Treatment of adolescent overweight and obesity

Abstract

Adolescence is a vulnerable period for the development of obesity, and adolescent weight tracks strongly into adulthood. Previous reviews of treatment strategies have failed to discriminate between adolescents and children, thereby, disregarding the uniqueness of this population. Hence, this review aims to summarise the evidence for treatment approaches for adolescent obesity. Pubmed, OVID, EBSCOhost and Google Scholar were searched for randomised controlled trials, meta-analyses and systematic reviews testing treatments for overweight/obese adolescents (aged 12-19 years), published from 1982-2006 in English. Eligible studies had to assess either weight, percentage overweight, body mass index (BMI) or body fat. Thirty-four randomised controlled trials were eligible. The results of this review indicate that the safety and efficacy of surgical and pharmacotherapy treatments for adolescent obesity is uncertain. Diet and physical activity approaches may improve obese status in the short term. However, obesity interventions appear more effective when strategies are combined, rather than when used in isolation. Psychological interventions, such as behavioural and cognitive behavioural therapy, show promise in achieving the necessary lifestyle changes for obesity reduction; however, long-term follow-up studies are needed. There were multiple limitations in appraising the literature. Inconsistent definitions of overweight/obesity make comparisons between studies difficult. Many studies have not used direct adiposity measures, have failed to assess pubertal status or have not used an exclusive adolescent sample. We conclude that, despite these limitations, current evidence indicates that behavioural and cognitive behavioural strategies combined with diet and physical activity approaches may assist in reducing adolescent obesity,although long-term follow-up studies are needed.

Evidence Update on the Treatment of Overweight and Obesity in Children and Adolescents

“…See also Table 3 for a summary of these levels and the number of studies included at each level. Multiple review papers and meta-analyses on this topic have also been conducted and reach similar conclusions (American Dietetic Association, 2006;McGovern et al, 2008;Oude Luttikhuis et al, 2010;Snethen et al, 2006;Tsiros et al, 2008;Whitlock et al, 2010;Wilfley, Tibbs, et al, 2007;Young, Northern, Lister, Drummond, & O'Brien, 2007). For a summary of these findings, refer to Table 4.…”

“…'' The reference sections of relevant articles were also reviewed to identify any additional studies for inclusion in this review. Finally, recent reviews and meta-analyses on this topic were examined to ensure that no pertinent studies were missed (American Dietetic Association, 2006;Ho et al, 2012;McGovern et al, 2008;Oude Luttikhuis et al, 2010;Snethen, Broome, & Cashin, 2006;Tsiros, Sinn, Coates, Howe, & Buckley, 2008;Whitlock, O'Connor, Williams, Beil, & Lutz, 2010;Wilfley, Tibbs, et al, 2007). Given that this is the first evidence update on this topic in this journal, research studies dating as early as 1983 and up to June 2014 are reviewed.…”

New Perspectives on Health Disparities and Obesity Interventions in Youth

“…A limitation of the previous interventions is the lack of focus on maintenance of behavior change for children who have successfully reached their goals. For treatment of adolescent obesity, there is insufficient evidence to conclude that any one treatment approach or combination of approaches is superior (Tsiros, Sinn, Coates, Howe, & Buckley, 2008). Studies in this area have provided conflicting results, suggesting that adolescents may be more responsive with parents (e.g., Brownell, Kelman, & Stunkard, 1983), whereas other studies have concluded that the level of parental involvement had no effect on treatment outcomes (Wadden et al, 1990).…”

Two-Year Follow-up of an Adolescent Behavioral Weight Control Intervention

“…Comprehensive BWC interventions have yielded a modest reduction in BMI. 4,5 Although surgical intervention for cases of severe adolescent obesity has garnered much attention recently, 23,24 BWC remains the most feasible and clinically appropriate strategy for moderately overweight youth. The current study extends existing literature by providing support for the long-term effectiveness of BWC as a weight maintenance strategy.…”

“…2 Modest decreases in BMI among overweight children and adolescents have been shown to be related to significant improvements in health outcomes, including lowered blood pressure and cholesterol, and improved insulin and lipid values. 3 Both a recent Cochrane Collaborative Review 4 and a review by Tsiros and colleagues 5 conclude that comprehensive lifestyle interventions, including diet, physical activity, and behavioral intervention, demonstrate short-term efficacy in addressing obesity in children and adolescents. Very few lifestyle interventions have exclusively targeted adolescents, and few of these provide long-term effectiveness results, rarely going beyond 6-or 12-month outcomes.…”