Clinical research in adolescents: challenges and opportunities using obesity as a model

Abstract

Adolescent medicine is relatively young, compared to paediatric or adult medicine. Descriptive and observational studies have dominated the adolescent literature, including those studies published in the International Journal of Obesity. In addition, many studies have combined child and adolescent age groups, making it difficult to determine adolescent-specific outcomes. It is important that high quality intervention studies in adolescents occur. Adolescence is a time of extraordinary plasticity. Habits, attitudes and physical morbidity that develop during adolescence set up trajectories that have a profound influence on health and wellbeing for the long term. Overweight and obesity are an excellent example of the need for high quality intervention studies and yet in the last two decades there have been very few randomized, controlled trials of overweight and obesity management in adolescents. There are a number of complexities in adolescent research that create additional challenges to those that accompany any clinical research. These include recruitment and retention, issues around consent and confidentiality and the central role that parents play in supporting the research protocol. Pubertal stage is a potential confounder and needs to be accurately measured. This is certainly true for studies in overweight and obesity where excess adiposity influences pubertal and other hormones. The opportunities to undertake quality research in adolescents are likely to be enhanced by the use of novel approaches which acknowledge the unique features of adolescents and their world.

Improvement in HOMA-IR is an independent predictor of reduced carotid intima-media thickness in obese adolescents participating in an interdisciplinary weight-loss program

“…Furthermore, study recruitment and compliance with any treatment is more difficult in adolescent populations, and the success of treatment depends at least partly on the participation of parents and/or guardians. 37 In conclusion, this shows that obesity intervention may prevent the development of cardiovascular disease among adolescents.…”

Facebook as a Recruitment Tool for Adolescent Health Research: A Systematic Review

“…[1][2][3] Adolescents are viewed as the natural target for social media use, 4,5 but this assertion requires further investigation regarding how social networking sites are being used to recruit adolescent participants. There is no financial cost to sign up to Facebook, however researchers should take into consideration of costs to use additional features such as advertising for research recruitment.…”

Recommendations for Recruiting and Retaining Adolescent Girls in Chronic Exercise (Training) Research Studies

“…Exercise training could be used to prevent this reduction in CRF and could, consequently, promote improved mental health, quality of life and academic performance [2]. Yet, recruiting adolescents to exercise research studies can be very challenging [3,4]. Adolescent girls can be particularly difficult to recruit, due, in part, to gender-specific challenges (e.g., body image concerns, social comparison [5] and conflicting activities [6]).…”

“…As a result, chronic exercise training programmes often place great demands on the participants, which can lead to low uptake to and/or poor compliance with the study [3]. This means the success of the research might be hindered from the outset.…”

“…While ensuring compliance with the research protocols, patient and public involvement (PPI) with the research design could benefit the external validity of the research through improved participant recruitment and retention to the study. Affording participants greater autonomy and ownership during the planning process might enhance recruitment and adherence to a study compared with the researcher-led training programmes employed traditionally [3,14]. With recent technological advancements in the measurement of behaviours such as free-living energy expenditure, it should be possible to still measure outcome variables with more novel and inventive exercise programmes.…”