Treatment of Child/Adolescent Obesity Using the Addiction Model: A Smartphone App Pilot Study

Abstract

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.

Texting and Mobile Phone App Interventions for Improving Adherence to Preventive Behavior in Adolescents: A Systematic Review

“…Adherence to preventive behavior was evaluated by clinic attendance in 4 [35,36,39,53], self-report of adherence in 3 [37,40,50], self-report and electronic device to monitor adherence in 1 [38], and electronic direct observation of adherence behavior (self-photographs or selfies) in 1 study [46]. All the included studies provided enough information to calculate standardized outcomes (ie, effect sizes d or SMDs), except 1 [42].…”

A systematic review of community‐based interventions for the treatment of adolescents with overweight and obesity

“…Study, program and participant characteristics are reported in Table . Half of the programs were from the United States (US; n = 11) with the remainder from Europe ( n = 7) , Australia ( n = 2) and the United Kingdom (UK; n = 1) . The programs were evaluated as controlled trials ( n = 15), both randomized ( n = 10) and non‐randomized ( n = 5) , and as pre–post case series ( n = 6) .…”

“…Study quality was assessed to be weak for five programs ; moderate for eight ; and strong for eight . More than half of the programs were rated as being weak for selection bias ( n = 11) , as they involved self‐referrals from community advertisements and public service announcements, as is commonplace for community interventions, and thus participants were not selected at random from the eligible population.…”

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“…According to Schwarz et al [39] given the current support for some sort of a mediating or moderating relationship to obesity in selected cases, a psychodynamically oriented approach to treating compulsive overeating, as well as an integrated model, rather than a medical model of intervention alone may be helpful for reducing obesity in selected cases. In addition, given the similarities of food addiction to other addictive behaviors Dimitrijovic et al [1] have advocated for the application of traditional addictive treatment approaches in the context of treating obesity, while a staged or incremental food withdrawal approach may be helpful as outlined by Pretlow et al [31].…”