Immersion treatment of childhood and adolescent obesity: the first review of a promising intervention

The lived experience of weight loss maintenance in young people

INTRODUCTION

There continues to be an imbalance of research into weight loss and weight loss maintenance (WLM), with a particular lack of research into WLM in young people under 18 years. Failure to coherently understand WLM in young people may be a potential contributor to the underdeveloped guidance surrounding long-term support. Furthermore, no research has investigated young people's preferences around WLM support following the attendance of a residential intensive weight loss intervention from a qualitative perspective. This study explored the influences of WLM in young people following a residential intensive weight loss intervention, considered how interventions could be improved and sought to develop recommendations for stakeholders responsible for designing WLM interventions.

METHODS

The context in which this research is framed was taken from a residential Intensive Weight Loss Intervention for young people aged 8-17 years in England. Six semi-structured interviews were carried out to understand the lived experience of WLM, including barriers and enablers influencing WLM, adopting an interpretative phenomenological analysis design.

FINDINGS

Three superordinate themes were developed to explain the barriers and enablers to WLM; (1) Behavioural control and the psychosocial skills to self-regulate WLM; (2) Delivering effective social support; and (3) Conflicting priorities and environmental triggers.

CONCLUSION

The findings of this research mirror that of other studies of WLM in young people, with the majority of young people struggling to maintain weight loss. However, by exploring the experience of WLM in young people through qualitative means, it was possible to understand the specific motivators and barriers influencing WLM behaviours in this context, providing recommendations to support WLM.

PATIENT OR PUBLIC CONTRIBUTION

The interview guide was developed in consultation with a young person from the intervention, and through discussions with the intervention stakeholders (delivery staff and management staff). The interview guide included topics such as knowledge and skills; experience of weight loss; reflections on weight maintenance, and experiences of daily life postintervention. We piloted the interview schedule with one young person who had consented to take part in the research. This first interview was used to check for understanding of questions and to assess the flow of the interview.

Examining weight stigmatization toward obese individuals among nutrition and dietetic students using the attribution theory

Background

Despite the increasing prevalence of obesity in the United States, negative attitudes toward obese individuals are widespread. Health-care providers, including dietetics and nutritionists, are not exempt from showing bias toward obese individuals, which may lead to subsequent psychological and health problems.

Objectives

The purpose of this study was to measure the extent of weight bias among dietetics and nutrition students and investigate its determinants.

Materials and Methods

A cross-sectional survey (316) was conducted among undergraduate dietetics and nutrition students at a large Midwestern University to assess weight bias using the Fat Phobia Scale. Eating competence was measured using the ecSI 2.0 and body dissatisfaction using the Stunkard Figure Rating Scale. Other variables included experience with obesity, media exposure to health and nutrition information, and demographic characteristics.

Results

About 36% of the participants had weight bias, 64% were unsatisfied with their body image and none of the participants had eating competence. Media exposure to health information, body dissatisfaction, and eating competence was related to fat phobia (P < 0.05).

Conclusion

These findings highlight that weight bias is an apparent issue among students enrolling in health-related programs. Considering their future role in clinical and community settings, this issue should be addressed properly.

ANALYSIS OF THE IMPACT OF DIFFERENT EXERCISE METHODS ON THE PHYSICAL HEALTH OF OBESE ADOLESCENTS

ABSTRACT Introduction: The unregulated development in the current life pattern has strengthened obesity among adolescents, and this problem is becoming more serious. Objective: Compare the impact of two exercise methods on the physical health of obese adolescents. Methods: 24 obese adolescents (12 females; BMI>30% ± 3%; age concentrated between 10 and 16 years) were selected and divided into group I and group II for a 4-week experimental study, and changes in physical fitness and function were recorded. Results: After four weeks of aerobic exercise control (group I), waist circumference, hip circumference, skinfold thickness, and abdominal fold thickness were significantly reduced in boys (p<0.05), and girls’ body shape indicators were significantly altered (p<0.05). After four weeks of aerobic exercise combined with resistance training (group II), the effects of weight, BMI, and body size were significant in boys and girls. Conclusion: Aerobic exercise can effectively improve the physical problems of obese adolescents. Under the same external conditions, the effect of aerobic exercise was shown to be more effective when combined with resistance training in the physical improvement of the analyzed group. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

Inpatient medical management of severe pediatric obesity: Literature review and case reports

Pediatric obesity rates continue to rise steeply with significant adverse effects on health outcomes across the lifespan. Significant obesity can affect the efficacy, side effects, and ability to use certain treatment, medication, or imaging modalities needed in the evaluation and management of acute pediatric conditions. Inpatient settings are rarely used as an opportunity for weight counseling and thus there is a paucity of clinical guidelines on how to manage severe obesity in the inpatient setting. We present a literature review and three patient cases with single-center protocol for non-surgical management of severe obesity in children admitted for other acute medical reasons. We performed a PubMed review from January 2002 to February 2022 utilizing keywords: "inpatient," "obesity," and "intervention." For our cases, we identified three patients with severe obesity acutely impacting their health while admitted for medical treatment who concurrently underwent acute, inpatient, weight loss regimens at a single children's hospital. The literature search yielded 33 articles describing inpatient weight loss treatments. Three patients met case criteria, all three of which demonstrated a decrease in their weight in excess percent of the 95th percentile after inpatient weight-management protocol implementation (% reduction BMI_p95: 16%-30%). This highlights obesity acutely limits or impacts specific medical care required during inpatient admissions in pediatric patients. It also suggests that implementation of an inpatient weight-management protocol during admission may provide an opportune setting to support acute weight loss and overall improved health outcomes in this high-risk cohort.

Multidisciplinary residential program for the treatment of obesity: how body composition assessed by DXA and blood chemistry parameters change during hospitalization and which variations in body composition occur from discharge up to 1-year follow-up

PURPOSE

Obesity is a chronic disease characterized by a complex variable clinical presentation with comorbidities. A multidisciplinary residential program (MRP) represents one of the best options for treating obesity. The purpose of this study was to evaluate the effectiveness of 8-week MRP on weight loss, body composition assessed by DXA, and metabolic blood parameters between entry (T0) and discharge (T1). The secondary endpoint was the evaluation of the patients' adherence to diet during the check-up outpatient visits, at 2 (T2), 6 (T3), and 12 (T4) months after discharge.

METHODS

168 subjects were enrolled (61 males and 117 females, aged 58.5 ± 13 years, BMI 41.3 ± 6 kg/m²) in the study. The difference in values ​​(end of hospitalization compared to baseline) was calculated through the univariate analysis procedure, which provides regression analysis and analysis of variance for a variable dependent on one or more variables.

RESULTS

There was a statistically significant improvement of all parameters investigated: total mass (- 5.68 kg), fat mass (- 4416.85 g), fat mass index (- 1724.56), visceral adipose tissue (- 332.76 g), arm circumference (- 1.63 cm) and calf circumference (- 1.16 cm). As it is reasonable to expect, even the fat free mass has been reduced (- 1236.03 g); however, the skeletal muscle index was not affected. Statistically significant improvement in glycaemic and lipid profile were reported. The BMI average reduction continued from discharge until T4. No statistically significant changes in fat free mass and visceral adipose tissue (VAT) were reported during a year of follow-up.

CONCLUSIONS

The present study demonstrated the clinical benefits of 8-week MRP, which includes hypocaloric diet, physical exercise, and psychological support.

LEVEL OF EVIDENCE

III, evidence obtained from cohort or case-control analytic studies.

The Predictive Value of Adipokines and Metabolic Risk Factors for Dropouts and Treatment Outcomes in Children With Obesity Treated in a Pediatric Rehabilitation Center

Background

Inpatient pediatric obesity treatments are highly effective, although dropouts and weight regain threaten long-term results. Preliminary data indicate that leptin, adiponectin, and cardiometabolic comorbidities might predict treatment outcomes. Previous studies have mainly focused on the individual role of adipokines and comorbidities, which is counterintuitive, as these risk factors tend to cluster. This study aimed to predict the dropouts and treatment outcomes by pre-treatment patient characteristics extended with cardiometabolic comorbidities (individually and in total), leptin, and adiponectin.

Methods

Children aged 8-18 years were assessed before, immediately after and 6 months after a 12-month inpatient obesity treatment. Anthropometric data were collected at each visit. Pre-treatment lipid profiles; glucose, insulin, leptin, and adiponectin levels; and blood pressure were measured. The treatment outcome was evaluated by the change in body mass index (BMI) standard deviation score (SDS) corrected for age and sex.

Results

We recruited 144 children with a mean age of 14.3 ± 2.2 years and a mean BMI of 36.7 ± 6.2 kg/m2 corresponding to 2.7 ± 0.4 BMI SDS. The 57 patients who dropped out during treatment and the 44 patients who dropped out during aftercare had a higher pre-treatment BMI compared to the patients who completed the treatment (mean BMI, 38.3 ± 6.8 kg/m2 vs 35.7 ± 5.5 kg/m2) and those who completed aftercare (mean BMI, 34.6 ± 5.3 kg/m2 vs 37.7 ± 6.3 kg/m2) (all p<0.05). Additionally, aftercare attenders were younger than non-attenders (mean age, 13.4 ± 2.3 years vs 14.9 ± 2.0, p<0.05).Patients lost on average 1.0 ± 0.4 SDS during treatment and regained 0.4 ± 0.3 SDS post-treatment corresponding to regain of 43 ± 27% (calculated as the increase in BMI SDS post-treatment over the BMI SDS lost during treatment). A higher BMI and more comorbidities inversely predicted BMI SDS reduction in linear regression (all p<0.05).The absolute BMI SDS increase after returning home was predicted by pre-treatment leptin and systolic blood pressure, whereas the post-treatment BMI SDS regain was predicted by pre-treatment age, leptin, and adiponectin levels (all p<0.05) in multivariate linear regressions.

Conclusion

Patients who need treatment the most are at increased risk for dropouts and weight regain, emphasizing the urgent need for interventions to reduce dropout and support inpatients after discharge. Furthermore, this study is the first to report that pre-treatment leptin and adiponectin levels predict post-treatment BMI SDS regain, requiring further research.

Comparison of Hospital Consultation and Summer Camp Lifestyle Intervention Programs for Sustained Body Weight Loss in Overweight/Obese Greek Children

Two lifestyle intervention programs of a health initiative named "Evrostia" were conducted at (a) an outpatient obesity clinic of a children's hospital and (b) summer camp (SC), respectively. Thirty overweight/obese children were randomly selected to participate in each intervention arm to assess the efficacy of the SC intervention and its possible superiority over usual hospital consultation (HC) practice. There was a statistically significant decrease in body weight (BW), and body mass index (BMI) in both programs. A higher duration of reduced BW was observed in the SC compared to HC intervention. Regarding the nutritional behavior, there was a significant increase in the consumption of breakfast, fruit and vegetables, and a reduction in the consumption of beverages and sweets in the SC group. A significant increase in the hours of weekly physical activity was also observed in children of the SC program. The comparison between the two lifestyle intervention programs showed that the SC program improved nutritional behaviors and physical activity and promoted longer preservation of BW loss than that of the HC program. Thus, the holistic and experiential approach of the SC program was more successful in the treatment of overweight and obesity in children than a conventional HC program.

Can a Multicomponent-Overnight Camp Increase Physical Activity Among Danish Children? A Retrospective Cross-Sectional Study

BACKGROUND

In Denmark, most children are not sufficiently physically active and only a few interventions have been found to increase long-term physical activity among overweight and obese children. The aim of our study was to investigate if children are physically active in correspondence to Danish recommendations after attending a multicomponent-overnight camp.

METHODS

A questionnaire was developed to estimate children's physical activity level and behavior and investigate how transport, economy, availability, time, motivation, and knowledge about physical activity affect children's physical activity level and behavior.

RESULTS

In this study, 60.9% of the children did vigorous physical activity (VPA) minimum 30 minutes 3 times per week up to 3 years after camp. Most children were physically active at a sports club (44.3%) and only 5.7% of the children did not participate in physical activity. Parental physical activity and child motivation toward physical activity were significantly (P < .05) associated with children doing VPA.

CONCLUSION

Our findings suggest that 60.9% of children who attended camp engage in VPA after camp, which compared with a recent Danish study, is more frequent than children who did not attend camp. Further investigations are needed to determine the long-term health effects in children attending interventions such as multicomponent-overnight camps.

Adolescent obesity treatments: news, views, and evidence

Obesity is a complex and multifactorial disease that is influenced by physiological, environmental, socioeconomic, and genetic factors. In recent decades, this serious disease has impacted a large number of adolescents as a result of lifestyle factors. A lack of exercise and the consumption of excessive calories from an inadequate diet are the main contributors to adolescent obesity. However, genetic and hormonal factors might also play a role. The short- and long-term consequences of this disease include chronic issues such as type 2 diabetes and cardiovascular disorders and an increase in early mortality rates. Although it is a serious disease, obesity in adolescents can be controlled with diet and exercise. When these lifestyle changes do not obtain the expected results, we can intensify the treatment by adding medication to the practice of diet and exercise. Additionally, for more severe cases, bariatric surgery can be an option. The purpose of this review is to clarify the current epidemiology, risks, and comorbidities and discuss news about the main treatments and the necessary improvements in this context.

The effect of weight regain on cardiometabolic health in children with obesity: A systematic review of clinical studies

AIMS

Children with obesity are treated by a lifestyle intervention to obtain weight loss. Nevertheless, weight regain often occurs. This systematic review examines the effect of weight regain on cardiometabolic health and summarizes these results in the metabolic syndrome prevalence as integrated endpoint.

DATA SYNTHESIS

A literature search was performed in PubMed and Web of Science. Studies were selected if they included participants aged <18 years with obesity and presented data before and after weight loss and after weight regain hereby reporting minimally 1 cardiovascular risk factor at every assessment. After screening, nine articles remained. Generally, the diastolic BP re-increased after weight regain, whereas for systolic BP a sustained result for 6 months was reported with an increase during longer follow-up. No significant changes in fasting glucose were reported after weight regain compared to baseline. Regarding triglycerides, a complete weight regain re-increased the lowered values to baseline, whereas a partial regain resulted in a sustained decrease in triglycerides in 2 studies and an increase to intermediate levels in 1 paper. HDL-cholesterol only rose several months after initiating treatment. Hs-CRP remained lowered for a longer period than the moment where the weight loss nadir was achieved.

CONCLUSION

Research on weight regain and cardiometabolic health in children with obesity is scarce. No convincing evidence was found for a worsening of the cardiometabolic profile after weight regain. Some benefits even persisted despite weight recovery. Subsequently, the metabolic syndrome prevalence seems temporarily lowered after weight loss, despite weight regain.

Testing a multicomponent lifestyle intervention for combatting childhood obesity

BACKGROUND

Childhood obesity is a major global health concern. Weight-management camps involving delivery of a program of physical activity, health education, and healthy eating are an effective treatment, although post-intervention weight-management is less well understood. Our objective was to assess the effectiveness of a weight-management camp followed by a community intervention in supporting weight-management for overweight children and children with obesity.

METHODS

Participants were overweight Qatari schoolchildren or schoolchildren with obesity, ages 8-14 years, (n = 300) recruited over a three-year period across 14 randomly selected schools in the Doha area. They attended a two-week weight management camp, then a 10-week program of weekly lifestyle education and physical activity sessions, which also included behavior change techniques. The programme was cognitive behavioural therapy (CBT)-focused with a strong element of behavioural economics blended in.

RESULTS

Participants saw a significant BMI SDS reduction as a result of the entire intervention (camp + education and activity sessions) both at the individual (p < 0.0001) and cluster/school (p = 0.0002) levels, and weight loss occurred during each intervention stage separately for the camp (p < 0.0001 for both the individual and cluster/school levels) and the lifestyle education and activity phase (p < 0.0001 and p = 0.0220 at the individual and cluster/school levels, respectively).

CONCLUSIONS

Weekly lifestyle education and activity sessions which include behavior change techniques may be useful in promoting continued weight management in the period following intensive, immersive childhood obesity interventions.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02972164 , November 23, 2016.

Improving Treatment Outcome in Children With Obesity by an Online Self-Control Training: A Randomized Controlled Trial

Background: Currently available treatment programs for children with obesity only have modest long-term results, which is (at least partially) due to the poorer self-control observed within this population. The present trial aimed to determine whether an online self-control training, training inhibition, and redirecting attentional bias, can improve the short- and long-term treatment outcome of (in- or outpatient) child obesity treatment programs. Methods: In this double-blind multi-center randomized controlled trial (RCT), participants aged 8-18 years with obesity were allocated in a 1:1 ratio to receive an online self-control or sham training added to their in- or outpatient multidisciplinary obesity treatment (MOT) program. The primary endpoint was BMI SDS. Data were analyzed by linear mixed models and the main interactions of interest were randomization by time and randomization by number of sessions, as the latter was cumulatively expressed and therefore represents the effect of increasing dose over time. Results: One hundred forty-four inpatient (mean age 14.3 ± 2.2 years, BMI 2.7 ± 0.4 SDS, 42% male) and 115 outpatient children (mean age 11.9 ± 2.1 years, BMI 2.4 ± 0.4 SDS, 45% male) were included. Children's BMI lowered significantly during treatment in both the in- and outpatient treatment centers, p < 0.001. In a mixed model with BMI as dependent variable, randomization by time was non-significant, but the number of self-control trainings (randomization ^* number of sessions) interacted significantly with setting and with age (p = 0.002 and p = 0.047), indicating a potential effect in younger inpatient residents. Indeed, a subgroup analysis on 22 inpatient children of 8-12 years found a benefit of the number of self-control trainings on BMI (p = 0.026). Conclusions: The present trial found no benefit of the self-control training in the entire study population, however a subgroup of young, inpatient participants potentially benefited.

Testing the effect of summer camp on excess summer weight gain in youth from low-income households: a randomized controlled trial

BACKGROUND

Children from racial and ethnic minority groups, low-income households, and those with overweight or obesity gain more weight during the summer than the school year. Summer day camps, which offer routine opportunities for physical activity and regular meal and snack times, have potential to mitigate excess weight gain. This randomized controlled trial was done to determine the feasibility and preliminary effectiveness of summer camp in preventing excess summer weight gain among youth from low-income households.

METHODS

Children, ages 6 to 12 years, were randomized to attend 8-weeks of summer day camp (CAMP) or to experience an unstructured summer as usual (SAU) in 2017-2018. Primary feasibility outcomes included retention, engagement and completion of midsummer measures. Secondary outcomes included changes in BMIz, engagement in moderate to vigorous physical activity (MVPA) and sedentary behavior, and diet quality and energy intake from the school year to summer. Multivariable linear mixed models were used to assess group differences.

RESULTS

Ninety-four participants were randomized to CAMP (n = 46) or SAU (n = 48), of whom 93.0 and 91.6% completed end of school and end of summer assessments, respectively. While CAMP participants attended only 50% of camp days offered, on average, they lost - 0.03 BMIz units while those in SAU gained 0.07 BMIz units over the summer (b = 0.10; p = .02). Group differences in change in energy intake from the school year to summer were borderline significant, as energy intake remained relatively unchanged in CAMP participants but increased among participants in SAU (p = 0.07).

CONCLUSIONS

Randomizing children to attend summer day camp or experience an unstructured summer as usual was effective in this low-income sample. Our findings support the potential for summer camps in mitigating excess summer weight gain. A larger randomized trial is needed explore efficacy, cost-effectiveness and longer-term effects of attending summer camp on weight and weight-related behaviors.

TRIAL REGISTRATION

ClinicalTrials.gov Registration: NCT04085965 (09/2019, retrospective registration).

Does an Age-Specific Treatment Program Augment the Efficacy of a Cognitive-Behavioral Weight Loss Program in Adolescence and Young Adulthood? Results from a Controlled Study

Research on weight-loss interventions in emerging adulthood is warranted. Therefore, a cognitive-behavioral group treatment (CBT), including development-specific topics for adolescents and young adults with obesity (YOUTH), was developed. In a controlled study, we compared the efficacy of this age-specific CBT group intervention to an age-unspecific CBT group delivered across ages in an inpatient setting. The primary outcome was body mass index standard deviation score (BMI-SDS) over the course of one year; secondary outcomes were health-related and disease-specific quality of life (QoL). 266 participants aged 16 to 21 years (65% females) were randomized. Intention-to-treat (ITT) and per-protocol analyses (PPA) were performed. For both group interventions, we observed significant and clinically relevant improvements in BMI-SDS and QoL over the course of time with small to large effect sizes. Contrary to our hypothesis, the age-specific intervention was not superior to the age-unspecific CBT-approach.

Severe Obesity in the Pediatric Population: Current Concepts in Clinical Care

PURPOSE OF REVIEW

This review describes (1) the clinical assessment of pediatric patients with severe obesity, including a summary of salient biological, psychological, and social factors that may be contributing to the patient's obesity and (2) the current state of treatment strategies for pediatric severe obesity, including lifestyle modification therapy, pharmacotherapy, and metabolic and bariatric surgery.

RECENT FINDINGS

Lifestyle modification therapy alone is insufficient for achieving clinically significant BMI reduction for most youth with severe obesity and metabolic and bariatric surgery, though effective and durable, is not a scalable treatment strategy. Pharmacological agents in the pipeline may 1 day fill this gap in treatment. Treatment of severe pediatric obesity requires a chronic care management approach utilizing multidisciplinary teams of health care providers and multi-pronged therapies.

The Food Addiction Construct May Do More Harm Than Good: Weight Controllers Are Athletes, Not Addicts

Food addiction has become a popular notion in the media and scientific community, with many proposing that an addiction to food causes obesity. An article published in this journal in December 2017 by Tompkins et al. asserted that food addiction poses a barrier to the treatment of adolescent obesity. This review questions some of the methods, results, and perspectives offered by Tompkins et al. It also considers the extant evidence overall about this construct. The data about food addiction provide minimal support for the discriminant validity of this conceptualization relative to depressed binge eating. We believe that the evidence suggests that the potential harm outweighs the benefits of encouraging researchers, clinicians, and especially obese people to view food addiction as a cause of obesity or a barrier to effective weight management. Ultimately, this review concludes that the construct of food addiction does not serve the interests of those striving to lose weight permanently (i.e., weight controllers) nearly as well as an alternative perspective: weight controllers are athletes, not food addicts.

Health-related quality of life after camp-based family obesity treatment: an RCT

OBJECTIVE

To compare the effects of a 2-year camp-based immersion family treatment for obesity with an outpatient family-based treatment for obesity on health-related quality of life (HRQoL) in two generations.

DESIGN

Randomised controlled trial.

SETTING

Rehabilitation clinic, tertiary care hospital and primary care.

PATIENTS

Families with at least one child (7-12 years) and one parent, both with obesity.

INTERVENTIONS

Summer camp for 2 weeks, with four repetition weekends, or lifestyle school, including four outpatient days over 4 weeks. Behavioural techniques to promote a healthier lifestyle.

MAIN OUTCOME MEASURES

Children's and parents' HRQoL were assessed using generic and obesity-specific measures. Outcomes were analysed using linear mixed models according to intention to treat, and multiple imputations were used for missing data.

RESULTS

Ninety children (50% girls) with a mean (SD) age of 9.7 (1.2) years and body mass index 28.7 (3.9) kg/m² were included in the analyses. Summer camp children had an estimated mean (95% CI) of 5.3 (0.4 to 10.1) points greater improvement in adiposity-specific HRQoL score at 2 years compared with the lifestyle school children, and this improvement was even larger in the parent proxy-report, where mean difference was 7.3 (95% CI 2.3 to 12.2). Corresponding effect sizes were 0.33 and 0.44. Generic HRQoL questionnaires revealed no significant differences between treatment groups in either children or parents from baseline to 2 years.

CONCLUSIONS

A 2-year family camp-based immersion obesity treatment programme had significantly larger effects on obesity-specific HRQoL in children's self-report and parent proxy-reports in children with obesity compared with an outpatient family-based treatment programme.

TRIAL REGISTRATION NUMBER

NCT01110096.

Pediatric Obesity and Eating Disorders Symptoms: The Role of the Multidisciplinary Treatment. A Systematic Review

The prevalence of obesity in children/adolescents has increased worldwide during the past 30 years, becoming a significant public health concern; prevention, and management of pediatric obesity onset is one of the most critical public health goals for both industrialized and developing countries. Pediatric obesity has been identified as a risk factor for various psychopathologies, including eating disorders (ED). Although it has been demonstrated that a comprehensive multidisciplinary treatment (MT), with small steps and practical approaches to lifestyle change, can be an effective treatment for children and adolescents with obesity, to the best of our knowledge, this is the first systematic review investigating the effect of MT on the development, progression or decrease of ED symptoms (EDS) in this target population. PubMed and Web of Science databases were searched (last search on 18 February 2019) according to a predetermined search strategy, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines and Statement. Original studies published in English examining the effect of MT on pediatric overweight/obesity, paying particularly attention at the development of EDS, were eligible for inclusion. Seven hundred and forty-four records have been identified; nine articles with study quality ranging from weak to moderate have been included. MTs were heterogeneous in nature including length, number, frequency and type of sessions, parent-involvement and use of technology, besides several psychometric questionnaires were used to screen for EDS, since there are no standardized criteria. In 3 studies there was a significant decrease in external and emotional eating and in four studies a significant increase in restraint eating post MT. Two studies found a significant decrease of binge eating symptoms and other two studies showed an improvement of self-perception, weight, and shape concern. A statistical significant decrease in BMI, BMIz, BMISDS, and adjusted BMI was observed after all MTs, except one. A narrative summary of the evidences reported highlighted the positive impact of MT on the EDS. Moreover, since weight loss post MTs was not necessarily related to EDS, clinicians should also look for the presence of EDS and treat them accordingly.

Summer Healthy-Lifestyle Intervention Program for Young Children Who Are Overweight: Results from a Nonrandomized Pilot Trial

OBJECTIVE

To examine initial outcomes of an 8-week Healthy-Lifestyle Intervention Program (HIP) which included children's participation in a daily summer camp along with parents' participation in a parenting program focused on overweight/obesity.

METHODS

Using a nonrandomized pilot trial design, 16 children (M child age = 6.42 yr; 81% male; 100% Latino) classified as overweight/obese and their mothers completed 3 assessments (baseline, posttreatment, and 6-8 mo follow-up).

RESULTS

Children who completed HIP experienced significant decreases in their body mass index z-scores (primary outcome) from baseline to posttreatment (d = -1.11) with such decreases being moderately maintained at follow-up (d = -0.64). In terms of secondary outcomes, HIP was effective in improving and maintaining healthy habits in both children and mothers and children's nutritional knowledge and fitness. Objective food data showed that children's dietary intake during HIP improved. High attendance and satisfaction were reported for families who completed HIP.

CONCLUSION

This pilot treatment development study shows that a family lifestyle intervention conducted in a summer camp setting that targets both children and parents is a promising option for addressing pediatric obesity in young children.

Vast Differences in Psychotropic Prescription Rates, But Not Outcomes, for Obese Adolescents in Immersion Treatment across Geographical Regions

BACKGROUND

Pediatric obesity is recognized as a worldwide epidemic. Treatment of this problem has proven difficult, but many promising interventions exist, including immersion treatment. The purpose of this study is to examine the potential influence of psychotropic medications on immersion treatment outcomes in a real-world treatment setting.

METHODS

This study examines the prescription rates of psychotropic medications and treatment process and outcomes of 642 adolescents in ten different cognitive behavioral therapeutic immersion weight-loss camps in the United States and in the United Kingdom.

RESULTS

The US participants received psychotropic medications at drastically varying rates by geographical location and overall at almost ten times the rate of UK participants. Those taking psychotropic medications engaged in treatment and decreased percentage overweight at similar rates as their nonmedicated peers. The medication group reported higher initial and final rates of distress, but both groups improved their moods during camp and exhibited smaller differences in mood ratings by the end of camp.

CONCLUSIONS

Significantly higher prescription rates of psychotropic medication, especially evident comparing the United States to the United Kingdom, were unrelated to immersion obesity treatment process and outcomes for youth. Immersion treatment for obese adolescents appears effective regardless of psychotropic medication status of the participant. This finding supports the use of cognitive behavioral immersion treatments for adolescent obesity and leads to several possible conclusions and directions for future study.

Health-Related Quality of Life in Children and Adolescents with Severe Obesity after Intensive Lifestyle Treatment and at 1-Year Follow-Up

OBJECTIVE

To examine changes in generic and weight-related, health-related quality of life (HRQoL) in children and adolescents with severe obesity participating in intensive lifestyle treatment, and to examine whether changes in SDS-BMI were associated with changes in HRQoL.

METHODS

In this prospective observational study, a referred sample of 120 children and adolescents (8-19 years) with severe obesity (SDS-BMI ≥ 3.0, or ≥ 2.3 in combination with obesity-related comorbidity) received an intensive 1-year lifestyle treatment with an inpatient period in a specialized childhood obesity center. A weight-related (IWQOL-Kids) and three generic (KIDSCREEN-52, PedsQL 4.0, and EuroQol) HRQoL questionnaires were administered at baseline (T0), after treatment (T1), and 1 year later (T2). Generalized Linear Mixed Models and partial correlations were used to analyze changes in HRQoL and associations with changes in SDS-BMI.

RESULTS

Statistically significant improvements in generic and weight-related HRQoL overall and domain scores were observed at T1and at T2 in comparison with T0, despite partial weight regain from T1 to T2. Larger weight loss at T2 was correlated with larger improvements in physical HRQoL domains.

CONCLUSION

Children and adolescents with severe obesity experienced long-term improvements in generic and weight-related HRQoL after participating in intensive lifestyle treatment, despite partial weight regain.

Impact of child summertime obesity interventions on body mass index, and weight-related behaviours: a systematic review and meta-analysis protocol

INTRODUCTION

In previous studies, it has been found that on average, children consistently gained weight during the summer months at an increased rate compared with the 9-month school year. This contributed to an increased prevalence of overweight and obesity in children. Several obesity-related interventions have occurred during or targeting the summer months. We propose to conduct a systematic review and meta-analysis of the impact of obesity prevention and treatment interventions for school-age children conducted during the summer or targeting the summer months when children are not in school on their body mass index (BMI), or weight-related behaviours.

METHODS AND ANALYSES

A literature search will be conducted by the first author (JPM) using MEDLINE/PubMed, Cochrane Library, Scopus, CINAHL, PsycINFO, EMBASE and Proquest Dissertations and Theses databases from the date of inception to present. Studies must examine interventions that address the modification or promotion of weight-related behaviours (eg, dietary patterns, eating behaviours, physical activity (PA), sedentary behaviour or sleep) and target school-age children (ages 5-18). The primary outcomes will be changes from baseline to postintervention and/or the last available follow-up measurement in weight, BMI, BMI percentile, standardised BMI or per cent body fat. Secondary outcomes will include changes in dietary intake, PA, sedentary behaviour or sleep. Risk of bias will be assessed using the Cochrane risk of bias tool for randomised and non-randomised studies, as appropriate.

ETHICS AND DISSEMINATION

Because this is a protocol for a systematic review, ethics approval will not be required. The findings will be disseminated via presentations at scientific conferences and published in a peer-reviewed journal. All amendments to the protocol will be documented and dated and reported in the PROSPERO trial registry.

PROSPERO REGISTRATION NUMBER

CRD42016041750.

A Twelve-Week Lifestyle Program to Improve Cardiometabolic, Behavioral, and Psychological Health in Hispanic Children and Adolescents

OBJECTIVES

To examine the effectiveness of a 12-week lifestyle program on cardiometabolic, behavioral, and psychological outcomes among overweight Hispanic children and adolescents.

DESIGN

A case series study with pre- and post-test analyses. Subjects/Settings/Location: A convenience sample of high-risk pediatric primary care patients (n = 22; 6 girls, 16 boys; M age = 11.73 ± 1.39 years) and their guardians in the Southeast United States.

INTERVENTION

Twice per week 60 min (total of 24 h) of moderate-to-vigorous intensity boxing exercise training, 12 h of nutrition education for guardians, and a 30-min pediatrician appointment.

OUTCOME MEASURES

Cardiometabolic (height [m], weight [kg], waist circumference [cm], body-mass index [BMI], BMI-z, BMI%, cholesterol [mg/dL], triglycerides [mg/dL], glucose [mg/dL], and low-density lipoprotein and high-density lipoprotein cholesterol [mg/dL]), behavioral (objective free time physical activity [PA] and sedentary time [min/day]), and psychological (self-determined exercise motivation) outcomes were measured/calculated, and paired-samples t-tests were conducted.

RESULTS

A significant reduction was observed in waist circumference t(17) = -2.57, p = 0.020, d = 0.64; BMI% t(15) = -2.53, p = 0.023, d = 0.20; fasting glucose t(15) = -6.43, p < 0.001, d = 1.67; and amotivation (-) t(17) = -2.29, p = 0.036, d = 0.64; whereas a significant increase was identified in moderate t(10) = 4.01, p = 0.002, d = 1.23 and vigorous t(10) = 3.41, p = 0.007, d = 1.07 intensity PA; intrinsic motivation t(17) = 2.71, p = 0.015, d = 0.38; and introjected regulation t(17) = 2.74, p = 0.014, d = 0.64.

CONCLUSIONS

A 12-week lifestyle program can be effective in improving selected health markers among overweight Hispanic children and adolescents. The positive changes in fasting glucose, BMI, and waist suggest that the participants are currently at lower risk for both type 2 diabetes and cardiovascular disease as a result of the Confidence, Ownership, Responsibility, and Exercise program.

Cost-effectiveness of a day-camp weight-loss intervention programme for children: Results based on a randomised controlled trial with one-year follow-up

AIMS

The aim was to analyse the cost-effectiveness of an intensive weight-loss intervention for children compared with a low-intensity intervention.

METHODS

One hundred and fifteen overweight children (mean age 12.0 ± 0.4) were randomised to either the camp group (CG) ( N=59) or the standard group (SG) ( N=56). Participants in the CG were offered a six-week day-camp weight-loss programme followed by a family-based supportive programme containing four meetings during the succeeding 46 weeks. Participants in the SG were offered a weekly two-hour exercise session for six weeks. Changes in body mass index (BMI) and BMI z-score 12 months after inclusion were used to compare the effects of the two interventions. Incremental cost-effectiveness ratios (ICER) were estimated from the perspective of a Danish municipality. To achieve the required number of participants, an additional intervention was initiated one year later.

RESULTS

In comparison with the SG, the CG changed their mean BMI by -1.2 (95% CI -1.8 to -0.5). Compared with the SG children, the CG children changed their BMI z-score by -0.20 (95% CI -0.35 to -0.05). The ICER per decreased BMI point in the CG compared with the SG was DDK 24,928.

CONCLUSIONS

Compared with the SG, the CG showed favourable effects after 12 months. However, the CG was more costly. The results observed in the present study may be helpful in guiding decision makers to take more informed decisions when choosing different types of intervention.

Weight loss interventions for overweight and obese adolescents: a systematic review

PURPOSE

To determine what factors contribute to the efficacy of non-drug treatments designed to promote weight loss in overweight and obese adolescents.

METHODS

Data sources Medline/PubMed; Psychinfo; EMBASE; Web of Science (ISI); and Cochrane Central Register of Controlled Trials. Study selection Randomized clinical trials of treatments for obesity and overweight in adolescents aged 10-19 years with a minimum duration of 2 months. Data extraction 115 of the 12,948 publications retrieved met eligibility criteria and 26 were included in the final sample. Period of extraction January 2004 to November 2014.

RESULTS

The Delphi list was used to evaluate the methodological quality of the studies (M = 5.58, SD = 1.027). There was considerable variability between the interventions, but they were all multifactorial, with components such as nutritional education, physical activity, family support and psychological therapy. The number of contacts with subjects during the course of the intervention was a predictor of treatment efficacy when the groups were compared. Limitations This systematic review was limited to trials reported in English and by the lack of methodological rigor and shortcomings in reporting in the studies reviewed.

CONCLUSIONS

Multidisciplinary interventions including family support and guided behavior modification appear to be effective methods of reducing BMI in overweight and obese adolescents.

Multidimensional improvements induced by an intensive obesity inpatients rehabilitation programme

PURPOSE

To analyse the short-term effectiveness of an intensive multidimensional inpatient programme specifically developed for patients with severe obesity.

METHODS

A multidisciplinary team managed a 3-week residential programme characterised by the integration of nutritional and physical rehabilitation with psychological and educational intervention. All patients consecutively admitted in 10 months were analysed at admission and discharge for changes in the following domains: anthropometry (weight, body mass index (BMI), waist and neck circumferences), cardiovascular risk factors (glycaemia, HbA1c, lipid profile, blood pressure), quality of life, eating behaviour, and physical performance (VO_2peak by incremental cycle ergometer test, 6-min walking test (6MWT), chair stands test).

RESULTS

136 subjects (61% females, median age 52.7 years) with obesity (mean BMI 43.2 kg/m²) and multiple comorbidities were analysed. A 3.9% BMI reduction and a reduction in waist (-3.8%) and neck (-3.3%) circumferences were observed. Glycaemic control was achieved in 68% of patients with uncontrolled diabetes at admission. Blood pressure control was achieved in all patients with uncontrolled hypertension at admission. Total cholesterol (-16%), LDL-cholesterol (-19%) and triglycerides (-9%) were significantly reduced. Psychometric assessment showed improvements in quality of life perception and binge eating disorder. Finally, a significant improvement in physical performance (+4.7% improvement in VO_2peak, with longer distances in 6MWT and a higher number of standings) was observed.

CONCLUSIONS

Our preliminary data prove that a 3-week programme determined a clinically significant multi-dimensional improvement in patients with severe obesity. Long-term follow-up data are needed to confirm the efficacy of our rehabilitation setting.

Camp-based family treatment of childhood obesity: randomised controlled trial

OBJECTIVE

To compare the effectiveness of a 2-year camp-based family treatment programme and an outpatient programme on obesity in two generations.

DESIGN

Pragmatic randomised controlled trial.

SETTING

Rehabilitation clinic, tertiary care hospital and primary care.

PATIENTS

Families with at least one child (7-12 years) and one parent with obesity.

INTERVENTIONS

Summer camp for 2 weeks and 4 repetition weekends or lifestyle school including 4 days family education. Behavioural techniques motivating participants to healthier lifestyle.

MAIN OUTCOME MEASURES

Children: 2-year changes in body mass index (BMI) SD score (SDS). Parents: 2-year change in BMI. Main analyses: linear mixed models.

RESULTS

Ninety children (50% girls) were included. Baseline mean (SD) age was 9.7 (1.2) years, BMI 28.7 (3.9) kg/m² and BMI SDS 3.46 (0.75). The summer-camp children had a lower adjusted estimated mean (95% CI) increase in BMI (-0.8 (-3.5 to -0.2) kg/m²), but the BMI SDS reductions did not differ significantly (-0.11 (-0.49 to 0.05)). The 2-year baseline adjusted BMI and BMI SDS did not differ significantly between summer-camp and lifestyle-school completers, BMI 29.8 (29.1 to 30.6) vs 30.7 (29.8 to 31.6) kg/m² and BMI SDS 2.96 (2.85 to 3.08) vs 3.11 (2.97 to 3.24), respectively. The summer-camp parents had a small reduction in BMI (-0.9 (-1.8 to -0.03) vs -0.8 (-2.1 to 0.4) in the lifestyle-school group), but the within-group changes did not differ significantly (0.3 (-1.7 to 2.2)).

CONCLUSIONS

A 2-year family camp-based obesity treatment programme had no significant effect on BMI SDS in children with severe obesity compared with an outpatient family-based treatment programme.

TRIAL REGISTRATION NUMBER

NCT01110096.

Self-esteem outcomes over a summer camp for obese youth

BACKGROUND AND OBJECTIVES

Variation in the existing literature on the psychosocial benefits of weight loss in obese youth results, in part, from methodological limitations and modest weight loss. Accordingly, this research assessed perceived self-competence and low self-esteem during an intensive weight loss programme in a large sample of obese youth and related these to starting weight, gender and weight loss.

METHODS

Over 4 years, 303 obese male and female adolescents (body mass index [BMI] 34.3 kg m^-2 , BMI standard deviation score 2.99; 14.7 years) attended a residential weight loss camp for a mean duration of 31 d. Outcome variables included dimensional self-esteem (Harter) and weight change over the camp.

RESULTS

At the start of camp, obese youth scored highest on social acceptance and lowest on physical appearance and athletic competence. Global self-worth and most domains of self-competence improved significantly over the intervention. The proportion with low global self-worth reduced from 35% to 16%, but there was little change in the proportion reporting high self-competence (23%). Mean weight loss was -5.5 kg (BMI standard deviation scores -0.25) with boys and those heaviest at the start losing most. Weight loss was significantly correlated with improved physical appearance (r = 0.13) and athletic competence (r = 0.19), but not global self-worth.

CONCLUSIONS

This intensive weight loss intervention yielded significant psychological benefit, especially in self-competence and among individuals achieving most weight loss. The weak association with weight loss suggests the influence of other contributing environmental or social features that should be the focus of further research.

Experiences and perspectives of children attending a weight loss camp in China: a qualitative study

BACKGROUND

Modernisation, urbanisation and the globalisation of food markets have exposed Chinese children to an obesogenic environment. With the dramatic increase in the prevalence of overweight and obesity among Chinese children, there are now over 2000 weight loss camps for children. The aim of this study was to investigate how one typical weight loss camp operates and to explore the experiences and perceptions of children attending the camp.

METHODS

This study utilised ethnographic techniques and semi-structured interviews with children attending a 28-day summer weight loss camp in Hangzhou, China. All children attending at the time of the study were included. Field notes were taken, and interviews with children were recorded, transcribed and analysed into themes.

RESULTS

Nine boys and 10 girls aged 7-18 years with a body mass index ranging from 21 to 37 kg/m(2) were interviewed. The weight loss programme combined dietary restriction (<350 calories/meal) and a daily schedule of 8 h of exercise in outdoor temperatures of around 40 °C. Field observation and interviews showed that the regime was distressing for all the children who suffered hunger and exhaustion leading to crying, squabbling, fighting and desperate phone calls to parents. All felt their weight loss could not be sustained.

CONCLUSIONS

The extreme conditions and total absence of health and nutrition education at the camp were of great concern. Parents should be aware of the potential dangers and long-term ineffectiveness of such interventions. At the very least, these camps must be subject to regulation.

The effect of a multi-component camp-based weight-loss program on children's motor skills and physical fitness: a randomized controlled trial

Background

Many weight-loss programs in children are performed without specific foci on training both physical fitness and motor skills. The aim of this study was to describe the effect of a one-year weight-loss program on children’s motor skills and physical fitness.

Methods

Participants included 115 overweight fifth-grade children (12.0 years) randomized into either a Day-Camp Intervention Arm (DCIA), with a subsequent family-based support program or a low-intense Standard Intervention Arm (SIA). Physical fitness was assessed by vertical jump, hand grip strength, and a progressive cardio-respiratory fitness test. Motor skills were assessed by the Movement Assessment Battery for Children – second edition (M-ABC-2), age band 3.

Results

Loss to follow-up after 52 weeks was 19 % and 32 % in the DCIA and SIA, respectively. Balance skills were improved post-camp, but not after 52 weeks in children from the DCIA compared to the SIA. Contrary to the expected, children from the SIA improved aiming and catching skills relative to the DCIA children. Overall z-scores of the physical fitness components and cardio-respiratory fitness improved more in children from the DCIA compared to children from the SIA.

Conclusion

In conclusion, the day-camp intervention led to improvements in physical fitness but not in motor skills compared to the standard intervention. Including both motor skills and physical fitness could advantageously be considered in future immersive intervention programmes.

Trial registration

Clinicaltrials NCT01574352, March 26, 2012 (retrospectively registered).

A Multi-Component Day-Camp Weight-Loss Program Is Effective in Reducing BMI in Children after One Year: A Randomized Controlled Trial

The objective of the present study was to evaluate the effectiveness of a one-year multi-component immersive day-camp weight-loss intervention for children with overweight and obesity. The study design was a parallel-group randomized controlled trial. One hundred fifteen 11-13-year-old children with overweight and obesity were randomized into either: A six-week day-camp intervention arm focusing on increased physical activity, and healthy diet followed by a subsequent one-year family-based intervention, or a standard intervention arm consisting of one weekly exercise session for six weeks. Body mass index (BMI) was the primary outcome. BMI z-score, clustered cardiovascular risk z-score, and body composition were secondary outcomes. All outcomes were measured at baseline, six week-, and 52 week follow-up. After six weeks, children from the day-camp intervention arm had improved their BMI (-2.2 kg/m² (95% CI -2.6 to -1.7, P<0.001)) and all secondary outcomes when compared to the children from the standard intervention arm. After 52 weeks, the day-camp intervention arm had a lower BMI (-1.2 kg/m² (95% CI -1.8 to -0.5, P = 0.001)), and BMI z-score (-0.20 (95% CI -0.35 to -0.05, P = 0.008)), and clustered cardiovascular risk z-score (-0.23 (95% CI -0.37 to -0.08, P = 0.002)) compared to the standard intervention arm. No group differences were detected in body composition after 52 weeks. This study shows that the day-camp intervention arm is effective in reducing BMI and improving the metabolic health of children with overweight and obesity. However, the effects seem to be diminishing over time.

Participation as a leader in immersion weight loss treatment: a 1-year follow-up study

Non-overweight individuals may follow aggressive weight management approaches alongside overweight/obese friends or family members; thus, research has begun to evaluate subsequent effects among non-overweight populations. A prior study evaluated the short-term effects of an immersion weight loss programme on healthy young adult staff leaders. Results indicated that participation seemed to benefit, not harm, the young adults. The current investigation examined 1-year eating disorder and weight trajectories in this sample. The total sample (N = 244) consisted of staff leaders (44.3%) and demographically similar comparison participants who completed eating disorder and weight assessments across four time points: baseline, end of summer, 6-week follow-up and 1-year follow-up. Forty-seven per cent of the original sample responded to all time points (staff leaders n = 60; comparison n = 55). Over the course of 1 year, risk trajectories did not differ between groups. Staff leaders did not report significant changes in body mass index, suggesting that they maintained healthy weight over the course of 1 year. Participation as an immersion weight loss programme leader appeared to be protective against weight gain, without increasing eating disorder risk, for healthy young adults. This provides further support for using weight management interventions across a wide range of individuals.

Managing temptation in obesity treatment: A neurobehavioral model of intervention strategies

Weight loss outcomes in lifestyle interventions for obesity are primarily a function of sustained adherence to a reduced-energy diet, and most lapses in diet adherence are precipitated by temptation from palatable food. The high nonresponse and relapse rates of lifestyle interventions suggest that current temptation management approaches may be insufficient for most participants. In this conceptual review, we discuss three neurobehavioral processes (attentional bias, temporal discounting, and the cold-hot empathy gap) that emerge during temptation and contribute to lapses in diet adherence. Characterizing the neurobehavioral profile of temptation highlights an important distinction between temptation resistance strategies aimed at overcoming temptation while it is experienced, and temptation prevention strategies that seek to avoid or minimize exposure to tempting stimuli. Many temptation resistance and temptation prevention strategies heavily rely on executive functions mediated by prefrontal systems that are prone to disruption by common occurrences such as stress, insufficient sleep, and even exposure to tempting stimuli. In contrast, commitment strategies are a set of devices that enable individuals to manage temptation by constraining their future choices, without placing heavy demands on executive functions. These concepts are synthesized in a conceptual model that categorizes temptation management approaches based on their intended effects on reward processing and degree of reliance on executive functions. We conclude by discussing the implications of our model for strengthening temptation management approaches in future lifestyle interventions, tailoring these approaches based on key individual difference variables, and suggesting high-priority topics for future research.

Participation as a leader in immersion weight loss treatment may benefit, not harm, young adult staff members

Despite the success of weight-management programmes, some researchers caution that participation in an aggressive approach to weight management could promote the development of eating pathology. The current study evaluated the risks and benefits for young adults of serving as staff members in an immersion treatment of adolescent obesity over the course of a summer. Participants included weight loss staff members (n = 108) along with a comparison group of young adults with similar demographic characteristics (n = 136). Participants completed assessments of eating disorder and obesity risk at three time points: the beginning of the summer, the end of the summer and a 6-week follow-up. Weight loss leadership participants who were initially overweight lost weight over the course of the summer, but those at healthy weights maintained their weight. Comparison participants also maintained their weight during the summer. Weight loss staff members also increased dietary restraint over the summer, and increases in dietary restraint appeared to facilitate appropriate weight reduction. Participation as a leader in an immersion weight loss programme seemed to benefit, not harm, young adults; this suggests potential advantages for using weight controlling interventions in a wide range of individuals, including as an obesity prevention strategy.

Treatment of child/adolescent obesity using the addiction model: a smartphone app pilot study

BACKGROUND

The aim of this study was to test a weight loss program for young people based on an addiction treatment approach.

METHODS

A pilot study (n=43) was conducted of a 20-week child/adolescent obesity intervention based on an addiction treatment model (staged, incremental withdrawal from problem foods, snacking/grazing, and excessive amounts at meals) and implemented by a server-integrated smartphone app with health professional support. The primary outcome was standardized %overBMI measured at four time points. Secondary outcomes were participants' self-ratings of self-esteem, control over food, and the degree they turned to food when stressed. User satisfaction data were collected with an online questionnaire. Latent growth modeling techniques were used to identify independent variables and possible mediating treatment process variables associated with weight change.

RESULTS

Mean age of participants was 16 years (range, 10-21), 65% girls, and 84% Caucasian. Twenty-seven (63%) completed the program. There was a significant decrease in %overBMI over time of 7.1. There were significant improvements in participant ratings of self-esteem, control over food, and a reduction in turning to food when stressed. Males, younger participants, and participants with higher levels of program compliance achieved better weight loss. Participants who reported that calling obesity an addiction made their guilt worse experienced poorer weight loss. Females were more likely than males to report "addiction guilt," and this partly mediated the overall gender effect.

CONCLUSIONS

The staged, incremental food withdrawal approach was feasible to implement and was useful in helping reduce excessive weight, particularly among boys.

Effects of a cognitive-behavioral therapy-based immersion obesity treatment program for adolescents on weight, fitness, and cardiovascular risk factors: a pilot study

BACKGROUND

Comprehensive, residential treatment for severe obesity in adolescents may be an alternative to bariatric surgery and more efficacious than outpatient treatment. The aim of this study was to evaluate the effects of a long-term cognitive-behavioral therapy-based immersion obesity treatment program for adolescents.

METHODS

Twelve obese adolescents with BMIs above the 95th percentile completed a 14- to 18-week multicomponent intervention.

RESULTS

We observed significant improvements in BMI z-score, waist circumference, mile run time, and blood lipids.

CONCLUSION

This study suggests that the tested program may be effective, at least in the short term; a randomized, controlled trial to further assess this model is warranted.

"I see inspiration everywhere": potential keys to nurturing healthy obsessions by very successful young weight controllers

BACKGROUND

The Healthy Obsession Model posits that committed weight controllers develop preoccupations with the planning and execution of target behaviors to reach healthy goals. We expected that successful weight controllers, more so than unsuccessful weight controllers, would report more elaborate definitions of their healthy obsessions, negative reactions to lapses, and constructive responses to high-risk situations. We also expected to find differential sources of commitment between losers and gainers, including a greater emphasis on emotional and experiential consequences by losers, as documented in the authors' 2012 study.

METHODS

Sixteen adolescent participants who had completed cognitive-behavior therapy immersion treatment for obesity at least 1 year before the interviews (8 successful and 8 unsuccessful weight controllers) completed in-depth interviews based on the Scanlan Collaborative Interview Method. A qualitative analysis followed in which two coders identified themes within the interviews.

RESULTS

Reliable coding of the interviews produced results that supported the hypothesis that highly successful weight controllers nurture strong healthy obsessions. Successful weight controllers also reported using significantly more helpful motivators than did unsuccessful weight controllers. In addition, these adolescent weight controllers seemed motivated by some of the same factors that elite athletes identified in the Sport Commitment Model.

CONCLUSIONS

Clinical implications include focusing weight loss interventions on nurturing healthy obsessions in general and, more specifically, on helping weight controllers use more diverse sources of commitment.

Ya gotta have friends: social support and self-efficacy predict success following immersion treatment

OBJECTIVE

This study examined the impact of perceived social support and self-efficacy on predicting success in weight management following immersion treatment of adolescent obesity.

METHODS

198 overweight and obese adolescents (M% overweight = 81.4%; M BMI = 36.0) participated in Wellspring's cognitive-behavioral therapeutic camps for 3-10 weeks during the summer of 2011. The campers and one of their caretakers completed a series of questionnaires at the halfway point during immersion. One year following camp, campers and their parents provided follow-up heights and weights.

RESULTS

Multiple regression intent to treat analyses indicated that campers who perceived their friends as supportive, reported confidence in their ability to succeed, and believed that their families functioned well achieved relatively more substantial reductions in percent overweight 1 year after immersion. Perceptions of support anticipated from parents failed to predict success. Campers who more fully engaged in the process of change at camp also achieved somewhat greater success in the long run.

CONCLUSIONS

These results suggest that participants in cognitive-behavioral immersion treatment may improve outcomes by nurturing support from their friends, increasing self-efficacy, and having their families consider family therapy if warranted.

Outcomes of group-based treatment program with parental involvement for the management of childhood and adolescent obesity

OBJECTIVE

An uncontrolled study was conducted to evaluate the effects of a group-based program on weight control, metabolic profiles, and obesity-related complications in obese youth.

METHODS

The program consisted of an initial in-patient session and five group sessions, one, two, three, six, and nine months into the study, providing participants and their parents with information about the consequences of obesity and lifestyle modifications. The severity of obesity and obesity-related complications were evaluated at baseline and 12 months after the intervention. The participants' and their parents' perceptions of the program were assessed.

RESULTS

Of the obese youth recruited (n=126), 115 completed the study. Their percentage weight for height and percentage body fat decreased significantly (both p<0.001), and their insulin resistance, lipid profiles, and transaminases levels improved (all p<0.01). The prevalence of prediabetes, dyslipidemia, and elevated transaminases decreased significantly (all p<0.05). The participants and their parents perceived the program as valuable.

CONCLUSION

A group-based program is effective in managing childhood obesity, improving metabolic profiles, and alleviating certain obesity-related complications.

PRACTICE IMPLICATIONS

A group-based program that provides education and raises the awareness of obese children and their parents about the consequences of obesity is an effective model for treating childhood obesity.

Current approaches to the management of pediatric overweight and obesity

OPINION STATEMENT

Family-based behavioral intervention has been demonstrated to be an effective and safe treatment for childhood obesity and should be considered a first-line treatment option. However, access to such intensive evidence-based treatment is limited and, currently, obesity care is dominated by high intensity behavioral treatment implemented in specialty clinics or less effective low intensity treatments implemented in primary care. However, capitalizing on the established and ongoing relationship between primary care providers and families, primary care providers have an invaluable role in early identification of overweight and obesity, and subsequent referral to an evidence-based treatment. Key aspects of effective treatment include: early intervention, moderate intensity to high intensity intervention of sufficient duration, multicomponent intervention targeting dietary modification, physical activity and behavioral strategies, family involvement and goals targeting family members, and follow-up contact during maintenance. The purpose of this review is to present the current empirically supported treatment options for pediatric obesity including primary care-based interventions and diagnostic tools, multicomponent behavioral intervention with a focus on family-based behavioral intervention, immersion treatment, and pharmacologic and surgical management.

Effects of exercise on BMI z-score in overweight and obese children and adolescents: a systematic review with meta-analysis

BACKGROUND

Overweight and obesity are major public health problems in children and adolescents. The purpose of this study was to conduct a systematic review with meta-analysis to determine the effects of exercise (aerobic, strength or both) on body mass index (BMI) z-score in overweight and obese children and adolescents.

METHODS

Studies were included if they were randomized controlled exercise intervention trials ≥ 4 weeks in overweight and obese children and adolescents 2 to 18 years of age, published in any language between 1990-2012 and in which data were available for BMI z-score. Studies were retrieved by searching eleven electronic databases, cross-referencing and expert review. Two authors (GAK, KSK) selected and abstracted data. Bias was assessed using the Cochrane Risk of Bias Assessment Instrument. Exercise minus control group changes were calculated from each study and weighted by the inverse of the variance. All results were pooled using a random-effects model with non-overlapping 95% confidence intervals (CI) considered statistically significant. Heterogeneity was assessed using Q and I2 while funnel plots and Egger's regression test were used to assess for small-study effects. Influence and cumulative meta-analysis were performed as well as moderator and meta-regression analyses.

RESULTS

Of the 4,999 citations reviewed, 835 children and adolescents (456 exercise, 379 control) from 10 studies representing 21 groups (11 exercise, 10 control) were included. On average, exercise took place 4 x week for 43 minutes per session over 16 weeks. Overall, a statistically significant reduction equivalent to 3% was found for BMI z-score (Χ¯, -0.06, 95% CI, -0.09 to -0.03; Q = 24.9, p = 0.01; I(2)=59.8%). No small-study effects were observed and results remained statistically significant when each study was deleted from the model once. Based on cumulative meta-analysis, results have been statistically significant since 2009. None of the moderator or meta-regression analyses were statistically significant. The number-needed-to treat was 107 with an estimated 116,822 million obese US children and adolescents and approximately 1 million overweight and obese children and adolescents worldwide potentially improving their BMI z-score by participating in exercise.

CONCLUSIONS

Exercise improves BMI z-score in overweight and obese children and adolescents and should be recommended in this population group. However, a need exists for additional studies on this topic.

Obesity and type 2 diabetes in children: epidemiology and treatment

The incidence of overweight and obesity among children has increased dramatically in recent decades, with about one-third of children in the U.S. currently being either overweight or obese. Being overweight in early childhood increases risk for later obesity. There is evidence for the efficacy of family-based behavioral treatment to control weight and improve health outcomes. Obesity-related health risks have been documented, including metabolic syndrome. There is also increasing incidence of type 2 diabetes (T2D) among youth in recent years, with obesity and family history of T2D generally present. Lower income and ethnic minority status are associated with both obesity and T2D in youth. Most youth with T2D do not achieve optimal glycemic control, and are at high risk for later health complications. Obesity and T2D represent significant public health issues with potentially great personal and societal cost. Research addressing the prevention of obesity and T2D among youth is urgently needed.

Characterizing severe obesity in children and youth referred for weight management

Background

Severe obesity (SO) in pediatrics has become increasing prevalent in recent decades.

The objective of our study was to examine differences in demographic, anthropometric, cardiometabolic, and lifestyle variables in children and youth with SO versus their less overweight/obese (OW/OB) peers.

Methods

A retrospective medical record review of 6-19 year old participants enrolled in an outpatient pediatric weight management clinic was conducted. SO (body mass index [BMI] ≥99^th percentile) and OW/OB (BMI ≥85^th and <99^th percentile) groups were created according to Centers for Disease Control and Prevention definitions. Demographic, anthropometric, cardiometabolic and lifestyle data reported at baseline (pre-intervention) were retrieved.

Results

Of the 345 participants, most were girls (56.2%), Caucasian (78.7%), and had family incomes > $50,000/year (65.7%). The SO group (n = 161) had lower HDL-cholesterol and higher liver enzymes, insulin resistance and blood pressure than the OW/OB group (n = 184; all p < 0.01). They also reported higher total energy intakes, fewer steps/day, less moderate-to-vigorous physical activity, and more leisure time screen time (all p < 0.02) than their leaner peers. Compared to the OW/OB group, a higher proportion of individuals in the SO group possessed cardiometabolic risk factors, including high triglycerides (45.8% vs 58.5%), alanine aminotransferase (55.4% vs 81.4%), insulin resistance (55.6% vs 82.1%), systolic blood pressure (11.5% vs 27.3%), diastolic blood pressure (17.8% vs 30.0%), and low HDL-cholesterol (44.6% vs 64.6%; all p < 0.02). Aside from the ~75% of participants (groups combined) who met the daily recommended intakes of grain and meat products, <50% of boys and girls met any of the remaining nutrition and physical activity-related recommendations. Compared to the OW/OB group, greater proportions of children and youth in the SO group failed to meet moderate-to-vigorous physical activity (48.4% vs 31.9%) and leisure-time-screen-time recommendations (43.4% vs 28.3%; both p < 0.05).

Conclusion

Children and youth with SO have a worse cardiometabolic profile and less favorable lifestyle habits than their OW/OB peers. These differences emphasize the heightened obesity-related health risks associated with SO in the pediatric years.

Camp-based immersion treatment for obese, low socioeconomic status, multi-ethnic adolescents

BACKGROUND

Immersion treatment (IT) provided in a camp setting has been shown to promote short-term improvements in weight and health status in obese adolescents. However, evidence of IT's long-term efficacy and efficacy for multi-ethnic and lower socioeconomic status (SES) adolescents is limited.

METHODS

This was a cohort study with a pre/post design and longitudinal follow-up. The intervention was a 19-day camp-based IT program comprising (1) a nutrition curriculum and ad-lib access to a nutritious diet, (2) several hours of physical activity daily, (3) group therapy, and (4) cognitive-behavioral therapy (CBT). This analysis included 52 low-SES adolescents that participated in 2009 and 2010. A subgroup of 33 campers and their families was offered follow-up monthly for 10 months. Primary outcome measures were change in weight-related parameters immediately postcamp and after 10 months of follow-up.

RESULTS

Campers had significant short-term improvements in mean waist circumference (mean [M], 2.6; standard deviation [SD], 3.2 cm), weight (M, 2.6; SD, 1.9 kg), BMI (M, 1.1; SD, 0.9 kg/m2), BMI z-score (M, 0.06; SD, 0.07), and percent overweight (M, 6.1; SD, 4.7). Campers offered follow-up had a modest increase in mean percent overweight (M, 2.0; SD, 8.4) during 10 months of follow-up. However, 33% experienced continuing decline in percent overweight during follow-up, and long-term follow-up was associated with significant overall (precamp vs. end of follow-up) improvements in percent overweight (M, 4.9; SD, 7.2).

CONCLUSIONS

Camp-based IT with CBT is a promising intervention for improving short- and long-term weight status of low-SES adolescents. Additional research is needed to increase long-term efficacy.

Neuropsychological assessment as a predictor of weight loss in obese adolescents

BACKGROUND

Obese individuals are known to be more impulsive than their normal-weight counterparts. Impulsivity has been postulated to be a predictor of weight loss.

DESIGN

A pre-post study was designed to determine for the first time whether impulsivity changed with weight loss during a lifestyle and physical activity intervention programme lasting 2-8 weeks.

SUBJECTS

Fifty-three obese adolescents with a body mass index (BMI) of 33.75 ± 7.9 attending a residential camp were tested and compared at baseline with 50 non-obese adolescents with a mean BMI of 20.6 ± 2.3.

MEASUREMENTS

Inhibitory control was measured with the CANTAB (Cambridge Cognition, Cambridge, UK) Stop Signal Task. MATLAB (The Mathswork Inc., Natick, MA, USA) was used to measure the temporal discounting constant.

RESULTS

The obese group was more impulsive than the normal weight adolescents. BMI reduced significantly from 33.76 kg m(-2) to 30.93 kg m(-2) after completing camp. The stop signal reaction time (SSRT) decreased from 225.38 ± 94.22 to 173.76 ± 107.05 ms (n=47, P=0.0001). A reduction in inhibitory control during camp was predictive of those who showed the greatest reduction in BMI (Wilks' Lambda=0.9, F(1,50)=4.85, P=0.034). The number of weeks in camp (Wilks' Lambda=0.83, F(1,50)=9.826, P=0.003) and the age of the adolescents (Wilks' Lambda=0.87, F(1,50)=5.98, P=0.02) were significantly associated with a reduction in inhibitory control as measured by the SSRT. A longer stay in camp was associated with a greater reduction in SSRT (B=25.45, t=2.02, P=0.05). Increasing age had a significant moderating role in the reduction of inhibitory control (B=-0.3, t=-0.034, P=0.05). Temporal discounting for monetary reward also fell significantly during camp.

CONCLUSION

This study highlights the potential to identify those who are obese by using an easy-to-measure psychometric test. Furthermore, it is the first study to report a reduction in impulsivity and an improvement in well-being as part of a government-approved residential camp for obese adolescents. The potential mechanisms for change in impulsivity with weight are discussed.

Five recent expert recommendations on the treatment of childhood and adolescent obesity: toward an emerging consensus--a stepped care approach

BACKGROUND

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.

METHODS

We compared the recommendations' approaches and conclusions pertaining to four treatments (self-help groups, outpatient cognitive-behavior therapy [CBT], immersion CBT, and surgery).

RESULTS

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.

CONCLUSIONS

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.