Behavioral Weight Control Treatment with Supervised Exercise or Peer-Enhanced Adventure for Overweight Adolescents

doi:10.1016/j.jpeds.2010.05.047

The Journal of Pediatrics

Volume 157, Issue 6, December 2010, Pages 923-928.e1

https://doi.org/10.1016/j.jpeds.2010.05.047 Get rights and content

Objective

To evaluate the efficacy of behavioral weight control intervention with a peer-enhanced activity intervention versus structured aerobic exercise in decreasing body mass index (BMI) and z-BMI in overweight adolescents.

Study design

Participants were randomized to 1 of 2 group-based treatment conditions: (1) cognitive behavioral treatment with peer-enhanced adventure therapy or (2) cognitive behavioral weight control treatment with supervised aerobic exercise. Participants included 118 overweight adolescents, ages 13 to 16 years, and a primary caregiver. Changes in BMI, standardized BMI, percent over BMI, and waist circumference were examined.

Results

Analysis of variance on the basis of intent-to-treat indicated significant decreases in all weight change outcomes at the end of treatment, with significant decreases maintained at the 12-month follow-up. No differences in treatment conditions were observed. Secondary analyses indicated that adherence with attendance and completion of weekly diet records contributed significantly to reductions in BMI.

Conclusions

A cognitive behavioral weight control intervention combined with supervised aerobic exercise or peer-enhanced adventure therapy is equally effective in short-term reduction of BMI and z-BMI in overweight adolescents. Adherence, as measured with session attendance and self-monitoring, is a key dimension of weight change.

Section snippets

Methods

A total of 118 overweight adolescents were randomized to treatment (Figure; available at www.jpeds.com). Participants were recruited from local newspaper advertisements and referrals from area pediatricians. Eligibility requirements included age between 13 and 16 years, between 30% and 90% overweight as defined with reference to median BMI for age and sex, at least one parent available to participate, and English speaking. Adolescents were excluded when they met the criteria for a major

Results

Participant demographic and baseline weight status data are presented in Table I. There were no significant differences in adolescents randomized to the two treatment conditions on baseline variables of BMI, percent over BMI, or demographics.

One hundred of the 118 participants (85%) randomized to treatment conditions completed the end-of-treatment assessment, and 93 participants (79%) were available for 12-month follow-up. Participants in both treatment conditions who completed the 12-month

Discussion

BMI reductions in this study were comparable with those observed in a small 10- week trial comparing CBT with a control condition in overweight adolescents⁸ and to findings based on prescription of a reduced glycemic index diet for obese adolescents.²⁰ A lifestyle intervention that reported superior outcomes with adolescents required greater weekly time commitment with a longer active intervention phase.²¹ Thus, this study adds to an increasing body of evidence demonstrating significant

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Development and initial validation of the Support for Healthy Lifestyle (SHeL) questionnaire for adolescents
2019, Eating Behaviors
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Considering that no adolescent lifestyle obesity interventions are yet considered well-established (Altman & Wilfley, 2015), there is a need to better understand and target the influences on adolescent health behaviors. Recent developments in adolescent obesity interventions have recognized the importance of social influences and have aimed to improve outcomes through meeting the unique social support needs of adolescents through teaching parents autonomy support and communication skills (Wilson et al., 2011; Wilson, Alia, Kitzman-Ulrich, & Resnicow, 2014) and enhancing peer support (Jelalian et al., 2010; Kulik et al., 2014). Given the focus on social facilitators of health behavior change in adolescent obesity interventions and developmental shifts in social relationships to increased interactions with peers and extra-familial adults that occur during adolescence, stronger understanding of the types and sources of support for adolescent health habits and means to measure social support received by adolescents are needed to study influences on weight-related behaviors, tailoring weight management interventions, and testing mediators of intervention outcomes for this developmental period(Draper, Grobler, Micklesfield, & Norris, 2015).
This study developed and provided initial validation for the Support for Healthy Lifestyle (SHeL), a set of scales designed to measure adolescent-perceived social support of healthy eating and physical activity. Item pool development utilized a prior focus group study of adolescents' perceptions of socially supportive behavior and a review of the literature on social support for health behavior change in adolescents. Exploratory factor analysis of the item pool completed by 220 adolescents, internal consistency estimates, and expert review of items and consensus resulted in 9 scales for the SHeL: Family Healthy Eating Support, Family Physical Activity Support, Family Hypocritical Control, Peer Health Eating Support, Peer Physical Activity Support, Peer Undermining, Professional Healthy Eating Support, Professional Physical Activity Support, and Professional General Support. Scale internal reliability estimates were α = 0.73–0.96. Supporting construct validity, the SHeL showed a pattern of stronger correlations between measures of the same source (parent/peer) and target behavior (healthy eating/physical activity) and stronger correlations with corresponding Sallis scales vis-à-vis other Sallis scales, with exceptions related to peer support for healthy eating. Divergent validity was somewhat limited, including in two instances, the SHeL scale was more strongly correlated with another SHeL scale. Supporting criterion validity, often the SHeL scales were correlated with related health behaviors. This study provided important psychometric information for a new measurement of social support for health behavior for adolescents. Further research with larger, more diverse, and treatment-seeking populations is needed to provide further validation of the SHeL and to begin to establish normative scores.
Mental, physical and social health benefits of immersive nature-experience for children and adolescents: A systematic review and quality assessment of the evidence
2019, Health and Place
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Two studies (Mann, 2007; Wood et al., 2014) were considered at low risk of biased data. Other sources of potential bias included sampling bias stemming from self-selection by the participants or participants' caretakers into the intervention and/or control group (American Institutes for Research, 2005; Ang et al., 2014; Dettweiler et al., 2017; Duerden et al., 2009; Fjørtoft, 2004; Furman and Sibthorp, 2014; Gehris, 2007; Jelalian et al., 2011, 2010; 2006; Larson, 2007; Orren and Werner, 2007; Romi and Kohan, 2004) and from large quantities of non-responses or missing data (American Institutes for Research, 2005; Hohashi and Kobayashi, 2013). We also encountered risk of analytical bias where a clustered design was used but statistical methods did not account for this (American Institutes for Research, 2005; Fjørtoft, 2004; Zachor et al., 2017), where simplified statistical methods had been used (Fjørtoft, 2004; Fuller et al., 2017; Larson, 2007; White, 2012b), and where comparisons between groups did not account for baseline differences in the measures (Connelly, 2012).
In this systematic review, we summarised and evaluated the evidence for benefits of immersive nature-experience on children and adolescents' mental, physical and social health. An electronic search was performed for English language articles published between January 2004 and May 2017. Data were extracted from 84 publications that met the inclusion criteria. Study quality was assessed for a subset of the studies, i.e. controlled between- and within-subject studies, using a systematic assessment scheme, and the quality of the evidence was reviewed at an outcome level. Across heterogeneous types of immersive nature-experience, there was conditional support for benefits on self-esteem, self-efficacy, resilience and academic and cognitive performance. Correlational research evidenced higher levels of physical activity in natural environments than comparison conditions. Benefits for outcomes such as self-concept, problem solving, and mood were more inconclusive. In addition, social skill-oriented and behavioural indicators were improved, although the categories comprised different outcomes. Risk of bias, insufficient sampling methods and unsuited comparison groups were common study limitations.
The Effectiveness of Nutrition Specialists on Pediatric Weight Management Outcomes in Multicomponent Pediatric Weight Management Interventions: A Systematic Review and Exploratory Meta-Analysis
2019, Journal of the Academy of Nutrition and Dietetics
Nutrition specialists are considered key members of multicomponent pediatric weight management intervention teams, but to date, their contribution has not been quantified.
The purpose of this systematic review was to estimate the effectiveness of interventions provided by treatment teams that include a nutrition specialist on pediatric weight management outcomes, including body mass index (BMI), BMI z score, and waist circumference when compared with treatment teams that do not include a nutrition specialist.
The results of a comprehensive literature search and a systematic and more targeted update of that search were included in the meta-analyses: a search of controlled trials published between July 2005 and April 2012, conducted during the 2015 Pediatric Weight Management Update Project of the Academy of Nutrition and Dietetics Evidence Analysis Library, and an update search of controlled trials published between May 2012 and December 2015 focusing on a more specific topic within the previous search. Studies included overweight and/or obese patients aged 6 to 18 years receiving outpatient weight management treatment. Data extraction of all studies identified was performed using a standardized tool. The resulting data from the search and the systematic update were merged. Ninety-nine studies and 209 study arms were included in the analysis. An exploratory meta-analysis using alternative meta-analytic methods designed for complex, heterogenous interventions was conducted to identify relative contributions by intervention provider category at selected time points. Meta-regression analyses were used to evaluate significant differences from the reference category for each provider category.
The nutrition specialist-only condition resulted in increased reductions in BMI z score compared with behavioralist-only, combined nutrition specialist and behavioralist, and neither nutrition specialist or behavioralist category (reference) throughout the analysis. Meta-regression analysis indicated that the difference in BMI z score between the nutrition specialist-only category and the reference category was significant at 3 to <6 months, 6 months to <1 year, and 1-year to 2-year time points (P=0.01, P=0.05, and P=0.01, respectively). There were smaller increases in BMI over time for the nutrition specialist-only provider category compared with reference categories, and this difference was significant at the 3 to <6 months and 1-year to 2-years time points (P=0.001 and P=0.05, respectively). There were no significant differences among provider categories for waist circumference at any time point.
Indirect evidence indicated that pediatric weight management outcomes for BMI z score and BMI at selected time points appeared to be better when a nutrition specialist was involved in delivering care.
Pediatric Weight Management Evidence-Based Practice Guidelines: Components and Contexts of Interventions
2018, Journal of the Academy of Nutrition and Dietetics
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Because the effect of any one component (eg, clinic vs outside the clinic) might depend on the presence of other components (eg, family involved vs no involvement), the analysis focused on configurations of these components and how they affect weight status outcomes. Thirty-two studies had data available for this part of the analysis and included data on the following variables: weight status outcomes at each time period, family involvement vs no family involvement, inclusion of group PWM sessions vs exclusively individual PWM sessions, teens only vs children or mixed children or teens, clinic vs any other setting, an intervention of 6 months or more vs <6 months, and included an intensive multicomponent vs minimal or no intervention (deficient interventions).27,28,30,32,35,38,44,49,50,53,54,56,59,62,65,67-72,75,78,81,82,84,85,88-90,94 These studies were included in the treatment context analysis and provided support for the following four recommendations.
Sex as a Moderator of Adolescents' Weight Loss Treatment Outcomes
2018, Journal of Adolescent Health
Weight loss treatments targeting adolescents often occur in mixed-sex contexts and produce variable outcomes. Sex considerations may be of particular importance, especially given differences in social relating. This study aggregated data from two randomized controlled trials of a peer-enhanced intervention compared with a standard cognitive-behavioral weight loss intervention to test the hypothesis that adolescent girls may demonstrate greater benefit than boys from a peer-enhanced weight loss intervention.
Participants were 193 adolescents with overweight/obesity (age M = 14.4 years, standard deviation = .99) from two randomized clinical trials comparing a peer-enhanced intervention with an active cognitive-behavioral weight loss intervention. Adolescents' percent over body mass index (percent greater than the 50th percentile for age and sex) was measured at baseline, end of treatment, and approximately 6 months post treatment. Multilevel modeling was used to test hypotheses.
Findings suggested different weight change trajectories from baseline to end of treatment, and from end of treatment to follow-up. On average, all participants demonstrated weight loss from baseline to end of treatmentm and there was evidence that adolescent boys in the peer-enhanced condition may have benefited the most. On average, weight was maintained from end of treatment to follow-up.
Adolescent males may particularly benefit from weight loss interventions that incorporate a team component to supervised physical activity.
Intentional self-regulation of eating among children and adolescents
2018, Pediatric Food Preferences and Eating Behaviors
Intentional self-regulation of eating refers to the volitional cognitive and behavioral processes involved in setting, pursuing, and attaining eating goals. The capacity to set and strive for eating goals emerges in late childhood and adolescence corresponding to maturation of the prefrontal cortex. Although substantially more is known about intentional self-regulation of eating among adults, it is increasingly evident that youth engage in intentional self-regulation of eating and such efforts tend to be associated with more healthy dietary choices, particularly in environments that promote unhealthy foods. This chapter addresses what is known about intentional self-regulation of eating among youth including its development, areas of intersection between intentional self-regulation of eating and dietary restraint, associations with dietary intake, and challenges to effective intentional self-regulation of eating. Questions in need of further investigation are also presented, including how we can effectively promote flexible intentional self-regulation of eating among children and adolescents.

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: Supported by the National Institute of Diabetes and Digestive and Kidney Diseases (grant R01DK062916 to E.J.) and the National Institutes of Health and the National Heart, Lung, and Blood Institute (grant K23HL069987 to E.L-R).

: Registered at www.ClinicalTrials.gov, Clinical Trial #: NCT00285558.

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Original ArticleBehavioral Weight Control Treatment with Supervised Exercise or Peer-Enhanced Adventure for Overweight Adolescents

Objective

Study design

Results

Conclusions

Section snippets

Methods

Results

Discussion

J Pediatr

Best Pract Res Clin Endocrinol Metab

Am J Clin Nutr

J Am Diet Assoc

Health-related quality of life of severely obese children and adolescents

JAMA

Adolescent obesity, overt and relational peer victimization, and romantic relationships

Obes Res

Empirically supported treatments in pediatric psychology: pediatric obesity

J Pediatr Psychol

Lifestyle interventions in the treatment of childhood overweight: a meta-analytic review of randomized controlled trials

Health Psychol

Treatment of adolescent overweight and obesity

Eur J Pediatr

Psychosocial correlates of physical activity in healthy children

Arch Pediatr Adolesc Med

Adventure therapy" combined with cognitive-behavioral treatment for overweight adolescents

Int J Obes (Lond)

Ensuring balanced distribution of prognostic factors in treatment outcome research

J Stud Alcohol Suppl

Randomization in substance abuse clinical trials

Subst Abuse Treat Prev Policy

Original Article
Behavioral Weight Control Treatment with Supervised Exercise or Peer-Enhanced Adventure for Overweight Adolescents