Adapting pediatric obesity care to better suit adolescent patients: Design of a treatment platform and results compared with standard care in the national patient quality register

Abstract

Background: Obesity constitutes a critical risk for adolescent health. This study aimed at identifying youth-friendly components of obesity treatment. Methods:In this feasibility study, an adolescent obesity treatment platform was implemented at two Pediatric outpatient clinics in Sweden. Body mass index (BMI), BMI z-score, and the category of obesity (International Obesity Task Force) were compared before and after the intervention and with data on standard care from the Swedish Childhood Obesity Treatment Register. Results:The study included 99 participants (49 females) aged 13-18 years from 1 September 2014, to 31 December 2016. A pediatric nurse met the participants on average 6.5 times in the average inclusion period of 15 months. Physical activity sessions attracted 63 participants. Acceptance Commitment Therapy and In Real Life groups attracted 24 participants. At inclusion, 62 participants had obesity and 37 severe obesity, and 71/99 (72%) remained in the same category. The mean BMI increased from 32.0 to 33.4 kg/m 2 (p < 0.01), but 56/94 (60%) participants lowered their BMI or increased less than 1 kg/m 2 and 73% stayed to the end of the study.Participants who were new to treatment and participants coming for more than eight visits to the nurse did not increase in BMI. BMI did not change for the 221 out of 641 register patients who had two recordings of BMI in the study period. Conclusions:The platform was successful in increasing retention, and 60% of participants lowered or maintained their BMI. Still, seven out of ten adolescents with obesity or severe obesity remained in the same weight category.

Significant effects of childhood obesity treatment with a web‐based component in a randomised controlled study (Web‐COP)

“…It remains to be elucidated what contribution the personal attachment to a health care provider and personalised approach adds to the treatment of children, or if all interactions can be based on web‐based care. For adolescent patients, the staff‐member's relation to the patient has been associated with better treatment results 30 …”

Integrating COM-B and the person-based approach to develop an ACT based therapy programme to raise self-determination in adolescents with obesity

“…The service user perspective has also heavily influenced the logistical aspects of the intervention. The four trials that have assessed ACT use in similar young populations have also shown promising feasibility results; however, none of the interventions have been developed in a service user-led way and all have included ACT as part of an integrated weight-management intervention with multiple elements, making it difficult to delineate the effectiveness and feasibility of the ACT components in this setting [51][52][53][54]. Practical factors such as access, location and timing contribute to the high attrition typically seen within weight-management interventions [55,56].…”

Metabolic and Bariatric Surgery in Adolescents: For Whom, When, and How?

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