Adolescent Weight Management Research Articles

Proefschrift: Long-term weight management in children and adolescents with severe obesity: psychological aspects

Proefschrift: Long-term weight management in children and adolescents with severe obesity: psychological aspects

The mediating role of energy intake on the relationship between screen time behaviour and body mass index in adolescents with obesity: The HEARTY study

Adolescents spend up to 6–8 h/day in sedentary screen behaviour and screen time is an independent risk factor for obesity. However, the mechanisms by which screen time confers obesity risk remain unclear. Via community level recruitment this study examined whether the relationship between screen time behaviours and body mass index (BMI: kg/m2) was mediated by total energy intake or macronutrient consumption. In a cross-sectional study of post-pubertal adolescents (N = 283: 86M, 197F) with overweight or obesity at baseline of an intervention for weight control, we examined self-reported total energy intake (mean Calories from 3 day food diary), macronutrient intake (grams/day of carbohydrate, fat, protein) and total screen time (aggregate of hours/day watching TV, playing seated video games, and recreational computer use). BMI was objectively measured and converted to standardized scores (z-BMI). Simple and multiple mediation analyses were conducted using the bootstrapping approach described by Preacher and Hayes. Covariates included age, sex, ethnicity, parental education, Tanner stage, and self-reported physical activity. The relationship between screen time and z-BMI was significantly mediated by energy intake. Higher levels of carbohydrate intake, but not fat or protein intake, significantly mediated the relationship between screen time and z-BMI (95% bias-corrected and accelerated confidence interval [0.0004, 0.0074]). Higher carbohydrate intake mediated the relationship between TV viewing and z-BMI, and video gaming and z-BMI. In conclusion, the relationship between screen time and BMI appears to be mediated by increased energy intake, primarily in the form of higher carbohydrate intake. It is possible that reducing time spent watching TV and playing video games may reduce food intake and help promote dietary adherence needed for weight management in obese adolescents. Clinical Trial RegistrationClinicalTrials.gov ID: NCT00195858.

Dietary Interventions for Weight Management in Adolescents: Preliminary Evidence‐Mapping Analysis Results

ObjectiveTo summarize published evidence on dietary interventions for weight management in adolescents using evidence mapping, an emerging method that aims to identify relevant literature on a broad field in order to assess both the existing evidence and the remaining gaps.MethodsA comprehensive literature search on Ovid MEDLINE® (from 1994 to 2015) was performed to identify dietary intervention studies in adolescents (≥10 to ≤19y), with changes in weight, body mass index, and/or body composition parameters as primary or secondary outcomes. Interventions consisted of various types of dietary manipulation, including changes in macronutrient intakes, dietary patterns, food groups, and individual food components or ingredients, individually or in combination with physical activity. The search strategy was designed to be broad in order to identify a wide range of publications to be further refined against pre‐designated inclusion and exclusion criteria. The resulting titles, abstracts, and keywords of all articles identified were screened using a web‐based citation screening tool, AbstrackrTM (http://abstrackr.cebm.brown.edu/) with a low threshold to exclude irrelevant abstracts. Data relevant to PICOD (Population, Intervention, Comparator, Outcome, and study Design) were extracted and preliminary descriptive analyses were performed.ResultsThe initial literature search yielded 5,555 citations. The first 1,500 (27%) abstracts were reviewed independently by two researchers based on pre‐defined study eligibility criteria and discrepancies were resolved by discussion, the remaining abstracts were single screened. Of these 1,500 abstracts screened, 114 full‐text articles were reviewed and 16 studies met inclusion criteria. After full‐text review, the most common reason for exclusion was that the studies did not use specific dietary manipulations as their primary intervention, and only addressed diet as part of larger lifestyle counseling and behavioral interventions. The mean age of the participants ranged from 11.2 to 17.9 years and 58.3% of them were female. Out of the 16 included studies, 14 were randomized controlled trials (RCTs) and 2 were single‐arm, before‐and‐after trials. The dietary interventions varied between the studies: the most common interventions were manipulations of dietary patterns (43.8%) or foods (31.2%) followed by dietary manipulations in combination with physical activity (25.0%). The durations of the interventions ranged from 2 weeks to 23 months. Each study assessed multiple outcomes of interest with the most studied outcome measures being changes in waist circumference (81.3%), weight (75.0%), and body mass index (68.8%).ConclusionOur preliminary results show that research evaluating the effects of dietary manipulation on body weight and related outcomes in adolescents is limited. Evidence mapping is a useful method to inform researchers, policy makers and funders on the research gaps in our understanding of dietary approaches for weight management in this population.Support or Funding InformationFunding provided by Biofortis Clinical Research (Addison, IL).

Caregiver Preferences regarding Technology's Role in Supporting Adolescent Weight Management.

Background. Health technology provides a wealth of strategies to address chronic health issues, such as childhood obesity. Few studies have assessed parental preferences regarding use of health technology to support weight management for adolescents. Objective. This study determined caregiver beliefs, attitudes, and practices towards using traditional methods and technology-based health applications to address weight management among overweight adolescents. Methods. Self-administered surveys were distributed to caregivers of children ages 11–18 years in Stony Brook Children's Hospital outpatient offices with a BMI ≥ 85th percentile for age, gender. The data were entered into StudyTrax research platform and analyzed using SAS. Results. N = 114. Mean BMI z-score = 1.95 ± 0.50. Two-thirds (65.8%) of caregivers preferred a weight management program that includes both traditional and technology components. Most parents rated involvement in program development (68.1%), access to content (72.4%) as very important. Those who believed their child's weight was a problem (p = 0.01) were more likely than other parents to prefer a program that combined both traditional and technology components. Conclusions. Parents' perceptions of their child's weight drove preferences about incorporating technology elements into a weight management program. Future weight management programs should incorporate parental content preferences and be tailored to different age groups.

Parents' perspective on weight management interventions for adolescents with intellectual and developmental disabilities

BackgroundAdolescents with intellectual and developmental disabilities (IDD) have high rates of obesity. However, little research has been conducted demonstrating effective strategies and barriers for weight loss or weight management in adolescents with IDD. Furthermore, parents play a large role in terms of weight management in children and adolescents with IDD, and their views should be taken into consideration when designing a diet and PA intervention for weight management. ObjectiveThe aims of this study are to better understand the parents' perspectives on the strategies and barriers for helping children and adolescents with IDD be successful in a weight management program and to identify how this information to guide future approaches. MethodsSemi-structured interviews were conducted in 18 parents whose children had just finished a diet and PA intervention. Interviews were transcribed verbatim, and thematic analysis was performed. ResultsParents reported a positive attitude toward the program, liked the convenience of the program, and felt that they learned beneficial strategies to encourage healthy habits in the home. Parents found time to be a major barrier to supporting their child with a diet and PA intervention. Parents were willing to change their own dietary behaviors to help their children successfully follow a weight loss intervention; however, no parent reported changing their own PA levels. ConclusionFuture diet and PA studies should aim to reduce parental time commitment and increase importance of PA.

Study protocol: evaluation of 'JenMe', a commercially-delivered weight management program for adolescents: a randomised controlled trial.

BackgroundEarly lifestyle intervention with overweight and obese adolescents could help to avoid serious health events in early adulthood, ultimately alleviating some of the strain on the public health system due to obesity-related morbidity. Commercial weight loss programs have wide reach into the community setting, and have demonstrated success in long term weight management in adults, beyond that of current public health care. Commercial weight-management programs have not been evaluated as a method of delivery for overweight and obese adolescents. This study aims to evaluate the efficacy of a new adolescent weight management program in a commercial environment.MethodsOne hundred and forty adolescents, 13 to 17 years old, will be randomised to either a weight management program intervention or a wait-listed group for 12 weeks. The commercial program will consist of a combined dietary and lifestyle approach targeting improved health behaviours for weight-loss or weight-stability. Participants will be overweight or obese (above the 85th percentile for BMI) and without existing co-morbidities. Outcome measures will be assessed at baseline and after 12 weeks. Primary outcome measures will be changes in BMI Z-score and waist-height ratio. Secondary outcome measures will include changes in behaviour, physical activity and psychosocial wellbeing. Intervention participants will be followed up at 6 months following completion of the initial program. Ethics approval has been granted from the Monash University Human Research Ethics Committee (CF11/3687–2011001940).DiscussionThis independent evaluation of a weight management program for adolescents, delivered in a commercial setting, will provide initial evidence for the effectiveness of such programs; which may offer adolescents an avenue of weight-management with ongoing support prior to the development of obesity related co-morbidities.Trial registrationThe protocol for this study is registered with the International Clinical Trials Registry ISRCTN13602313.

Human adenovirus 36. Prevalence, association with obesity and response to inpatient weight management in Czech adolescents

Human adenovirus 36. Prevalence, association with obesity and response to inpatient weight management in Czech adolescents

Associations of the Home Food Environment with Eating Behaviors and Weight Status among Children and Adolescents

Primary objective: Understanding the aspects of the home food environment of children and adolescents such as the availability, accessibility, and visibility of home healthy and unhealthy foods and the frequency and quality of family meals is necessary for developing direct interventions for weight management. This review examined the literature on associations of home food environment including availability, accessibility, and visibility of home healthy and unhealthy foods and frequency and quality of family meals with children’s eating behaviors and weight status and methods to assess the availability and accessibility of foods in the home. Main outcomes and results: Research suggests:1) the availability and/or accessibility of home healthy or unhealthy foods were associated with children or adolescents’ dietary intakes; 2) the link between home food availability and accessibility with weight status is weak; 3) the evidence on associations of frequency or nutritional quality of family meals with weight status is inconsistent; 4) the in-home assessments for food availability, accessibility and visibility appear to be necessary; however the assessment tools may need to be further improved to capture the quantity of the healthy and unhealthy foods in the home; and 5) repeated in-home assessments are needed to help determine the stability of foods routinely purchased at home. Conclusions: The obesogenic home environment is complex. This review aims to provide valuable insights for designing direct interventions for weight management in children and adolescents by improving their home food environment.

A process evaluation of an adolescent weight management intervention: findings and recommendations.

Process evaluation is valuable in guiding development of effective intervention programmes but rare in adolescent weight management. This paper presents a process evaluation of the Loozit(®) randomized controlled trial, a community-based behavioural lifestyle intervention for obese 13-16 year olds. Adolescents were randomized to receive the two-phase Loozit(®) group programme, with (n = 73) or without (n = 78), additional therapeutic contact (telephone coaching, short message service and/or emails) in Phase 2. Quantitative and qualitative process data were collected. Facilitators used a standardized evaluation form to document participant attendance, and comment on lesson adherence and process delivery. Adolescents and parents completed satisfaction questionnaires at 2-, 12- and 24-month follow-ups. Following the intervention, 14 adolescents who provided informed written consent were interviewed about their experience with additional therapeutic contact. Data were analysed using descriptive statistics, parametric and non-parametric tests to compare group means, and thematic analyses. Group attendance rates averaged 85 and 47% during Phases 1 (0-2 months) and 2 (3-24 months), respectively. Facilitators frequently noted that participants reported making healthy lifestyle changes. Elements enjoyed in the sessions included practical activities, fun active games, resistance training and forming new friendships. Adolescents struggled with setting specific, measurable, achievable, realistic and timely (SMART) goals. Overall, participants were satisfied with the help received including the telephone and electronic contact. More than 80% of participants found the programme changed adolescents' eating and physical activity habits, and 89% of parents reported changing parenting strategies. Future adolescent group-based programmes may enhance participant engagement and programme effectiveness by including more interactive and frequent telephone and electronic contact.

The contribution of fat-free mass to resting energy expenditure: implications for weight loss strategies in the treatment of adolescent obesity

Owing to the strong relationship between fat-free mass (FFM) and resting energy expenditure (REE), the preservation of FFM is often emphasized in the treatment of adolescent obesity. Typical treatment regimens including an increased dietary consumption of protein and participation in resistance training are common components of adolescent weight management programs, despite limited evidence of a positive influence of FFM on weight loss outcomes in adolescents. Given the larger volume of FFM in obese relative to normal weight adolescents and the common treatment goals of both maximizing weight loss and attenuating the loss of FFM, a better understanding of the influence of FFM on energy balance is needed to determine whether strategies to preserve lean tissue or maximize absolute weight loss should be most emphasized. We review the associations among FFM, REE, and weight loss outcomes, focusing on how these relationships might influence energy balance in obese adolescents.

Usability of an internet-based platform (Next.Step) for adolescent weight management

ObjectiveThe current study evaluates the usability perception of an e-therapeutic platform (supported by electronic processes and communication), aiming to promote the behavior change and to improve the adolescent health status through increased and interactive contact between the adolescent and the clinical staff. MethodsThis was a correlational study with a sample of 48 adolescents (12-18 years) who attended a Pediatric Obesity Clinic between January and August of 2012. Participants were invited to access, during 24 weeks, the e-therapeutic multidisciplinary platform (Next.Step) in addition to the standard treatment program. A usability questionnaire was administered and the platform performance and utilization indicators were analyzed. ResultsThe users’ perception of satisfaction, efficiency, and effectiveness regarding the Next.Step platform was clearly positive. However, only 54.17% of the enrolled adolescents accessed the platform, with a mean task-completion rate of 14.55% (SD=18.853). The higher the number of the platform consulted resources, the greater the tendency to enjoy the platform, to consider it exciting and quick, to consider that the time spent in it was useful, to consider the access to information easy, and to login easier. Post-intervention assessment revealed a significant reduction in anthropometric and behavioral variables, including body mass index z-score, waist circumference percentile, hip circumference, and weekly screen time. ConclusionThese results highlight the importance of information and communication technologies in the health information access and the healthcare provision. Despite the limited adherence rate, platform users expressed a positive overall perception of its usability and presented a positive anthropometric and behavioral progress.

A Collaborative Effort to Address Adolescent Obesity in Primary Care

Adolescent obesity is a growing national healthcare concern. Barriers to effective treatment, such as limited time for office visits and limited reimbursement for obesity counseling, leave both patient and practitioner feeling frustrated and unsupported. This article will discuss the adolescent weight management program, Triple E: Eat, Exercise, and Enjoy. This program was created in collaboration with a pediatric primary care practice, a local university, an affiliated pediatric practice within the health system, the local middle school, and the community. Triple E was developed, with minimal funding, to combat the adolescent obesity epidemic occurring in a primary care practice.

A Qualitative, Exploratory Study of Predominantly Female Parental Perceptions of Consumer Health Technology Use by Their Overweight and/or Obese Female Adolescent Participating in a Fee-Based 4-Week Weight-Management Intervention

Consumer health technologies (CHTs) are a growing part of the continuum of care for self-management of overweight and obesity. Parents positively or negatively influence adolescent weight-management efforts and are especially important throughout continuum of care settings. User-centered design (UCD) applications have been developed to assist primary users, such as adolescents, with their weight management, but less is known about the influence of parents as secondary users across many socio-ecological environments. The purpose of this study was to use the Unified Theory of Acceptance and Use of Technology (UTAUT) to inform the design of a UCD application in a qualitative study that sought to determine parental views on how technology can support previously learned behaviors that require ongoing management and support beyond formal lifestyle interventions. Parents of overweight and obese adolescents (n=14) were interviewed about perceived usefulness and planned user-intent of CHT that was designed for adolescents. UTAUT provided theoretical parental constructs (intention, performance and effort expectancy, and social influence) interactions within several socio-ecological contexts, including the home food environment and restaurant dining experiences. Although generalizations of this qualitative study are limited by a small sample size with predominantly mothers (n=13) of overweight and obese daughters (n=12), the exploratory inquiry using a parent as a secondary consumer user can complement the adoption of applications designed by adolescents.

Effects of a summer program for weight management in obese children and adolescents in Shanghai.

To investigate the effects of a combined intervention of diet and physical activity on body composition, resting energy expenditure (REE) and metabolic factors in obese children and adolescents. Twenty obese children and adolescents aged 7 to 17 years completed a 4-week summer camp program which focussed on personal behaviour, including energy-restricted diets and supervised physical activity. Anthropometry, bioelectrical impedance, ultrasonography (US) for subcutaneous and hepatic fat, and abdominal Magnetic Resonance Imaging assessments were made and blood pressure (BP) recorded before and after the 4-week intervention. 1) Weight loss was 7.2 ± 2.2 kg, with losses of 5.5 ± 2.2 kg and 1.7 ± 1.2 kg in fat mass (FM) and fat free mass (FFM), respectively, with associated reductions in abdominal and hip fat and in the waist/hip circumference ratio and in BP. 2) There were no significant changes in REE or in its ratio with weight. 3) Reductions in uric acid, total cholesterol, triglycerides, LDL cholesterol, HbA1C, insulin, C-Peptide and insulin resistance (HOMA-IR) and the ratio of fatty liver were observed, but not in the inflammatory marker hsCRP. With behavioural intervention during a summer camp, body fat and its distribution were favourably changed, but with some loss of lean mass. However, there were no detectable reductions in REE. Weight management programs which achieve fat loss with maintenance of REE ought to be more sustainable.

Adolescent and parent views of an adolescent weight management program: Lessons from the Loozit® randomised controlled trial

group (under 17 years at follow-up) higher levels of PA were associated with higher HRQoL. In the older group both PA and SBM were associated with HRQoL. Among overweight/obese adolescents, positive relationships existed between SBM and HRQoL and for normal weight adolescents similar relationships existed between PA and HRQoL. Conclusion: Physical activity or less frequent use of SBM was associated with higher HRQoL scores. This suggests that, independent of the effects of PA or SBM on body weight, it is important that these behaviours are targeted as maintaining high levels of HRQoL is critical especially in adolescence.

Responding to Pediatric Providers’ Perceived Barriers to Adolescent Weight Management

Primary care clinics are an ideal setting for early identification and possibly treatment of adolescent obesity. However, despite practice recommendations promoting preventive screening and monitoring of obesity, implementation has been modest. In this study, we interviewed providers to determine barriers to managing pediatric obesity, perceived skill in obesity interventions, and interest in additional training. The sensitivity of weight-related discussions and time were the 2 most significant barriers reported. We designed a brief training program, implemented it within a larger randomized controlled trial, and surveyed providers regarding its utility. The training was satisfactory to attendees and led to reported changes in practice patterns. Providers who received more complete training reported greater ease working with overweight teens and greater confidence that they could motivate teen patients to make healthy lifestyle changes compared with those who received less training. A fairly modest training intervention could improve patient care in the primary care setting.

An initial evaluation of a family‐based approach to weight management in adolescents attending a community weight management group

BackgroundFamily-based approaches are recommended for the prevention and management of childhood obesity. Given the large numbers of obese children, scalable practical solutions are required. The present study evaluated a family-based national programme that aimed to empower adolescents to adopt healthier lifestyles.MethodsGroup facilitators supporting more than six young members (11–15 years) participated in the study. A questionnaire was designed to determine the characteristics of the adult attending with the adolescent, any health professional recommendations given and the young member’s integration within traditional adult weight management groups. Data on measured height and weight [and calculated body mass index (BMI)], sex and attendance were collated from member’s records.ResultsQuestionnaires were completed by 22 facilitators (15% response rate), representing data for 128 young members with complete weight data available for 106. All members had a joining BMI > 91st centile, with 68% >98th centile. The mean (SD) number of weeks attended was 12.5 (8.1), with 19% (20) having attended for more than 20 weeks with 62% still attending. A mean (SD) BMI Z-score change of 2.49 (0.72) to 2.27 (0.74) was achieved (P < 0.001). The relationship of the adult supporter to the young member was varied, with 62% either already members or joining alongside their daughter/son. Limited guidance was provided by health professionals before or during attendance. Facilitators were comfortable about the age mix within groups.ConclusionsThe community weight management organisation studied takes a family-based approach and successfully supports young members to manage their weight.

Twelve-Month Outcomes of the Loozit Randomized Controlled Trial

To assess the outcomes of the Loozit adolescent weight management intervention and to evaluate the effect of additional therapeutic contact 12 months into the program. A 24-month, 2-arm randomized controlled trial. Results at 12 months are presented. Community health center and children's hospital in Sydney, Australia. A total of 151 overweight or obese 13- to 16-year-olds. In the first 2 months (phase 1), participants received 7 adolescent and parent weekly sessions focused on lifestyle modification. From 2 to 24 months (phase 2), adolescents attended booster sessions once every 3 months. During phase 2, adolescents randomized to the additional therapeutic contact arm also received telephone coaching and electronic communications once every 2 weeks. Baseline to 12-month changes in body mass index z score and waist to height ratio (primary outcomes) and changes in metabolic, psychosocial, and behavioral variables. Of 151 randomized adolescents, 82.1% completed 12-month follow-up. Intent-to-treat analyses showed significant reductions in mean body mass index z score (-0.09; 95% CI, -0.12 to -0.06), waist to height ratio (-0.02; 95% CI, -0.03 to -0.01), total cholesterol level (-4 mg/dL; 95% CI, -8 to 0 mg/dL; to convert to millimoles per liter, multiply by 0.0259), and triglycerides level (geometric mean, -80 mg/dL; 95% CI, -88 to -71 mg/dL; to convert to millimoles per liter, multiply by 0.0113). Most psychosocial outcomes improved, including global self-worth, but there were few dietary, physical activity, or sedentary behavior changes. No difference was found in primary outcomes between participants who did or did not receive additional therapeutic contact. The Loozit randomized controlled trial produced a significant but modest reduction in body mass index z score and improved psychosocial outcomes at 12 months. Supplementary telephone and electronic contact provided no additional benefit at 12 months. Trial Registration anzctr.org.au Identifier: 12606000175572.

Preparing Adolescents for Bariatric Surgery: Foundational Elements Applying Erikson's Theory of Human Development

Obesity prevention is a national initiative with the attention of First Lady Michelle Obama and is being addressed on many levels with a multifactorial approach. However, many children and adolescents are beyond the benefit of prevention efforts and need treatment. Bariatric surgery in the adolescent population is a broadly debated topic that generates valuable discussion about the management of childhood obesity. This article seeks to describe the unique and pertinent developmental aspects of preparation and support given to obese adolescents and their families, and to present the experience at the University of Illinois Medical Center Adolescent Weight Management Program in Chicago, Illinois. There is a lack of scientific evidence in the current literature addressing what factors influence an adolescent's success with weight loss surgery, or clinical practice guidelines that outline recommendations for preparation of adolescents for bariatric surgery. It is the hope that reporting this experience will stimulate more scientific inquiry in this area. The purpose of this article is to encourage the provider to focus toward assisting the adolescent through the educational and psychosocial stages, with a goal of creating a solid foundation for success with bariatric surgery. The following stages and themes are noted from our clinical and management experience with adolescents in a weight management program that included the option of bariatric surgery. Erikson's Psychosocial Theory of Human Development1 was the construct for the developmental care provided in this novel program at the University of Illinois Medical Center.

77. Outcomes of a Pilot Study of a Physician and Nurse Delivered Adolescent Weight Management Program

Successful weight management in children and adolescents requires a multidisciplinary program based around behavior modification and motivation. Doctors and nurses manage substantial numbers of young people with obesity each year. There are currently no evidence-based behavioral interventions for young people that can be delivered in the office setting by physicians and nurses. Multidisciplinary programs for children and young people are usually labor intensive and expensive, and behavior changes are often difficult to maintain once they cease.