; ΔHOMA-IR did not differ among groups; Δ leptin (ng/ml) was negative and different from LPA for both AT and AT + RT groups. In conclusion, both AT and AT + RT promoted a reduction on leptin levels, however, the adolescents subjected to AT + RT presented better results in body composition than the AT group. These results highlight the importance of associating aerobic and resistance training with nutritional and psychological approaches in the treatment of obese adolescents.

The role of glucagon-like peptide-1 receptor agonists for the treatment of adolescent obesity

The role of glucagon-like peptide-1 receptor agonists for the treatment of adolescent obesity

Long-term effect of the Go4it group treatment for obese adolescents: A randomised controlled trial

Few studies evaluating treatment of adolescent obesity have been published. Therefore, long-term effects of the Go4it group treatment for obese adolescents were examined. Obese adolescents (11-18 years) visiting an outpatient paediatric obesity clinic were randomly assigned to 1) intervention group (Go4it) or 2) current regular care i.e. referral to a dietician in the home care setting (controls). Linear mixed models analysis was performed to evaluate intervention effects. Effect modification by sex, age and ethnicity was checked. Outcome measures included body mass index standard deviation score (BMIsds), body composition and metabolic components at 6 and 18 months follow-up. 122 adolescents, 71 Go4it and 51 controls, with a mean BMIsds of 2.9±0.5 were randomised. At 18 months a modest significant reduction in BMIsds (between group difference:-0.16; 95%CI:-0.30,-0.02; p=.028) was observed. None of the other body composition or metabolic components showed significant treatment effects. Ethnicity was a significant effect modifier. Posthoc analysis showed a large significant reduction on BMIsds (between group difference:-0.35; 95%CI:-0.64,-0.07) at 18 months for obese adolescents from western descent, while no effect was observed for adolescents from non-western descent. Significant treatment effects were also observed for systolic and diastolic blood pressure, as well as HDL cholesterol level, but only for obese adolescents from western descent. Go4it showed promising long-term effects on BMIsds compared with regular care in obese adolescents. Larger benefits were achieved for adolescents of western ethnicity. This trial was registered at www.trialregister.nl with the Netherlands Trial Register as ISRCTN27626398.

Treatment of Adolescent Obesity Comparing Self-Guided and Group Lifestyle Modification Programs: A Potential Model for Primary Care

Lifestyle modification programs (LMP) for weight loss in adolescents with obesity are effective but not available. Primary care may be a setting for reaching more adolescents. Two models of LMP for use in primary care were examined. Adolescents and caregivers enrolled in a 1-year randomized trial comparing Group LMP with Self-Guided LMP. All participants (N = 169) received the same treatment recommendations and met with a health coach six times in clinic. Group LMP participants had an additional 17 group sessions; those in Self-Guided LMP followed the remainder of the program at home with parental support. The primary outcome was percentage change in initial body mass index. The mean (SE) 1.31% (0.95%) reduction in Group LMP did not differ significantly from the 1.17% (0.99%) decrease in the Self-Guided LMP (p = 0.92). Both treatments were significantly effective in reducing body mass index. Given its brevity, the Self-Guided LMP offers an innovative approach for primary care.

Type 2 Diabetes in Children and Adolescents

Type 2 Diabetes in Children and Adolescents

Treatment of Obesity-Related Hypertension in Children and Adolescents

The obesity epidemic has become a common concern among pediatricians, with an estimated 32 % of US children and adolescents classified as overweight and 18 % as obese. Along with the increase in obesity, a growing body of evidence demonstrates that chronic diseases, such as Type 2 diabetes, primary hypertension, and hyperlipidemia, once thought to be confined solely to adulthood, are commonly seen among the obese in childhood. Following a brief summary of the diagnosis and evaluation of hypertension in obese children and adolescents, this review will highlight recent research on the treatment of obesity-related hypertension. Pharmacologic and non-pharmacologic treatment will be discussed. Additionally, current and emerging therapies for the primary treatment of obesity in children and adolescents, which have been gaining in popularity, will be reviewed.

Weight Change in Pediatric TennCare Recipients Referred to a Commercial Weight Loss Program

BackgroundThe epidemic of overweight and obesity in the United States is not limited to adults but also affects children and adolescents. Low-income children are disparately affected because they have an elevated risk for developing obesity. Effective interventions are urgently needed to prevent and treat obesity in children. In 2006, Tennessee Medicaid (TennCare) and Weight Watchers formed the TennCare Weight Watchers Partnership Program, which allowed pediatric recipients to attend Weight Watchers with no out-of-pocket cost. MethodsThis study is a nonconcurrent prospective analysis of administrative data from the TennCare Weight Watchers Partnership Program. It examined the weight change of TennCare beneficiaries between the ages of 10 and 17 who participated in the program from January 2006 to January 2009 and compared the weight change to the recommendations of the Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Childhood and Adolescent Overweight and Obesity. ResultsFifty-three percent of participants either met or exceeded the recommendations of the panel on childhood obesity at the end of their involvement in the program. Participants who attended the program for more than 12 weeks and those who attended 10 or more meetings had a 5% decrease in their body mass index z score. ConclusionsThe TennCare Weight Watchers Partnership Program was successful in helping a majority of children and adolescents who participated to meet or exceed the Expert Committee’s recommendations. This type of partnership can give children in low-income families the opportunity to participate in a structured program with a good chance of success.

From body dissatisfaction to obesity: how virtual reality may improve obesity prevention and treatment in adolescents.

Different studies, including longitudinal studies, suggest a link between body dissatisfaction, unhealthful weight-control behaviors and obesity in both male and female adolescents. Here we suggest that body dissatisfaction in obese adolescents may be driven by an allocentric negative body image that is no more updated by contrasting egocentric representations driven by perception. In other words, subjects are locked to an allocentric negative representation of their body (allocentric lock hypothesis - http://dx.doi.org/10.1016/j.mehy.2011.10.039) that their sensory inputs are no more able to update even after the dramatic body changes following a successful diet. More, the possible role of virtual reality in the prevention and treatment of obesity in adolescence is presented and discussed.

Long Term Outcomes of Laparoscopic Adjustable Gastric Banding for Treatment of Morbid Obesity in Adolescents

Background: Obesity in adolescents increased dramatically and has become commonplace in the last decade. Children with BMI >99th percentile tend to become obese adults with more health complications, as well as higher mortality rate than those who become obese in adulthood. Nonoperative managements through a well-supervised diet, psychological counseling, and physical activity program have been shown to have poor long-term sustainability and low success rate in significant percentage of adolescents. Laparoscopic adjustable gastric banding (LAGB) is considered a minimally invasive procedure that does not alter the anatomy and physiology of the intestine, therefore it is considered safer in pre-adult population. We designed a study to evaluate the current outcomes of LAGB in obese adolescents. Methods: Using PubMed, MEDLINE, and CHINAHL databases, a systematic review of 14articles from 2005 to 2012 was performed.

Effects of a combined intervention for treating severely obese prepubertal children

Obesity has become the most common modern pediatric chronic disease. Early prevention and treatment of childhood and adolescent obesity is mandated. Severe obesity [body mass index (BMI) percentile >98%] reduces the likelihood of the multidisciplinary childhood obesity program to succeed, suggesting, most probably, that a more intense program is needed to treat severely obese children. To prospectively examine the effects of an intense, 3-month, combined dietary-behavioral-physical activity intervention on anthropometric measures, leisure time activity patterns, and fitness in prepubertal severely obese (BMI percentile >98%) children (n=22) compared to age, gender, and obesity matched controls (n=18). At 3 months, there were significant differences (p<0.05) in changes in body weight (-0.5±2.4 vs. 1.7±1.9 kg), BMI (-0.9±1.2 vs. 0.4±1.0 kg/m2), BMI percentile (0.39±0.39% vs. -0.04±0.32%), sum skinfolds (-3.1±8.1 vs. 1.1±4.7 mm), total habitual physical activity (25.4±10.8 vs. 0.3±10.1 Mets), and fitness (142±72 vs. -8±88 s) in the intervention vs. control participants. Our data demonstrate the beneficial, short-term effects of an intense combined dietary-behavioral-physical activity intervention on anthropometric measures, activity patterns, and fitness in severely obese children. However, despite the encouraging results, the modest effect on BMI percentiles emphasizes the difficulty of treating severely obese children using the conventional nutritional-behavioral-physical activity approach.

The Ethical Dilemma of Adolescent Bariatric Surgery

Adolescent obesity and obesity-related conditions have risen at alarming rates in the United States, positioning childhood obesity as a major public health issue. The consequences of adolescent obesity are far-reaching and often include medical, psychosocial, emotional, and economic burdens. Traditional interventions targeted at diet and behavior modification are largely ineffective in reducing adolescent adiposity. Bariatric surgery, therefore, is gaining recognition as a means to significant and sustained weight loss in the teenage population. Given the innovative nature of this intervention and the lack of robust evidence to support its safety and efficacy in this population, few procedures are being performed on pediatric patients. Surgical weight loss in young patients with severe obesity poses a staid ethical burden to all involved. This article addresses the ethical issues of beneficence and nonmaleficence as they apply to adolescent bariatric surgery. Bariatric surgery for the treatment of severe adolescent obesity is an ethical and effective approach when performed discriminately in centers that can provide expert interprofessional support.