Dietary Patterns in Adolescent Obesity as Predictors of Long-Term Success Following an Intensive Inpatient Lifestyle Programme

(1) Background: Lifestyle interventions for adolescents with obesity show minor long-term effects on anthropometric parameters. The persistence of dietary changes after obesity inpatient rehabilitation has not been sufficiently investigated. (2) Objectives: To analyse dietary patterns in German adolescents with obesity as predictors of long-term success following an intensive inpatient lifestyle programme regarding food choices as well as body weight and comorbidities. (3) Methods: Food consumption data of 137 German adolescents with obesity aged 10-17 years were collected by a nutrition interview. Cluster analysis was used to group the participants according to their food consumption. Dietary patterns, changes in body weight and insulin resistance were compared over a 2-year-period. (4) Results: Three dietary patterns were identified. Big Eaters (n = 32) consume high amounts of total sugar and meat, Moderate Eaters (n = 66) have a diet comparable to the national average, and Snackers (n = 39) have a particularly high consumption of total sugar. Big Eaters and Snackers significantly reduced the consumption of total sugar. Among Moderate Eaters, no persistent changes were observed. (5) Conclusion: Weight reduction interventions can induce long-lasting changes in the diet of adolescents with obesity. Therefore, the success of a weight reduction intervention should not be determined by weight reduction only.

Surgery for the treatment of obesity in children and adolescents

BACKGROUND

Child and adolescent overweight and obesity have increased globally and are associated with significant short- and long-term health consequences.

OBJECTIVES

To assess the effects of surgery for treating obesity in childhood and adolescence.

SEARCH METHODS

For this update, we searched Cochrane Central Register of Controlled Trials, MEDLINE, Latin American and Caribbean Health Science Information database (LILACS), World Health Organization International Clinical Trials Registry Platform (ICTRP)and ClinicalTrials.gov on 20 August 2021 (date of the last search for all databases). We did not apply language restrictions. We checked references of identified studies and systematic reviews.

SELECTION CRITERIA

We selected randomised controlled trials (RCTs) of surgical interventions for treating obesity in children and adolescents (age < 18 years) with a minimum of six months of follow-up. We excluded interventions that specifically dealt with the treatment of eating disorders or type 2 diabetes, or which included participants with a secondary or syndromic cause of obesity, or who were pregnant.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane. Two review authors independently extracted data and assessed the risk of bias using the Cochrane Risk of Bias 2.0 tool. Where necessary, we contacted authors for additional information.

MAIN RESULTS

With this update, we did not find any new RCTs. Therefore, this updated review still includes a single RCT (a total of 50 participants, 25 in both the intervention and comparator groups). The intervention focused on laparoscopic adjustable gastric banding surgery, which was compared to a control group receiving a multi-component lifestyle programme. The participating population consisted of Australian adolescents (a higher proportion of girls than boys) aged 14 to 18 years, with a mean age of 16.5 and 16.6 years in the gastric banding and lifestyle groups, respectively. The trial was conducted in a private hospital, receiving funding from the gastric banding manufacturer. For most of the outcomes, we identified a high risk of bias, mainly due to bias due to missing outcome data. Laparoscopic gastric banding surgery may reduce BMI by a mean difference (MD) of -11.40 kg/m2 (95% CI -13.22 to -9.58) and weight by -31.60 kg (95% CI -36.66 to -26.54) compared to a multi-component lifestyle programme at two years follow-up. The evidence is very uncertain due to serious imprecision and a high risk of bias. Adverse events were reported in 12/25 (48%) participants in the intervention group compared to 11/25 (44%) in the control group. A total of 28% of the adolescents undergoing gastric banding required revisional surgery. The evidence is very uncertain due to serious imprecision and a high risk of bias. At two years of follow-up, laparoscopic gastric banding surgery may increase health-related quality of life in the physical functioning scores by an MD of 16.30 (95% CI 4.90 to 27.70) and change in health scores by an MD of 0.82 (95% CI 0.18 to 1.46) compared to the lifestyle group. The evidence is very uncertain due to serious imprecision and a high risk of bias. No data were reported for all-cause mortality, behaviour change, participants' views of the intervention and socioeconomic effects. Finally, we have identified three ongoing RCTs that are evaluating the efficacy and safety of metabolic and bariatric surgery in children and adolescents.

AUTHORS' CONCLUSIONS

Laparoscopic gastric banding led to greater body weight loss compared to a multi-component lifestyle program in one small study with 50 participants. These results have very limited application, primarily due to more recent recommendations derived from observation studies to avoid the use of banding in youth due to long-term reoperation rates. This systematic review update still highlights the lack of RCTs in this field. The authors are concerned that there may be ethical barriers to RTCs in this field, despite the lack of other effective therapies for severe obesity in children and adolescents and the significant morbidity and premature mortality caused by childhood obesity. Nevertheless, future studies, whether pre-registered and planned non-randomised or pragmatic randomised trials, should assess the impact of the surgical procedure and post-operative care to minimise adverse events, including the need for post-operative adjustments and revisional surgery. Long-term follow-up is also critical to comprehensively assess the impact of surgery as participants enter adulthood.

Gustatory Function Can Improve after Multimodal Lifestyle Intervention: A Longitudinal Observational Study in Pediatric Patients with Obesity

Introduction: Obesity is a major health burden in children and adolescents. One influential factor is the choice of food, which is partly determined by gustatory perception. Cross-sectional studies have provided evidence that gustatory function is reduced in patients with obesity compared to individuals with normal weight. This longitudinal study was aimed at investigating potential effects of a multimodal lifestyle intervention program on gustatory function in pediatric patients with obesity. Methods: Gustatory perception of five different taste qualities (sweet, sour, salty, bitter, and umami) was assessed in n = 102 patients (age 6-18) with obesity (BMI >97th percentile). Testing was performed before (T0) and after (T1) a residential multimodal weight reduction program between June and December 2015 using well-established taste strips. Results: Overall, identification performance increased between T0 and T1. Patients were most successful at identifying the taste quality sweet at both time points and reached higher scores at identifying umami and bitter at T1 compared to T0. Moreover, patients rated the highest concentration of sweet significantly sweeter at T1 compared to T0. Conclusion: Gustatory function can improve after a multimodal lifestyle intervention program in pediatric patients with obesity. This may lead to a modified choice of food, possibly resulting in a long-term therapeutic success. Therefore, these findings underline the importance of professional nutritional counseling as part of treatment for obesity.

Cooperation behaviour of primary care paediatricians: facilitators and barriers to multidisciplinary obesity management

BACKGROUND

Multidisciplinary management of obesity by primary care paediatricians, providing a promising approach to tackle childhood obesity includes cooperation with other health care professionals. However, facilitators for and barriers to multidisciplinary cooperation in ambulatory care are not yet well understood and are investigated in the present study.

METHODS

A nationwide, cross-sectional survey of 83% of German primary care paediatricians was conducted, using a questionnaire based on qualitative expert interviews. Frequency of paediatricians' cooperation with external partners (i.e. nutrition counsellors; sports groups; interdisciplinary obesity centres; inpatient rehabilitation centres; and endocrinologists) was assessed. Individual and structural factors were associated with cooperation patterns. Missing values were addressed using multiple imputation.

RESULTS

Out of the 6081 primary care paediatricians approached, 2024 (33.3%) responded. Almost half of the respondents (40.8%) stated that they disengaged in the field of obesity prevention due to perceived inefficacy. Lack of financial reimbursement for consultation was agreed on by most of the respondents (90.4%). Identified barriers to cooperation included: higher proportion of patients with migration background, lack of time and available services. A more comprehensive conception of the professional role regarding overweight prevention, higher age, female gender, higher proportion of overweight/obese patients and practice location in urban or socially strained areas surfaced as facilitators for cooperation.

CONCLUSION

Low-perceived self-efficacy in obesity management and insufficient financial reimbursement for consultation are commonly stated among German paediatricians. For cooperation behaviour, however, other individual and structural factors seem to be relevant, which provide indications on how multidisciplinary childhood obesity management can be improved.

[Health promotion and overweight prevention-a systematic evaluation of available information materials with a focus on risk groups]

BACKGROUND

Children and adolescents from families with a migration background and/or low social status belong to risk groups for the development of overweight. At the same time, they are considered difficult to approach for health promotion. This paper aims to provide an overview of freely available print and web-based materials on health promotion and to evaluate these in terms of formal, content-related, and target-group-specific criteria.

METHOD

From August to September 2017, print media and websites were screened using systematic keyword searches in a large search engine. Search results were evaluated by an evidence-based catalogue of criteria and rated by comparative analysis. Health apps freely available from an app store were investigated, tested, and evaluated descriptively.

RESULTS

Eighty-nine print media, 58 websites and 32 apps were found. Of the print media items, 11.2% are available in different languages; in 29% culturally sensitive aspects are considered and in 12.4% the material makes use of clear, nontechnical language. In 40.6% of the websites, either another language can be chosen or foreign language downloads are available. Most common are translations into English (37.5%), Turkish (31.3%), Arabic (28.1%), and Russian (25%). In 37.5% of the websites, the material addresses culturally sensitive aspects. From the tested apps (n = 25), only a few qualitatively high-ranked ones are aimed at parents and pregnant women and these are often text-based and exclusively available in German.

DISCUSSION

Only few informational materials are directly oriented to the everyday world of risk groups. For this target group, material drawn up in clear language with multiple translations as well as with culturally adapted designs is recommended.

[Current literature overview on the therapy of obesity in children and adolescents]

BACKGROUND

Obesity is a chronic disease due to the comorbidity associated with it and the need for long-term medical care. Therapeutic intervention is possible at every stage of pathophysiology.

AIM

The aim of the study is to demonstrate the effect of multimodal lifestyle interventions not only on the BMI/BMI-SDS, but also on (secondary) outcomes such as comorbidities, quality of life as well as the nutritional and movement behavior.

MATERIALS AND METHODS

The literature database PubMed has been searched for internationally clinical studies on lifestyle interventions among 0 to 18-year-olds with overweight and obesity in the period from 01/01/2009 to 01/01/2016.

RESULTS

64 publications with data from 55 studies were included in this overview. Through multimodal lifestyle interventions, many improvements have been achieved in the fields of comorbidity, quality of life, diet and exercise.

DISCUSSION

The use of obesity therapy goes far beyond a weight reduction, which is why other parameters should be regularly recorded as therapeutic targets. Thus the improvement of comorbidities, the quality of life as well as the movement and nutritional behavior for a long-term healthy lifestyle are at least as important and reduce the risk of regain after initial weight reduction.

[Electronic media in obesity prevention in childhood and adolescence]

BACKGROUND

The increasing prevalence of childhood obesity is - amongst other factors - due to changed leisure time habits with decreased physical activity and increased media consumption. However, electronic media such as tablets and smartphones might also provide a novel intervention approach to prevent obesity in childhood and adolescence.

OBJECTIVES

A summary of interventions applying electronic media to prevent childhood obesity is provided to investigate short term effects as well as long term results of these interventions.

METHODS

A systematic literature search was performed in PubMed/Web of Science to identify randomized and/or controlled studies that have investigated the efficacy of electronic media for obesity prevention below the age of 18.

RESULTS

A total of 909 studies were identified, and 88 studies were included in the analysis. Active video games did increase physical activity compared to inactive games when applied within a peer group. Interventions via telephone had positive effects on certain lifestyle-relevant behaviours. Interventions via mobile were shown to decrease dropout rates by sending regular SMS messages. To date, interventions via smartphones are scarce for adolescents; however, they might improve cardiorespiratory fitness. The results from internet-based interventions showed a trend towards positive effects on lifestyle-relevant behaviors. The combination of different electronic media did not show superior results compared to interventions with only one medium. Interventions via TV, DVD or video-based interventions may increase physical activity when offered as an incentive, however, effects on weight status were not observed.

DISCUSSION

Children and adolescents currently grow up in a technology- and media-rich society with computers, tablets, smartphones, etc. used daily. Thus, interventions applying electronic media to prevent childhood obesity are contemporary. Available studies applying electronic media are however heterogeneous in terms of applied medium and duration. Positive effects on body composition were not observed, but only on certain lifestyle-relevant behaviours. In addition, these effects could only be seen in the short term. Follow-up data are currently scarce.