Treatment of Pediatric Obesity (TOP) - A Multidisciplinary Approach Involving Adolescents and Their Peers
Condition: Obesity; Physical Activity; Sedentary Lifestyle
MeSH terms: Obesity
Study type: Interventional

Summary: 
      The purpose of this study is to analyse if a multidisciplinary approach including peers is
      effective in the treatment of obesity in adolescence.
    

Detailed description: 
      One in every 3 Portuguese adolescents is overweight (14% obese) (ONOCOP, 2009). Several
      institutions state that prevention is of upmost importance to deal with this epidemic
      (Council on Sports Medicine and Fitness; Council on School Health, 2006, August et al, 2008,
      Kohn et al, 2006), but public health stakeholders should also increase their efforts to treat
      those who already have excessive weight (Oude Luttikhuis et al, 2009). Several facts support
      this need, namely that obesity in adolescence: a) has a significant impact on both physical
      and psychosocial health (Lobstein et al, 2004); b) is an independent risk factor for adult
      obesity (Singh et al, 2008); c) is an independent risk factor for all cause mortality in
      adulthood - a more powerful predictor than being overweight in adult (Must et al, 1992); and
      d) is a major threat to the steady rise in life expectancy that occurred during the past two
      centuries (Olshansky et al, 2005).

      Albeit this cumulative knowledge, treatment options remain elusive. A Cochrane review (Oude
      Luttikhuis et al, 2009) concluded that combined behavioral lifestyle interventions, when
      compared to standard care or self-help, provide significant and clinically meaningful
      reductions on weight in adolescents; and that the interventions should consider psychosocial
      determinants for behavior change and strategies to improve clinician-family interaction, in
      order to improve the desired outcomes.

      The team of the TOP project has been working in this subject since 2004: the consult for
      obese adolescents of the Hospital de Santa Maria (HSM), a result of the collaboration between
      the two proponent Institutions. This has allowed the inclusion of exercise specialists in the
      obese adolescent' consult of the HSM, leading to an unusual (Fonseca et al, 2008), but surely
      necessary (Barlow et al, 2007), multidisciplinary program where, in the same Unit,
      adolescents are evaluated and receive medical, dietary and physical activity counselling. In
      compliance with the latest recommendations (Oude Luttikhuis et al, 2009), we use behavior
      change techniques directed not only to the adolescent but also to their parents, using the
      self-determination theory (SDT) rationale and motivational interviewing techniques (Teixeira
      et al, 2012), a treatment protocol that has been recognized by the Society for Adolescent
      Medicine (Fonseca et al, 2010).

      Based on our previous experience and on recent literature that claims for the inclusion of
      peers as co-adjuvant on the weight management tasks, we hypothesize that: a) a larger and
      more frequent contact with the treatment staff; and b) the inclusion of peers as co-adjuvant
      on the weight management tasks in the TOP is necessary. Indeed, literature shows that
      adolescent' health related behaviors are associated with peer behaviors, in what Dishion
      named Social Contagion (Dishion & Dodge, 2005). Additionally, we think that regular physical
      activity (PA) and interactive educative sessions can provide the background to promote these
      two factors (Fonseca et al, 2012).

      Therefore, the primary objective of this project is to develop, implement, and evaluate a
      treatment for adolescent obesity, which will use PA and interactive sessions to promote
      weight management skills, through the increase of contact time between the adolescent,
      parents, peers and treatment staff.

      The primary outcomes will be body composition related variables, PA and sedentary behaviors.
      We will also look for putative moderators and mediators, derived from the behavior change
      rationales followed in the project, which will help understand and predict how the program
      has influenced the outcomes.

      This project holds unique characteristics which comply with the latest recommendations for
      the treatment of adolescent obesity, and others that we have not been able to find in the
      literature: a) the inclusion of peers explicitly on the treatment protocol; b) the clinical
      setting of the treatment, with "real-life" subjects; c) objective measurements of the
      outcomes; d) the long-term treatment; and e) a well established rational (SDT and
      experiential learning) for the behavior change and to analyze the causal relations between
      predictors and outcomes.

      This research is expected to contribute with increased knowledge about treatment options for
      adolescent obesity, specifically about the potential role of the inclusion of peers and
      increased time of contact through PA and interactive sessions. We also expect to contribute
      in a significant and clinically meaningful way to the weight management of the intervened
      adolescents. And, as HSM is a central hospital and a part of a medical university, the
      accumulated knowledge of the project will certainly be efficiently widespread to several
      other hospitals and obesity centers.
    

Intervention name(s): Peer support; Regular treatment
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The participants in this arm will receive the regular obesity treatment provided by the hospital and university (interactive sessions and physical activity).
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Adolescents; Obesity; Physical activity; Sedentary behavior; Psychosocial health