Identification and correlates of weight loss in adolescents in a national sample

A visualized and scientometric analysis of research trends of weight loss in overweight/obese children and adolescents (1958-2021)

Background

Weight loss is an appropriate approach to reduce the health risks associated with overweight/obese children and adolescents, and the optimal method of weight loss requires further research. This study systematically explores scientific co-operation, disciplinary interaction, hotspots and trends in the field of weight loss in overweight/obese children and adolescents (WLOCA), and provides references for further research.

Methods

Citespace 5.8.R1 (64-bit) was adopted to conduct a comprehensive visualization analysis of the literature on WLOCA from Web of Science Core Collection, including publication, institution, country/region, author, journal, keywords and reference.

Results

2,513 papers were found in the Web of Science Core Collection, and the annual number of papers published has increased significantly since 2003. Cincinnati Children's Hospital is the institution with the largest number of publications, while Washington University plays a pivotal role in the collaboration network. In terms of nations, USA has made greater contributions than the rest in terms of the number of publications and global co-operation research. The most influential authors in this field are Thomas H. Inge, Thomas Reinehr, Todd M. Jenkins, Epstein LH, Ogden CL, etc. The most active journals are "Obesity," "International Journal of Obesity," "Obesity Surgery," "Pediatrics," etc. which are characterized by interdisciplinary interactions. Research hot topics mainly include "assessment of obesity and pathophysiological mechanism," "comprehensive intervention," and "bariatric surgery," and there's a gradual shift from "lifestyle intervention" and "pathophysiological mechanism" to "clinical surgical application." In addition, disciplinary integration and comprehensive research, targeted intervention and treatment, and prospective research are the future research trends.

Conclusion

The overall trend in WLOCA study is positive. The main contribution of this study is to reveal the overall picture of the research in this field with visual maps and detailed data by combining quantitative with qualitative approaches, which can provide valuable references for relevant researchers to quickly understand the status of studies on WLOCA, to seek co-operation, and grasp research hotspots and frontier trends.

Effects of school-based "We Fit" weight control programme in adolescents

Aim

This study examined the effects of a 12‐week school‐based “We Fit” weight control programme.

Design

A nonequivalent control group was used, with a non‐synchronized pretest–posttest design.

Methods

In total, 109 Korean high school adolescents participated. The programme comprised exergaming, diet diary and counselling, health education, and social networking service‐based group discussions. Anthropometric factors, physiological factors and physical activity (daily steps and sitting time) were measured in the intervention and the control groups before and after the intervention. Programme satisfaction was assessed post‐intervention. Data were analysed using descriptive statistics; the chi‐square, Mann–Whitney U and t tests; and generalized estimating equations.

Results

The intervention group showed a significantly decreased waist circumference, increased skeletal muscle mass, increased high‐density lipoprotein cholesterol, decreased low‐density lipoprotein cholesterol and reduced weekend sitting time.

Conclusion

This study adds to the evidence for the applicability and effectiveness of healthy weight control programmes using exergames for adolescents in school settings.

Do sex differences in reported weight loss intentions and behaviours persist across demographic characteristics and weight status in youth? A systematic review

Background

Evidence suggests that young females are more likely to try to lose weight than young males, however whether this sex difference persists across demographic characteristics and weight status is unclear. Further, whether females are more likely than males to try to lose weight using unhealthy weight loss strategies has never been systematically assessed. The objective of this systematic review was to examine the literature on sex differences in weight loss intentions and strategies in children and adolescent observational studies to determine whether sex differences persisted across demographic characteristics (race/ethnicity, grade level) and weight status.

Methods

Relevant articles published after 1990 were identified using PubMED, Web of Science, and PsycInfo. Searches were conducted in May of 2015 and again in May of 2017. Studies conducted in the US and Canada with participants 18-years old or younger who measured weight loss strategies in the context of weight loss intention were selected. Descriptive statistics were extracted from 19 studies.

Results

Almost two-thirds of youth reported trying to lose weight. High-school and middle-school aged females reported consistently higher prevalence of weight loss intentions compared to male counterparts, as did Caucasian, African-American, and Hispanic females. The proportion of youth using unhealthy or extreme strategies reached 44 and 13%, respectively, with a similar proportion of males and females endorsing the use of each category of weight loss strategies across studies. Native-American youth reported the highest prevalence (27%) of using extreme strategies.

Conclusions

Researchers should consider demographic characteristics when reporting prevalence information for weight loss intentions and behaviours, as certain groups might require more targeted public health initiatives. Across characteristics, prevalence ranges were broad for weight loss intentions and use of particular strategies, suggesting the need to standardize and refine data collection and reporting practices in this literature.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-6179-x) contains supplementary material, which is available to authorized users.

Successful weight loss initiation and maintenance among adolescents with overweight and obesity: does age matter?

Treatments for adolescents with overweight/obesity demonstrate mixed success, which may be due to a lack of consideration for developmental changes during this period. Potential developmental differences in weight loss motivations, weight maintenance behaviours and the role of parents in these efforts were examined in a sample of successful adolescent weight losers. Participants enrolled in the Adolescent Weight Control Registry (n = 49) self-reported demographic information and weight history, reasons for weight loss and weight control, weight loss approach and weight maintenance strategies, and perceived parental involvement with weight loss. Associations between age at weight loss initiation and the aforementioned factors were examined using linear and generalized regressions, controlling for highest z-BMI and sex. Adolescents who were older (≥16 years) at their weight loss initiation were more likely to report losing weight on their own (37.5% vs. 75%, P = 0.01) and reported greater responsibility for their weight loss and weight loss maintenance (P < 0.001) compared to younger adolescents. Younger age at weight loss initiation was associated with greater parental involvement (P = 0.005), whereas older age was associated with greater adolescent responsibility for the decision to lose weight (P = 0.002), the weight loss approach (P = 0.007) and food choices (P < 0.001). Findings suggest the importance of considering developmental differences in responsibility for weight loss and maintenance among adolescents with overweight/obesity.

'Now I care': a qualitative study of how overweight adolescents managed their weight in the transition to adulthood

OBJECTIVES

A qualitative study of recalled experiences of early adolescent overweight/obesity revealed low levels of weight-related concern. This further analysis aimed to explore weight-related concern and weight-loss efforts as participants transitioned into adulthood.

DESIGN, PARTICIPANTS AND METHODS

Participants were 35 young adults from a population-based cohort study who had body mass index (BMI) >95th centile between ages 11 and 15 and participated in semistructured interviews aged 24. At age 24, they were categorised as: 'slimmers' (N=13) who had lower BMI Z-scores at 24 than their adolescent peak and were not obese (BMI<30 kg/m²); 'relapsers' (N=8, of whom 2 were morbidly obese (BMI>35 kg/m²) at age 24); 'stable' (N=3, of whom 1 morbidly obese); and 'gainers' (N=11, of whom 5 morbidly obese). Themes were identified and coded using NVivo qualitative data analysis software, blind to participants' current weight status.

RESULTS

Contrasting with the lack of concern recalled in respect of earlier adolescence, weight-related concerns and/or desire to lose weight generally increased around the time of school leaving and almost all participants described some form of exercise (formal/informal) and dietary weight-control strategies. Among 'slimmers', there was some (subtle) evidence of more consistent use of exercise, self-monitoring of diet and exercise and of lifestyle changes becoming habitual and/or part of identity. Few participants had accessed professional support. Diet clubs seemed to have been used most by 'gainers', some only recently. Labour-market and housing transitions were strong influences, described as facilitating weight losses by some, but increases by others. For some participants, it appeared that weight loss was simply a by-product of these transitions.

CONCLUSIONS

In contrast to earlier adolescence, even the heaviest participants tended to show actual weight loss action or preparation for action. The transition to adulthood could thus be a key life stage for interventions.

Characteristics of a Favorable Weight Status Change From Adolescence to Young Adulthood

PURPOSE

To explore 10-year longitudinal predictors (personal, psychological, behavioral, and socioenvironmental) of exiting obesity from adolescence to young adulthood.

METHODS

Data were collected from a population-based cohort of adolescents (n = 2,287) attending middle/high schools in Minneapolis-St. Paul in 1998-1999 (mean age = 14.9) and again in 2008-2009 (mean age = 25.3) participating in Project Eating and Activity Among Teens and Young Adults. Self-reported height and weight were used to calculate weight status change between adolescence and young adulthood, among participants with obesity at baseline (n = 175). Questionnaires assessed personal, psychological, behavioral, and socioenvironmental factors hypothesized to play a role in obesity. Modified Poisson regressions estimated adjusted relative risks (RRs) for exiting obesity as a function of each baseline and 10-year change in predictor, controlling for relevant covariates.

RESULTS

Thirty-two percent of adolescents exited obesity in young adulthood. Reductions in fast food intake (RR = .73, 95% confidence interval [CI] = .61-.87) and screen time (RR = .98, 95% CI = .96-.99), and increases in fruit/vegetable intake (RR = 1.06, 95% CI 1.01-1.12), moderate-to-vigorous physical activity (RR = 1.06, 95% CI = 1.00-1.12), home fruit/vegetable availability (RR = 1.58, 95% CI = 1.19-2.09), family meals (RR = 1.12, 95% CI = 1.03-1.22), and serving vegetables at dinner (RR = 1.45, 95% CI = 1.10-1.92) were associated with exiting obesity. Not dieting as an adolescent and improvements in body satisfaction, depressive symptoms, self-esteem, and weight teasing were also associated with exiting obesity.

CONCLUSIONS

Promoting healthy eating and activity, and improving the healthfulness of home food environments may be promising intervention targets for promoting healthier weights in adolescents and young adults with obesity. Addressing dieting behavior and the psychosocial health of adolescents with obesity may also be needed throughout the transition to young adulthood.

Predictors of Weight Loss in Young Adults

BACKGROUND

Increased understanding of weight loss among healthy young people in naturalistic settings could inform the development of effective weight control programs. The aim of this study was to describe loss in BMI over 7 years in a population-based sample of healthy young adolescents (mean age 17 years at beginning of follow-up) and identify determinants of BMI loss.

DESIGN AND METHOD

Data were available for 681 participants in the Nicotine Dependence in Teens Study (1999-2012), a longitudinal investigation of adolescents in Montreal (Canada). Loss in BMI was assessed between age 17 and 24 years. Potential predictors of BMI loss including age, sex, mother's education, worry about weight, physical activity, screen time, and cigarette smoking were studied in multivariable logistic regression.

RESULTS

Males and females gained 2.0 and 1.4 BMI units, respectively, on average, between age 17 and 24 years. However, 9% of males and 14% of females experienced a loss in BMI ≥1.0 unit. Female sex and a higher BMI at age 17 were associated with a higher probability of BMI loss, but none of age, mother's education, physical activity, screen time, or cigarette smoking were associated with BMI loss between ages 17 and 24.

CONCLUSIONS

Whereas BMI increased on average between age 17 and 24 years in a population-based sample of healthy young people, 12% of participants experienced a loss in BMI ≥1 unit. Weight loss was highest among the heaviest persons and did not affect the prevalence of underweight. No single behavior at age 17 stands out as associated with predicting BMI loss.

Who's calling for weight loss? A systematic review of mobile phone weight loss programs for adolescents

CONTEXT

Adolescent overweight and obesity are ongoing public health concerns, and innovative weight loss interventions are needed to reach this age group.

OBJECTIVE

The objective of this systematic review was to assess and synthesize the literature on adolescent weight loss programs that utilize cell phones as an intervention component to reduce weight, as measured by body mass index or body mass index z-score.

DATA SOURCES

A systematic review of the literature, consistent with PRISMA guidelines, was undertaken using 11 databases.

STUDY SELECTION

Studies of weight loss interventions published in peer-reviewed journals in English during the last 10 years were eligible for inclusion if they examined an adolescent population, used validated measures for pre- and post-test weight, identified weight loss as a primary or secondary outcome, and specified use of cell phones to deliver a component of the program.

DATA SYNTHESIS

While within-group weight loss results were noted, no significant between-group differences were found across the majority of studies reviewed. Cell phone components were embedded within larger weight loss programs, making it difficult to determine their true effect.

CONCLUSIONS

Cell phone use is ubiquitous and, as such, may offer an interesting addition or alternative to current weight loss programs, particularly for adolescents who are considered digital natives. Future research in this area should be systematic in design so that the true effect of the individual components (i.e., cell phones) can be detected.

A qualitative study of successful adolescent and young adult weight losers: implications for weight control intervention

BACKGROUND

Our study aims to provide an in-depth analysis of behavioral strategies, psychological factors, and social contributors to adolescent weight loss and weight loss maintenance among participants in the Adolescent Weight Control Registry (AWCR).

METHODS

Qualitative analyses were conducted using semi-structured interview data from 40 participants from the AWCR who successfully lost ≥10 lbs and maintained their weight loss for at least one year.

RESULTS

In contrast to existing literature, our findings suggest that primary motivating factors for adolescent weight loss may be intrinsic (e.g., desire for better health, desire to improve self-worth) rather than extrinsic. In addition, life transitions (e.g., transition to high school) were identified as substantial motivators for weight-related behavior change. Peer and parental encouragement and instrumental support were widely endorsed as central to success. The most commonly endorsed weight loss maintenance strategies included attending to dietary intake and physical activity levels, and making self-corrections when necessary.

CONCLUSIONS

Results from this study highlight considerations for future adolescent weight control treatment development.

Family support and weight-loss strategies among adolescents reporting sustained weight loss

OBJECTIVE

The current research aims to describe the weight-control strategies and family support for young people reporting sustained weight loss in a large, population-based sample.

DESIGN

Data were collected as part of Youth'07, a nationally representative survey of the health and well-being of New Zealand youth.

SETTING

New Zealand secondary schools, 2007.

SUBJECTS

Secondary-school students (n 9107).

RESULTS

Among young people who attempted weight loss in the previous year, 51% reported long-term weight loss (lost weight and maintained weight loss for 6 months). Students reporting long-term weight loss were more likely to be male, but did not differ by age, ethnicity, socio-economic deprivation or measured weight status from students who reported temporary/recent weight loss or no weight loss. Students with long-term weight loss also reported healthier weight-control strategies (e.g., exercising, eating fewer fatty foods, eating fewer sweets), high parental support for healthy eating/activity and were less likely to report being teased about their weight by their family and having junk food available at home than students with temporary/recent weight loss or no weight loss.

CONCLUSIONS

Approximately 50% of young people attempting weight loss reported sustained weight loss. Young people who reported sustained weight loss appeared to have more family support than those who did not achieve this, suggesting the importance for weight-control services and interventions in adolescents of actively engaging the family.

Systematic review of sedentary behaviour and health indicators in school-aged children and youth

Accumulating evidence suggests that, independent of physical activity levels, sedentary behaviours are associated with increased risk of cardio-metabolic disease, all-cause mortality, and a variety of physiological and psychological problems. Therefore, the purpose of this systematic review is to determine the relationship between sedentary behaviour and health indicators in school-aged children and youth aged 5-17 years. Online databases (MEDLINE, EMBASE and PsycINFO), personal libraries and government documents were searched for relevant studies examining time spent engaging in sedentary behaviours and six specific health indicators (body composition, fitness, metabolic syndrome and cardiovascular disease, self-esteem, pro-social behaviour and academic achievement). 232 studies including 983,840 participants met inclusion criteria and were included in the review. Television (TV) watching was the most common measure of sedentary behaviour and body composition was the most common outcome measure. Qualitative analysis of all studies revealed a dose-response relation between increased sedentary behaviour and unfavourable health outcomes. Watching TV for more than 2 hours per day was associated with unfavourable body composition, decreased fitness, lowered scores for self-esteem and pro-social behaviour and decreased academic achievement. Meta-analysis was completed for randomized controlled studies that aimed to reduce sedentary time and reported change in body mass index (BMI) as their primary outcome. In this regard, a meta-analysis revealed an overall significant effect of -0.81 (95% CI of -1.44 to -0.17, p = 0.01) indicating an overall decrease in mean BMI associated with the interventions. There is a large body of evidence from all study designs which suggests that decreasing any type of sedentary time is associated with lower health risk in youth aged 5-17 years. In particular, the evidence suggests that daily TV viewing in excess of 2 hours is associated with reduced physical and psychosocial health, and that lowering sedentary time leads to reductions in BMI.

Factors associated with weight loss dieting among adolescents: the 11-year follow-up of the 1993 Pelotas (Brazil) birth cohort study

Evidence has shown the negative effects of unsupervised diets and those with excessive calorie restriction. The aim of this study was to determine the proportion of adolescents engaging in weight loss dieting and associated factors. This was a cross-sectional study of 4,452 adolescents born in Pelotas, Rio Grande do Sul State, Brazil, in 1993. The outcome was defined as adolescents that reported having practiced some type of weight loss dieting in the previous 12 months. Prevalence of such dieting was 8.6% (95%CI: 7.7;9.4), and was higher in girls. Elevated maternal body mass index (BMI) was associated with dieting among girls. The adolescent's and parents' view of the adolescent's weight, excess weight, and consumption of diet or light soft drinks were associated with adolescent dieting. There was a positive association between dieting and socioeconomic status. The findings provide important backing for policies aimed at improving adolescents' diet, since they express a major concern over weight and thus a significant percentage of individuals with erroneous and unhealthy behaviors.

Analysis of Weight Control in Korean Adolescents Using the Transtheoretical Model

The purpose of this study was to identify the stages of change, the processes of change, and the decisional balance for weight control, self-efficacy, and other weight control—related variables and to determine the significant factors explaining movements between the stages of change in Korean adolescents. A total of 475 adolescents completed questionnaires and anthropometric measures. The majority of the adolescents were in the precontemplation (42.1%) and contemplation (43.0%) stages. The benefits of weight control (pros), desire for weight change, perceived body shape, and past experience with weight control increased the odds ratio of movement from precontemplation to contemplation. Stimulus control, self-reevaluation, regular exercise, and past experience of weight control significantly influenced the movement to action and maintenance from contemplation. The study results suggest that weight control programs should emphasize significant factors to help adolescents move through the stages of change.

Adolescent obesity and puberty: the "perfect storm"

Obesity is the most serious long-term health risk currently facing America's adolescents. Weight gain during adolescence carries a higher risk for adult obesity and the metabolic syndrome. This review highlights early adolescence as a particularly high-risk time for weight gain due to the synergy of naturally occurring metabolic changes along with increasing behavioral risk factors. One of the first potential health effects of abnormal weight gain during this period is earlier puberty, usually manifested as thelarche. The obesity epidemic is clearly implicated in the national trend toward earlier thelarche, although the data are not as strong in relation to menarche. Leptin activation of the hypothalamic-pituitary axis, combined with insulin resistance, and increased adiposity may result in the higher estrogen levels that are linked to breast development. Young adolescents also experience a sharp decline in their level of physical activity, worsening nutritional habits, and other important psychosocial and developmental risk factors that may contribute to obesity and estrogen-dependent disease in later life, including polycystic ovary syndrome and breast cancer. Unfortunately, the very psychosocial factors that contribute to abnormal weight gain during early adolescence make prevention and treatment in this population particularly challenging. Therefore, intervening prior to pubertal onset becomes even more important given the risk factors present once puberty begins.