Childhood and adolescent obesity: Multidisciplinary approaches in a clinical setting

BACKGROUND: The high prevalence of obesity in children and adolescents emphasizes the necessity to develop evidence-based treatment programs that are useful in a clinical setting. AIMS: The overall aim of the thesis was to develop and evaluate multidisciplinary approaches for management of children and adolescents with obesity. The focus was on generalizability of the treatment in a clinical setting as well as to analyze which factors might explain and influence the results. The development of treatment programs took into account clinical necessities such as the waiting list and available resources at the Childhood Obesity Unit in southern Sweden, a tertiary referral centre. The aim of Paper I was to assess the effects of low intensity solution-based single family therapy intervention on self-esteem and body mass index (BMI), BMI z-scores in obese pediatric subjects, and functioning in their families. The aim of the Paper II was to evaluate the efficacy of a Family Weight School – a one-year treatment model based on family therapy and brief solution-focused therapy in four group meetings with extremely and morbidly obese adolescents compared with waiting list controls. The aim of Paper III was to examine factors associated with self-esteem in a clinical sample of obese children. The findings could be used to improve family-based programs. The aim of Paper IV was to evaluate the effect on childhood obesity of a one-week sports camp followed by a six-month support program at local sports clubs. The aim of Paper V was to describe the implementation of the theory of family therapy in a clinical setting in order to provide tools for clinicians in the field of obesity who work with families, alone or in a multidisciplinary team. RESULTS: The single family therapy treatment (Paper I) resulted in a significant decrease in the degree of obesity of the child, as well as improvements in self-esteem and family functioning. These results were obtained after 3.8 sessions. Eighty-one percent of the children (44 out of 54) participated in the follow-up. The Family Weight School (Paper II) resulted in a significant decrease in the degree of obesity in adolescents with BMI z-scores of less than 3.5 (adult equivalent approximately BMI 40), but not in adolescents with BMI z-scores of more than 3.5, compared with a waiting list control group. Ninety percent of the intervention group (65 out of 72) completed the one-year-program. In Paper III we showed that self-esteem in a sample of severely obese children and adolescents referred for treatment is lower after the age of twelve, especially in girls. In Paper IV we have shown that one year after the camp the intervention group had significant decreases in BMI z-score. The control group had also reduced their BMI z-score. No differences were found in baseline values, follow-up values or changes in BMI z-score between groups, or between boys and girls. In Paper V we have described the key elements (approach, language, and process) of the family therapy-based program and tools that are helpful in treating children and adolescents with obesity in a clinical setting. CONCLUSIONS: Family therapy-based interventions may be useful in the treatment of childhood and adolescent obesity in a clinical setting. A future strategy might include the Family Weight School for those with BMI z-scores of less than 3.5 as a first step and the single family therapy for younger children and those who have BMI z-scores of more than 3.5. Treatment should start at a young age with special attention given to girls, since their self-esteem is particularly affected. Furthermore, the residential one-week sports camp combined with six-months of local club support has not proved to be an effective therapeutic intervention. (Less)