Behavioral Weight Loss Intervention Preferences of Adolescents with Overweight/Obesity

Wellness Achieved Through Changing Habits: A Randomized Controlled Trial of an Acceptance-Based Intervention for Adolescent Girls With Overweight or Obesity

Background: Obesity prevalence among adolescent girls continues to rise. Acceptance-based therapy (ABT) is effective for weight loss in adults and feasible and acceptable for weight loss among adolescents. This pilot randomized controlled trial (RCT) assessed effectiveness of an adolescent-tailored ABT intervention on decreasing weight-related outcomes and improving psychological outcomes compared with enhanced care. Methods: In this 6-month, two-arm pilot RCT, participants were randomized to the ABT intervention or to enhanced care. The ABT intervention condition attended 15 virtual, 90-minute group sessions. The enhanced care comparison received 15 healthy lifestyle handouts and virtually met twice with a registered dietitian. The primary outcome assessed was change in BMI expressed as a percentage of the 95th percentile (%BMIp95). Results: Participants included 40 girls (ages 14-19) assigned to ABT (n = 20) or enhanced care (n = 20). A decrease in %BMIp95 was observed within the ABT intervention [d = -0.19, 95% confidence interval, CI: (-0.36 to -0.02)], however, not within the enhanced care comparison [d = -0.01, 95% CI: (-0.09 to 0.07)]. The ABT group showed slight changes in psychological flexibility [d = -0.34, 95% CI: (-0.62 to -0.06)] over enhanced care [d = -0.11, 95% CI: (-0.58 to 0.37)]. There was no significant intervention effect noted between groups. Conclusion: In this pilot RCT, the ABT intervention was as effective as enhanced care for weight loss. However, previous ABT studies occurred in person, and this study was conducted virtually due to COVID-19. Thus, future research investigating the potential effectiveness of ABT in-person among adolescents and optimization of virtual interventions is needed.

Weight-neutral interventions in young people with high body mass index: A systematic review

AIM

This systematic review explored the feasibility, acceptability and effect on health outcomes of weight-neutral interventions in health improvement-seeking young people with overweight/obesity.

METHODS

Six databases were searched to March 2021 for health, but not weight, focused interventions (PROSPERO, CRD42020152671). Eligible studies recruited young people (10-24 years) with overweight/obesity. The studies were described using narrative synthesis, with numerical results summarised. The quality of included studies was assessed using the Joanna Briggs Institute critical appraisal tools.

RESULTS

Six articles were included, representing three pilot studies. Study 1 (n = 37, 14-17 years) compared a 6-week mindful eating program with single-session lifestyle education; Study 2 (n = 35, 14-17 years) compared 12-week weight-neutral lifestyle education focused on intuitive eating and carbohydrate quality, with/without guided imagery; and Study 3 (n = 33, 12-17 years) compared a 6-week mindfulness intervention with cognitive behavioural therapy in adolescents with depressive symptoms at risk of type 2 diabetes. All interventions explored feasibility (intervention group retention 57%-88%, attendance >80%) and reported interventions were acceptable. Studies 1 and 3 reported no change in mindfulness. Study 2 reported an increase (p < 0.05) in intuitive eating following weight-neutral plus guided imagery (0.32 ± 0.36, Hawks' Scale, score 1-4), compared with weight-neutral alone (0.15 ± 0.29). Study 1 reported decreased body mass index (p < 0.001) following mindful eating (-1.1 kg/m² ), compared with single-session lifestyle education (+0.7 kg/m² ); Studies 2 and 3 found no change in body mass index or body mass index z-score.

CONCLUSIONS

Weight-neutral interventions may be feasible and acceptable in adolescents with overweight/obesity in the short term (≤12 weeks), but data are limited.

Social influences on physical activity for establishing criteria leading to exercise persistence

Despite well-documented health benefits from exercise, a study on national trends in achieving the recommended minutes of physical activity guidelines has not improved since the guidelines were published in 2008. Peer interactions have been identified as a critical factor for increasing a population's physical activity. The objective of this study is for establishing criteria for social influences on physical activity for establishing criteria that lead to exercise persistence. A system of differential equations was developed that projects exercise trends over time. The system includes both social and non-social influences that impact changes in physical activity habits and establishes quantitative conditions that delineate population-wide persistence habits from domination of sedentary behavior. The model was generally designed with parameter values that can be estimated to data. Complete absence of social or peer influences resulted in long-term dominance of sedentary behavior and a decline of physically active populations. Social interactions between sedentary and moderately active populations were the most important social parameter that influenced low active populations to become and remain physically active. On the other hand, social interactions encouraging moderately active individuals to become sedentary drove exercise persistence to extinction. Communities should focus on increasing social interactions between sedentary and moderately active individuals to draw sedentary populations to become more active. Additionally, reducing opportunities for moderately active individuals to engage with sedentary individuals through sedentary social activities should be addressed.

Does Weight-Motivation for Exercise Predict Physical Activity Levels Across the Life Course From Adolescence to Adulthood?

Healthcare professionals may motivate their patients to exercise to lose weight, but it is unknown how weight-focused motivations influence young peoples' PA trajectories.

PURPOSE

To examine if weight-motivated exercise predicts moderate-to-vigorous physical activity (MVPA) from adolescence to adulthood in a population-based sample and if this relationship differs by age and body mass index (BMI).

METHODS

Participants (N = 1,428; 13-18 years at baseline; 48.6% female; 49.0% white) responded to surveys in the 15-year longitudinal study, Project EAT (Eating and Activity in Teens and Young Adults). Weight-motivated exercise was examined as a predictor of MVPA across the life course at five-year intervals using linear regression generalized estimating equations and adjusting for demographics (age modeled continuously), BMI (modeled continuously), weight-related intentions, and prior MVPA.

RESULTS

Weight-motivated exercise predicted higher subsequent MVPA at five-year intervals among females (B = .57, 95% CI:0.13, 1.00) but not males (B = .31, 95% CI:-.09, .72). The association differed by BMI in females (p = .02); weight-motivated exercise was associated with higher subsequent MVPA at lower BMI but lower subsequent MVPA at higher BMI. The association also differed by age in males (p = .008), such that older males who reported weight-motivated exercise had higher subsequent MVPA, whereas this association was not present in younger males.

CONCLUSION

Weight-motivated exercise may have a deleterious influence on MVPA for females with higher BMI and may have an advantageous influence on older males. Understanding how motivations for exercise may influence PA trajectories can inform PA promotion over the life course by providing more nuanced guidance by age, BMI, and sex.

Perceptions of Weight Management: Interviews with Adolescents with Severe Obesity and Their Mothers

Background: Adolescence is a challenging time for families, which is intensified when managing a chronic health condition. In adolescents with severe obesity, little is known about how adolescent/mother dyads approach management. Our study aims to (1) explore similarities/differences in adolescent/mother dyads' perceptions of weight management behaviors and (2) describe their experiences with successes and challenges related to weight management. Methods: This was a qualitative descriptive analysis of interviews from 21 adolescent/mother dyads. Conventional content analysis was used to identify themes characterizing dyads' weight management efforts. Results: Two patterns of perceptions were identified across the dyads specific to weight management behaviors: collaborative (dyads agreed) and conflicting (dyads disagreed). Weight management themes with collaborative perceptions were food preferences; food and emotion; the adolescent is active; exercise is not enjoyable; the family is active together; and stopping medications. Weight management themes with conflicting perceptions were responsibility for initiating and maintaining exercise, motivation and willingness to exercise, and responsibility for medications. Dyads had collaborative pattern responses on perceptions of success and challenges. Themes related to successes were weight loss and supportive relationships. Themes related to challenges were inconsistent daily routines and schedules, and unsupportive relationships. Conclusions: Dyads responded with collaborative or conflicting perceptions to weight management behaviors and with collaborative responses to success and challenges. Sustaining healthy habits was difficult from the perspectives of dyads. For youth with severe obesity, providing care that recognizes and addressees issues youth and their families experience may require improved and innovative interventions.

The role of parents in adolescent obesity treatment: Results of the TEENS+ randomized clinical pilot trial

BACKGROUND

The optimal role for involving parents in adolescent obesity treatment is unknown.

OBJECTIVE

To demonstrate that two parent approaches within adolescent obesity treatment are distinct, as evidenced by differential parent outcomes, and determine the preliminary efficacy of each approach on adolescent weight loss.

METHODS

Adolescent/parent dyads (N = 82; mean adolescent age = 13.7 ± 1.2 years) participated in TEENS+, a 4-month behavioural weight loss treatment. Participants were randomized to: (1) TEENS+parents as coaches (PAC; parent skills training), or (2) TEENS+parent weight loss (PWL; adult behavioural weight loss). Assessments occurred at 0, 4 (post-treatment), and 7-months. Within- and between-group repeated measures general linear mixed models examined change in parent weight (∆kg; primary outcome); parenting, feeding, weight control strategies, home environment, and adolescent body mass index (∆BMI; secondary outcomes).

RESULTS

PWL parents had greater 4-month weight losses (∆kg_0-4m  = -5.14 ± 4.87 kg) compared to PAC (-2.07 ± 3.89 kg; between-group p < 0.01). Key constructs differed between groups as expected. Both groups yielded significant within-group adolescent ∆BMI_0-4m (PWL: -0.97 ± 1.38 kg/m² vs. PAC: -0.93 ± 1.42 kg/m² ; ps < 0.01); during maintenance, adolescents in PWL had ∆BMI_4-7m increases (+0.41 ± 1.07 kg/m² ; p = 0.02) while PAC did not (+0.05 ± 1.31 kg/m² ; p = 0.82).

CONCLUSION

Parent treatments were distinct in implementation and both yielded significant 4-month adolescent weight loss. Differential weight patterns were observed during maintenance, favouring PAC, warranting further exploration.

Predicting the effect of healthy lifestyle belief on attitude toward nutrition, exercise, physical activity, and weight-related self-efficacy in Turkish adolescents

OBJECTIVES

This study was conducted to examine the effect of healthy lifestyle beliefs on their attitudes toward physical activity, nutrition, exercise, and weight-related self-efficacy lifestyles in Turkish adolescents.

METHODS

This study used a methodological and descriptive design. The study was conducted with 445 adolescents aged 13-18 years. The data were collected using a Descriptive Information Form, the Healthy Lifestyle Beliefs Scale for Adolescents, the Nutrition Exercise Attitudes Scale, and the Attitudes Toward Physical Activity Scale. Mean and percentage values, t-test, ANOVA test, and linear regression analysis were used in the analysis of the research data.

RESULTS

A statistically significant difference was found between adolescents' obesity status, paternal educational level, maternal educational level, income status, and the mean scores obtained for healthy lifestyle beliefs, nutrition and exercise attitudes, physical activity attitudes, and weight-related self-efficacy, as well as between sex and mean scores for attitudes toward nutrition, exercise, and physical activity. In the model created with regression analysis, it was found that the adolescents' healthy lifestyle beliefs and sociodemographic variables explained 96.3% of their attitudes toward nutrition and exercise, 93.6% of physical activity attitudes, and 96.5% of weight-related self-efficacy levels, with statistical significance.

CONCLUSION

According to the results of the study, healthy lifestyle beliefs are an important predictor of adolescents' attitudes toward nutrition, exercise, and physical activity as well as their weight-related self-efficacy. We recommend that school nurses consider healthy lifestyle beliefs when creating intervention programs for adolescents .

Teachers' perspectives on the barriers to healthy lifestyle behaviors among adolescent girls of disadvantaged backgrounds in Ireland: A qualitative study

Though adolescence is a particularly sensitive period regarding the development of long-lasting health-related attitudes and behaviors, little research has examined the factors which influence their engagement in such behaviors. Adolescent females are particularly sensitive to suffer from overweight and obesity. It is also a time that can impact the health patterns of future generations due to the influence of preconception maternal factors on the health of their offspring. Furthermore, much research has identified a strong socioeconomic gradient in obesity in Ireland, with individuals from low socioeconomic backgrounds being particularly likely to develop unhealthy habits. The current study aimed to develop an understanding of the factors which influence the health-related behaviors of adolescent girls of low-socioeconomic status in Ireland, an underrepresented yet particularly sensitive cohort. Semi-structured interviews were conducted with nine teachers from disadvantaged schools in Dublin and were examined using a thematic analytic approach. Nine themes were identified: lack of interest and knowledge, lack of self-confidence, the dual role of modern technology, behaviors of significant others, need for good role models, availability of convenience foods, inadequate existing approaches and initiatives, lack of resources to promote a healthy lifestyle, and living difficulties at home and in the community. Findings suggested ways for intervening at personal, interpersonal, organizational and community levels. In conclusion, a range of practical changes are required in the home, school, and community environments in order to improve the health of these individuals, and ultimately to improve the health of future generations.