Psychosocial predictors and moderators of weight management programme outcomes in ethnically diverse obese youth

Abstract

Background An important area of research in childhood obesity is the identification of factors that predict or moderate the responses to obesity intervention programs, yet few studies have examined the impact of self-esteem and family functioning on obesity treatment outcomes. Objectives We sought to determine whether baseline self-esteem and family functioning predicted or moderated childhood obesity intervention outcomes at six months. Methods From 2009–2011, seventy-five 10–16 year old, racially/ethnically-diverse obese youths with abnormal glucose tolerance were randomized to six months of an intensive family-based obesity lifestyle intervention (Bright Bodies) or routine outpatient Clinic Care. We examined youth self-esteem/self-concept, parent-rated family functioning, and 6-month outcomes (youths’ glucose tolerance, weight, body mass index, and percent fat). We set the significance threshold as P ≤ 0.05 for moderator and predictor analyses. Results Baseline poor family functioning and self-concept scores indicating high anxiety and low self-esteem predicted poor six-month outcomes overall (Bright Bodies and Clinic Care groups combined). Additionally, baseline self-esteem and family functioning moderated treatment effects–Bright Bodies outperformed Clinic Care in youths with low self-esteem and poorly functioning families, whereas youths with high self-esteem and high-functioning families did similarly well with either intervention. Discussion Our findings suggest intensive family-based lifestyle programs are particularly beneficial for youth with low self-esteem and poorly functioning families. ClinicalTrials.gov Identifier NCT01030978

Pediatric obesity treatment, self‐esteem, and body image: A systematic review with meta‐analysis

“…Three studies did not report on personnel involved in intervention delivery. Parental involvement was reported as part of the intervention in 50 studies …”

“…The change in body image between pre‐intervention and postintervention was reported in 27 studies, between pre‐intervention and follow‐up in three studies, and 13 studies reported data at all three time points. Of the 40 studies reporting body image pre‐intervention and postintervention ranging in duration from 2 weeks to 24 months, body image was reported to be significantly improved compared with baseline in 22 studies, not significantly changed in 10 studies, five studies did not state whether or not the change was significant and three studies reported a significant improvement in one body image measure and no change in another.…”

Factors associated with depression and anxiety symptoms among children seeking treatment for obesity: A social‐ecological approach

“…Parenting is already a major component of FBT (eg, encouraging parents to offer praise and positive reinforcement for healthy energy‐balance behaviors). Although FBT is particularly beneficial (compared with standard care) for poorly functioning families, treatment could be tailored, when needed, to also educate parents on the importance of empathy, promoting child autonomy, and avoiding emotionally manipulative strategies for controlling their child's behavior. Finally, although weight‐control programs have been developed that focus on the social/peer aspects of food and activity behaviors, this content could be expanded to also focus on ways to improve children's subjective social status.…”

Predictors of responses to clinic‐based childhood obesity care

“…Pinhas‐Hamiel et al, showed no effect of age, yet did not include children below the age of 10, which may explain the different findings presented in our analysis. The reasons for the poorer response of pubertal adolescents to behavioral modification may range from the physiological effects of puberty to psychosocial factors . In addition, greater obesity duration, as expected in older adolescents, has been associated with an adverse metabolic profile and with modifications of the hypothalamus, both of which may impact the response to dietary interventions.…”