[Attention deficit disorder with/without hyperactivity and obesity in adolescence]. / Trouble du déficit de l'attention avec/ou sans hyperactivité et obésité à l'adolescence.

Attention-Deficit Hyperactivity Disorder (ADHD) is a prevalent neuropsychiatric disorder associated with significant impairment and distress throughout the lifespan. ADHD is also frequently associated with obesity. Epidemiological studies that have strongly suggested a causal relationship between ADHD and obesity, underscoring the importance of clarifying the underlying pathophysiological mechanisms. An important focus has been the link between ADHD-related impulsivity and obesity, potentially mediated by impulsive eating behavior. Studies suggest that targeting the impulsive dimension of ADHD significantly reduces the risk of obesity. ADHD detection and treatment in children, adolescents and adults is important in terms of prevention and managing of obesity across the lifespan.

Le trouble déficitaire de l'attention avec hyperactivité (TDAH) est un trouble neuropsychiatrique prévalent lié à une déficience et à une détresse significative tout au long de la vie. Il est également fréquemment associé à l'obésité, des études épidémiologiques ayant prouvé une relation de cause à effet. Le lien entre l'impulsivité liée au TDAH et l'obésité a fait l'objet d'une attention particulière. Des études suggèrent que le fait de cibler la dimension impulsive du TDAH devrait réduire de manière significative le risque d'obésité. La détection et le traitement du TDAH chez les adolescents souffrant d'obésité sont importants pour la prévention et la prise en charge de cette pathologie souvent réfractaire aux traitements habituels de l'obésité.

Family based behavioral treatment in adolescents suffering from obesity: evolution through adulthood.

BACKGROUND: Family Based Behavioral Treatments (FBBT) are reported to have a favorable impact on the short and mid-term evolution on the body mass index (BMI) of adolescents suffering from obesity. This study investigated the long-term BMI z-score evolution, as well as variables associated with favorable or unfavorable evolution in adolescents who beneficiated from FBBT group therapy treatment for obesity. METHODS: This was a prospective study including adolescents who participated in FBBT group therapy for obesity sessions (n = 131). All adolescents were invited for a study's clinical interview 4 years after the therapy, during which their weight and height were measured, and they answered a questionnaire on some life habits. Anthropometric measurements at the time of therapy as well as socio-demographic data were retrospectively extracted from the electronic medical record. RESULTS: Seventy-six subjects (57% of the sample) accepted to participate in the study. At the study's clinical interview (mean 5.5 years after FBBT), 52.6% of the adolescents showed a favorable evolution of their weight status defined as a decrease (>-0.2) or stabilization (between - 0.2 and + 0.2) of their BMI z-score. 32% were engaged in a daily physical activity and 40.6% monitored their weight at least once a week or more. Only these 2 variables were associated with a favorable evolution (p = 0.009 and p = 0.001, respectively). Less than half of the sample (45.9%) have maintained a medical weight-management follow up, of which 67% had a BMI equal or more than 30. CONCLUSIONS: Long-term evolution of the BMI z-score was favorable for most of the adolescents, emphasizing the potential benefits of FBBT treatment on the long term for adolescents suffering from obesity. This study highlighted the difficulty for long-term weight management follow up in this population at risk of numerous medical comorbidities, confirming the need to improve adherence to weight management treatment at this age of transition of care. Prospective observational study registered.

Impact of COVID-19 lockdown on adolescents in treatment for obesity.

OBJECTIVE: The aim of this study was to evaluate the impact of coronavirus disease 2019 (COVID-19) lockdown on body mass index (BMI) z-score of adolescents treated for obesity, and to assess the correlation between BMI z-score changes and lifestyle variables. METHODS: This cross-sectional study recruited 66 participants aged 11-18 years with overweight or obesity who attended our obesity clinics before and after the lockdown. We assessed demographic and anthropometric characteristics as well as lifestyle variables. RESULTS: The mean BMI z-score of the participants was stable during this period (p = 0.233). Balanced diet, snacking, and sweet beverage consumption improved in about half of the participants. Having at least one parent at home was associated with a significantly more balanced diet (p = 0.008) and an increase in family activities (p = 0.015). Physical activities decreased (51.5%) and screen time increased for most of the adolescents (86.4%). The BMI z-score decreased significantly when three or more lifestyle habits improved (p<0.001). CONCLUSIONS: This study showed that BMI z-scores were stable for a majority of adolescents treated for obesity during the COVID19 lockdown, along with positive and negative changes on weight-related lifestyle habits. This extraordinary period may have created opportunities for lifestyle modification and has emphasized the importance of family support in the management of obesity in adolescents.

Evaluation of the impact of the COVID-19 lockdown on BMI in children and adolescents with or without obesity.

BACKGROUND: In Switzerland, from March 15th to May 11th 2020, schools and most shops were closed nationwide due to the COVID-19-related lockdown. This cessation of activities may have impacted weight gain in children and adolescents. The aims of our study were to evaluate the effects of the COVID-19 lockdown on the BMI of children and adolescents in treatment for obesity, and to compare its evolution to that of the previous year at the same time, as well as to that of normal-weight children. METHODS: This retrospective study gathered demographic and anthropometric data from subjects aged 6-18 years both with normal weight and with obesity, who attended our hospital clinics at four time points: before and after the lockdown period in 2020, and at the same times of the year in 2019. We used paired t-tests to assess weight, BMI and BMI z-score changes, linear and standard multiple regressions, independent Student's t-tests or Chi-square tests to compare groups, and Pearson correlation coefficient when appropriate. RESULTS: Forty-seven children with obesity and 18 normal-weight subjects had complete data for the 4 visits. The mean BMI increased in both groups during the lockdown (obese: + 0.96 ± 1.5 vs. control: + 0.51 ± 0.1), however the increase was significantly more important in the subjects with obesity compared to the same period in 2019 (2019: + 0.33 ± 1.0; mean difference between 2019 and 2020: + 0.63 ± 2.0 p = 0.034). CONCLUSION: The COVID-19 lockdown had a negative impact on the BMI of youth with obesity. Interestingly we observed extreme changes in this population, which was not the case in normal-weight children. Therefore, families with a child with obesity must be actively supported during these stressful and obesogenic periods of confinement.

[Health needs of unaccompanied minors - An experience of a consultation for adolescents in Geneva]. / Besoins de santé des mineurs non accompagnés - L'expérience d'une consultation d'adolescents à Genève.

This article addresses the health needs of unaccompanied undocumented minors (UMs) received in Geneva. In our experience and according to the literature, the most frequent diagnoses in this population are depression, anxiety disorder, posttraumatic stress disorder and substance abuse. Their medical and psychological treatments are often complicated by their psychosocial difficulties as well as by their wandering. Their treatment should be given by a multidisciplinary care team that works with the different structures that support them both socially and administratively. The adolescent health unit of the Geneva University Hospital give them the opportunity to reclaim their physical and mental health. It also enables them to bond with others and rethink their future trajectories.

Cet article propose d'aborder les besoins de santé des mineurs non accompagnés non requérants d'asile accueillis à Genève. Dans notre expérience et selon la littérature, les diagnostics les plus fréquents dans cette population sont les troubles anxio­dépressifs, l'état de stress post-traumatique et les abus de substances. Leur prise en charge, souvent compliquée par leurs difficultés psychosociales et leur errance, devrait se faire par une équipe pluridisciplinaire de soins ainsi qu'en réseau avec les différentes structures qui les soutiennent sur le plan social et administratif. L'Unité santé jeunes (USJ) des Hôpitaux universitaires de Genève leur propose des espaces pour se réapproprier leur santé tant physique que psychique, afin de leur donner la possibilité de se lier à l'autre et de repenser leur errance.

Health status and healthcare services utilisation among unaccompanied asylum-seeking minors settled in Switzerland: a protocol for a retrospective cohort study from a hospital-based youth outpatient clinic.

INTRODUCTION: Unaccompanied asylum-seeking minors (UASMs) represent a population group with complex healthcare needs. Initial and ongoing healthcare is challenging for host countries but considered essential. This publication describes the protocol concerning a large cohort of UASMs settled in Switzerland in 2015-2016. Our aim is to assess their health status and examine their trajectories of healthcare services utilisation during the 3-year period after their initial health control. METHODS AND ANALYSIS: We will retrospectively analyse data of all newly arrived UASMs aged 12-18 years who benefited from a first health assessment at the Youth Clinic of Geneva University Hospitals between 1 January 2015 and 31 December 2016. Source of data will be electronic medical records. Main outcomes include the determination of their health status (acute and chronic conditions) and the utilisation of different care sectors (ambulatory primary care and subspecialty clinics, emergency room and inpatient wards). A secondary outcome will be the identification of patients at risk for high use of services as well as those with limited access to care. We will extract the following data: demographic characteristics (age, gender and country of origin), social determinants (place of residence, the presence of family in Geneva, school performance and asylum status), clinical information (reason for attending service, anthropometric measurements and medical diagnosis at discharge) and laboratory parameters (complete blood count, ferritin level, 25-hydroxyvitamin D level, hepatitis B antigen and antibodies, tetanus antibodies, QuantiFERON and stool and serology tests for intestinal parasites). We will collect data from first health assessment and during a follow-up period of 3 years for each patient. ETHICS AND DISSEMINATION: In accordance with the Swiss clinical research law, this protocol has been approved by the local ethics committee (project ID: 2021-01260). Our findings will provide important information for the development of quality healthcare services focusing to UASMs. We intend to disseminate our results through publication in peer-reviewed journals.

[Eating disorders and obesity in adolescents†: clinical implications]. / Troubles des conduites ­alimentaires et obésité à l'adolescence†: ­implications cliniques.

Binge eating disorder (BED) is associated with obesity and a quarter of adolescents with weight excess may suffer from the complete or a partial form of this disorder. A systematic screening for BED should be performed in this population as non-identification will complicate the patient's management. A short screening tool, -named ADO-BEDs, was specifically developed for these adolescents. This latter tool appears to be useful to guide the medical consul-tation. As such, the health professional will be able to refer the -patient for further evaluation in case of BED suspicion. Health -professionals should be aware that body dissatisfaction or teasing triggered by the adolescent's body are not an incentive to lose weight and increase the risk of eating disorders. Therefore, negative comments should be avoided in consultation.

Les troubles des conduites alimentaires (TCA) de type accès ­hyperphagiques sont associés à l'obésité et sont présents sous leurs formes complètes ou partielles chez près d'un quart des adolescents en excès de poids. Un dépistage systématique doit être effectué dans cette population lorsqu'elle consulte, afin de permettre une prise en charge optimale. Un outil de dépistage nommé ADO-BEDs a été spécifiquement développé pour ces ­adolescents. Utile pour guider la consultation, il permet au ­soignant d'aborder le trouble et d'adresser le patient pour une évaluation spécialisée en cas de suspicion de TCA. Viser une ­augmentation de l'insatisfaction corporelle ou faire des commentaires négatifs portant sur le physique de l'adolescent ne sont pas une aide à la motivation, mais augmentent le risque de TCA et devraient être évités en consultation.

Screening Obese Adolescents for Binge Eating Disorder in Primary Care: The Adolescent Binge Eating Scale.

OBJECTIVE: To investigate the performance of a simple and developmentally appropriate 10-item questionnaire (Adolescent Binge Eating Scale) for the prediction of binge eating disorder (BED) diagnosis in adolescents seen for obesity. STUDY DESIGN: We evaluated the performance of the questionnaire in comparison with a clinical interview, in a population of adolescents being seen for obesity. The ?2 or Fisher exact tests were used. RESULTS: There were 94 adolescents aged 12-18 years (59.6% girls) who completed the study. The questionnaire demonstrated a good association with the clinical interview and distinguished different levels of risk for having a BED: participants who responded positively to questions 1 or 2 and had more than 6 positive answers to the 8 additional questions had a high risk of subclinical and clinical BED (83.3%); participants with 3 or fewer positive answers had a low risk of clinical BED (4%). CONCLUSIONS: The Adolescent Binge Eating Scale questionnaire is a potential screening tool to identify adolescents with obesity at high risk of BED and guide referral to a specialist to clarify the diagnosis and provide adequate care.

Parents' integration in the treatment of adolescents with obesity: A qualitative study.

INTRODUCTION: Obesity during adolescence is particularly challenging. Our aims were to identify parents' and adolescents' perceptions regarding obesity, as well as family dynamics before and after family-based behavioral therapy (FBBT) to improve obesity. METHOD: Using a qualitative approach, 23 parents and 21 adolescents aged 12 to 18 years participated in 6 focus groups, before and after FBBT. Focus groups were audio-taped, transcribed verbatim, and analyzed using content analysis. RESULTS: Transcript analyses suggested 3 major themes from both adolescents and parents: obesity as a source of strong negative emotions, adolescents and weight-control responsibility, and disruption in family dynamics. FBBT improved self-confidence and family functioning, allowing for behavioral changes. Both adolescents and their parents felt empowered. DISCUSSION: Family dynamics are an important issue in weight-loss treatment during adolescence. Including both parents and adolescents in therapy is crucial for tackling obesity and addressing health needs related to this age group. (PsycINFO Database Record

Obesity Management in Adolescents: Comparison of a Low-Intensity Face-to-Face Therapy Provided by a Trained Paediatrician with an Intensive Multidisciplinary Group Therapy.

OBJECTIVE: This study aimed to compare the effects of a low-intensity face-to-face therapy provided by a trained paediatrician to an intensive group therapy provided by a multidisciplinary team on the BMI of adolescents with obesity. METHODS: This longitudinal cohort study included 233 adolescents aged 11-18 years (mean 13.1 ± 1.7 years). Patients and their parents choose either a low-intensity face-to-face therapy or an intensive group therapy (total 88 h). RESULTS: At baseline, the mean BMI was 29.4 ± 4.9 kg/m2. Within groups changes of BMI z-scores were significant at the end of follow-up both in the face-to-face (-0.2 ± 0.5) and the group therapy (-0.24 ± 0.5). There was no difference among groups. Younger age (12-14 years), gender, follow-up duration as well as BMI z-score at inclusion were significantly related to BMI z-score changes, independently of the type of intervention. As expected, the face-to-face therapy was far less expensive than the group therapy (USD 1,473.00 ± 816.00 vs. USD 6,473.00 ± 780.00). CONCLUSION: A low-intensity face-to-face therapy resulted in similar changes of the BMI z-score of adolescents than an intensive multidisciplinary group therapy. This approach could be easily disseminated in primary care settings with a specific training in obesity care.

Insulin secretion response during oral glucose tolerance test is related to low cardiorespiratory fitness in obese adolescents.

BACKGROUND: The obesity paradox refers to a category of subjects who may be less prone to develop co-morbidities, such as type 2 diabetes. Cardiorespiratory fitness (CRF) has been identified as one of the key factors. We aimed at exploring the difference in insulin metabolism between fit and unfit obese adolescents. METHODS: We recruited 22 obese adolescents and assessed CRF during an incremental treadmill test. According to a cut-off at 80% of predicted maximal oxygen consumption (VO2max), subjects were separated into low or normal CRF. Body composition was determined by densitometry. Serum levels of insulin were measured sequentially during an oral glucose tolerance test and insulin secretion responses were calculated. RESULTS: Compared to adolescents with normal CRF, the ones with low CRF had higher insulin resistance indices (p=0.023) and insulin secretion response (p=0.010), independently of the body mass index z-score. CONCLUSIONS: Interventions in obese adolescents should focus on the maintenance or improvement of CRF to at least 80% of predicted VO2max. Indeed, this cut-off was significantly related to insulin secretion responses, independently of the adiposity level. A CRF above the proposed cut-off may prevent the development of insulin resistance.

Medical and non-medical complications among children and adolescents with excessive body weight.

BACKGROUND: The burden of disease from childhood obesity is considerable worldwide, as it is associated with several co-morbidities, such as dyslipidemia, hypertension, type 2 diabetes (T2DM), orthopedic and psychosocial problems. We aimed at determining the prevalence of these complications in a population of children and adolescents with body weight excess. METHODS: This is a cohort study including 774 new patients (1.7 - 17.9 yrs, mean 11.1 ± 3.0) attending a pediatric obesity care center. We assessed personal and family medical histories, physical examination, systemic blood pressure, biochemical screening tests. RESULTS: We found that the great majority of the children suffered from at least one medical complication. Orthopedic pathologies were the most frequent (54%), followed by metabolic (42%) and cardiovascular disturbances (31%). However, non-medical conditions related to well-being, such as bullying, psychological complaints, shortness of breath or abnormal sleeping patterns, were present in the vast majority of the children (79.4%). Family history of dyslipidemia tends to correlate with the child's lipids disturbance (p = .053), and ischemic events or T2DM were correlated with cardiovascular risk factors present in the child (p = .046; p = .038, respectively). CONCLUSIONS: The vast majority of obese children suffer from medical and non-medical co-morbidities which must be actively screened. A positive family history for cardiovascular diseases or T2DM should be warning signs to perform further complementary tests. Furthermore, well-being related-complaints should not be underestimated as they were extremely frequent.

[Specialized adolescent health clinic: who should be referred to it?]. / Consultations spécialisées en médecine de l'adolescent: à qui s'adressent-elles?

Adolescent health clinics were created in response to the specific health needs of this age-group. Adolescents may present complex health problems which require a multidisciplinary and global assessment. The aim of this article is to provide an overview of the type of health problems for which adolescents are referred to our clinics and the care they receive in response to them.

BMI changes in children and adolescents attending a specialized childhood obesity center: a cohort study.

BACKGROUND: Multidisciplinary group therapies for obese children and adolescents are effective but difficult to implement. There is a crucial need to evaluate simpler management programs that target the obese child and his family. This study aimed to determine changes in body mass indexes (BMI) after individual family-based obesity intervention with a pediatrician in a specialized obesity center for child and adolescent. METHODS: This cohort study included 283 patients (3.3 to 17.1 years, mean 10.7 ± 2.9) attending the Pediatric Obesity Care Program of the Geneva University Hospitals. Medical history and development of anthropometric were assessed in consultations. Pediatricians used an integrative approach that included cognitive behavioral techniques (psycho-education, behavioral awareness, behavioral changes by small objectives and stimulus control) and motivational interviewing. Forty five children were also addressed to a psychologist. RESULTS: Mean follow-up duration was 11.4 ± 9.8 months. The decrease in BMI z-score (mean: -0.18 ± 0.40; p < .001) was significant for 49.5% of them. It was dependent of age, BMI at baseline (better in youngest and higher BMI) and the total number of visits (p = .025). Additional psychological intervention was associated with reduced BMI z-score in children aged 8 to 11 years (p = .048). CONCLUSIONS: Individual family obesity intervention induces a significant weight reduction in half of the children and adolescents, especially in the youngest and severely obese. This study emphasizes the need to encourage trained pediatricians to provide individual follow up to these children and their family. Our study also confirms the beneficial effect of a psychological intervention in selected cases.

[Obesity, migration and adolescence]. / Obésité, migration et adolescence.

Weight management interventions during adolescence are challenging. Migration adds complexity to this problem, making migrant families more vulnerable. Teenagers confront families to new values transmitted by the host society: opulence, junk food, video games. Obesity should not be seen as a single issue of calories-excess, but must be considered as being part of a larger problem, which takes into account the context of the familial and societal life of the migrants. The caregivers must have an overall view of the situation to provide appropriate approaches to weight management.

[Adolescent medicine. Is the weight of the obese adolescent difficult for their family?]. / Médecine de l'adolescence. Le poids des adolescents: un poids pour la famille?

The increasing prevalence of obesity creates a need to develop healthcare services that address both obesity and the health problems common to all young people. It is particularly important to involve parents and significant adults to promote easy access and continuity. Improved quality of life is as important as weight loss and prevention of complications. The family has an important role to play in helping adolescents develop their autonomy and enter adulthood. When family structures are affected by a child's chronic condition, it is necessary to provide support to parents during these changes. Feelings of isolation and discouragement are best tackled by involving parents and helping them to find ways to motivate and assist their children on their developmental path.

Is there a role for primary care physicians' screening of excessive weight and eating concerns in adolescence?

OBJECTIVES: To determine the extent to which adolescents with excessive weight concerns and eating concerns are in contact with primary care physicians and could thus be identified in primary care. STUDY DESIGN: A representative sample of 7548 (16 to 20 years old) students completed a self-administered questionnaire on health-related topics (2002 Swiss Multicenter Adolescent Health Survey). Adolescents with excessive weight and eating concerns were compared with control subjects for frequency of somatic complaints and primary care visits in the past year. Analyses were stratified by sex. Logistic regression was used to adjust for confounders. RESULTS: Excessive weight and eating concerns were frequent in adolescents, particularly in girls (girls, 13.9%; boys, 1.6%). Adolescents with these concerns reported more frequent somatic complaints compared with their peers. Nearly 80% of them were in contact with a primary care physician at least once a year. CONCLUSION: Primary care physicians are in contact with adolescents who have excessive weight and eating concerns. Identification of these concerns should be encouraged for appropriate management.