Identification and Characterization of Youth With Extreme Obesity

Study Overview
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Brief Summary
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While obese and extremely obese youth are at increased risk of health complications, especially the extremely obese group rarely seek medical care. One of the underlying reasons might be the lack of adequate treatment options. This study is a subproject of the Medical and psychosocial implications of adolescent extreme obesity - acceptance and effects of structured care study, short: Youth with Extreme obesity Study (YES), which aims at improving the medical care and social support structures for youth with obesity and extreme obesity in Germany. In this subproject, information on the causes and consequences of extreme obesity will be gathered via questionnaires and medical examinations. Obese youth and young adults (BMI ≥ 30kg/m2) between the ages of 14 and 24.9 years (initially up to 21 years) are eligible to participate. Participants will be asked to complete a series of questionnaires on their general health, psychosocial situation and wellbeing in 2-3 sessions. They will be offered a thorough medical examination comprising a general check-up, a fasting blood draw and oral glucose tolerance test, a focused orthopaedic examination, a sleep apnea screening, and an ultrasound of the liver. The aim of the study is to elicit the acceptance of diagnostic and therapeutic procedures, and to assess the frequency of co-morbidities in obese and extremely obese youth. This knowledge will optimize medical treatment and support options. Interested participants will be invited to participate in further steps of YES, which entail medical care and psycho-social support.

Detailed Description
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In this multicenter study, we aim to recruit adolescents from various medical and non-medical settings and examine their acceptance of diagnostic and subsequent treatment procedures. We will compare the prevalence rates and severity of co-morbidities between adolescents with extreme obesity (BMI ≥35kg/m2)and those with less severe obesity (BMI 30-34.9kg/m2). This project is part of the Medical and psychosocial implications of adolescent extreme obesity - acceptance and effects of structured care study, short: Youth with extreme obesity Study (YES), which also comprises a randomized controlled trial to investigate a novel intervention targeted at improving quality of life and social functioning of extremely obese adolescents, a structured prospective evaluation of adolescent bariatric surgery, and economic assessments of the financial burden of extreme adolescent obesity on the healthcare system. Based on the current state of knowledge, we have formulated the following hypotheses in regards to baseline characteristics: The prevalence of somatic, psychiatric and psycho-social co-morbidities is higher, and health related quality of life is lower in extremely obese youth compared to the control group. The prevalence of somatic co-morbidities is equal in treatment-seeking and non treatment-seeking youth. The prevalence of psychiatric co-morbidities is higher and health related quality of life is lower in treatment-seeking compared to non treatment-seeking youth. The acceptance of diagnostic and therapeutic procedures is lower in extremely obese youth compared to the control group. The acceptance of diagnostic and therapeutic procedures is lower in non treatment-seeking- compared to treatment-seeking youth. Socio-economic status, intelligence and educational status are predictors of treatment seeking behaviour and of the acceptance of diagnostic and therapeutic procedures. The five participating university centers are distributed across 4 geographic regions in the North (Berlin), in the West (Essen/Datteln), in the East (Leipzig) and in the South (Ulm) of Germany, and will therefore render data that are representative of Germany as a whole. We will recruit a total of 600 adolescents age 14 to 24.9 years (initial age 21 years, changed in an amendment in February 2013) with extreme obesity (BMI ≥ 35 kg/m2) and 600 adolescents with obesity (BMI 30-34.9 kg/m2) over a 24 months period. Baseline assessments include an array of standardized questionnaires and validated instruments to assess health, psycho-social situation, psychiatric co-morbidities and health related quality of life (in the amendment in February 2013, the scope of psychosocial questions was reduced), as well as a physical examination, laboratory tests, liver ultrasound, and screenings for orthopedic co-morbidities and sleep apnea. Subjects who participate in the baseline examination will be invited to participate in the subsequent components of YES. The project will reveal comorbidity rates and psycho-social situation, and demonstrate the acceptance and outcomes of a structured healthcare program for adolescents with extreme obesity. The planned subsequent longitudinal study will provide unique information on the medical and psychosocial development of adolescents with extreme obesity in Germany.

Official Title
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Medical and Psychosocial Implications of Adolescent Extreme Obesity - Acceptance and Effects of Structured Care Study, Subproject 1

Conditions
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Obesity, Extreme Obesity

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: BMI ≥30kg/m2 sufficient German language skills Exclusion Criteria: none

Ages Eligible for Study
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Minimum Age: 14 Years
Maximum Age: 24 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| extremely obese<br>BMI ≥35kg/m2 | |
| obese<br>BMI 30-34.9kg/m2 | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percentage of subjects that participate in the fasting blood draw | Subjects will be offered a diagnostic blood draw. The percentage of subjects that undergo this blood draw will be calculated. | baseline | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Predictors of the acceptance of the diagnostic procedures |  | baseline | 
| Prevalence of obesity associated psychiatric co-morbidities | Co-morbidities will be assessed via validated patient questionnaires. | baseline | 
| Percentage of patients that accept treatment of somatic co-morbidities | Appropriate medical treatment of the diagnosed somatic co-morbidities will be offered to all subjects. The percentage of subjects who initiate such therapy will be calculated. | baselin | 
| Predictors of acceptance of treatment of co-morbidities |  | baseline | 
| Health related quality of life | assessed by validated questionnaire EQ5D | baseline | 
| Socio-economic status | Assessed by standardized questionnaire. | baseline | 
| Prevalence of obesity associated somatic co-morbidities | Co-morbidities will be assessed via standardized physical examination, laboratory and apparative tests, and standardized patient questionnaires. | baseline | 
| Percentage of patients that accept treatment of psychiatric co-morbidities | Appropriate medical treatment of the diagnosed psychiatric co-morbidities will be offered to all subjects. The percentage of subjects who initiate such therapy will be calculated. | baseline | 
| Percentage of subjects that initiate a standardized low key intervention | All subjects will be offered the participation in a low key intervention as described in subproject two. The percentage of patients that accept and initiate this intervention will be calculated. | baseline | 
| Percentage of subjects that participate in diagnostic procedures. | Subjects will be offered a diagnostic liver ultrasound, sleep apnea screening, orthopedic screening, and an array of questionnaires to assess somatic- and psychiatric co-morbidities, psycho-social situation and health related quality of life. The percentage of subjects that comply with these diagnostic procedures beyond the initial visit will be calculated. | baseline | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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obesity, adiposity, psychosocial, healthcare, co-morbidities, low key intervention, quality of life