[First favourable results of the group education programme Go4it for overweight and obese adolescents]. / Eerste gunstige bevindingen van het groepseducatieprogramma Go4it voor adolescenten met overgewicht of obesitas.

OBJECTIVE: To evaluate the effect of Go4it, a multidisciplinary group education programme for adolescents with overweight or obesity. DESIGN: Uncontrolled intervention study. METHOD: At the obesity outpatient clinic of the Transmural Research and Treatment Centre for Overweight and Obese Children of the VU University Medical Center, Amsterdam, The Netherlands, a group education programme was developed for adolescents (age 12-18 year) who are overweight or obese. Obese adolescents who were referred to the obesity outpatient clinic were asked to participate. During 7 sessions (one session every two weeks) the adolescents were educated on the health consequences of obesity, diet, physical activity, energy balance, improving self-esteem and how to handle bullying and other difficult situations. All sessions were held in groups of 8-10 adolescents. In addition, two sessions were organised for the parents concerning the health consequences of obesity, diet, and physical activity. Body weight and height, glucose tolerance (by an oral glucose tolerance test; OGTT), and insulin resistance were measured at enrolment into the Go4it programme and 6 months later. RESULTS: In total, 93 adolescents (39 boys, 54 girls) were included with a mean age of 3.9 (SD: 1.7) years. Of those, 69 adolescents (74%) attended at least 6 out of 7 sessions of the education programme. Stabilisation or reduction in obesity levels following completion of Go4it was achieved in 51 (74%) of these participants. 50 adolescents had a second OGTT. The BMI standard deviation score (BMI-sds) decreased by 4.3% for boys (p = 0.020) and 3.3% for girls (p = 0.017). Among girls, fasting blood glucose levels decreased by an average of 0.37 mmol/l (95% CI: 0.14-0.60) and insulin concentrations decreased by an average of 299 pmol/l (95% CI: 71-528). CONCLUSION: Participation in the Go4it education programme is accompanied by a stabilisation or reduction in the level of obesity and has favourable effects on glucose and insulin metabolism.

Long-term effect of the Go4it group treatment for obese adolescents: a randomised controlled trial.

BACKGROUND & AIMS: Few studies evaluating treatment of adolescent obesity have been published. Therefore, long-term effects of the Go4it group treatment for obese adolescents were examined. METHODS: Obese adolescents (11-18 years) visiting an outpatient paediatric obesity clinic were randomly assigned to 1) intervention group (Go4it) or 2) current regular care i.e. referral to a dietician in the home care setting (controls). Linear mixed models analysis was performed to evaluate intervention effects. Effect modification by sex, age and ethnicity was checked. Outcome measures included body mass index standard deviation score (BMIsds), body composition and metabolic components at 6 and 18 months follow-up. RESULTS: 122 adolescents, 71 Go4it and 51 controls, with a mean BMIsds of 2.9 ± 0.5 were randomised. At 18 months a modest significant reduction in BMIsds (between group difference: -0.16; 95%CI: -0.30, -0.02; p = .028) was observed. None of the other body composition or metabolic components showed significant treatment effects. Ethnicity was a significant effect modifier. Posthoc analysis showed a large significant reduction on BMIsds (between group difference: -0.35; 95%CI: -0.64, -0.07) at 18 months for obese adolescents from western descent, while no effect was observed for adolescents from non-western descent. Significant treatment effects were also observed for systolic and diastolic blood pressure, as well as HDL cholesterol level, but only for obese adolescents from western descent. CONCLUSIONS: Go4it showed promising long-term effects on BMIsds compared with regular care in obese adolescents. Larger benefits were achieved for adolescents of western ethnicity. This trial was registered at www.trialregister.nl with the Netherlands Trial Register as ISRCTN27626398.

Health-related-quality-of-life in obese adolescents is decreased and inversely related to BMI.

AIM: To compare health related quality of life (HRQoL) of obese adolescents with normal weight controls and to explore the relation between Body Mass Index (BMI) and HRQoL. METHODS: Cross-sectional study in 31 adolescents (12-18 years), referred for obesity, in comparison with 62 age and sex matched normal weight controls. HRQoL was assessed using the PedsQL 4.0 and Child Health Questionnaire (CHQ). The main outcome measure was difference in HRQoL between obese and control subjects. RESULTS: Mean BMI (SD) in patients versus controls was 34.9 (8.8) versus 19.5 (2.2) kg/m2. In obese adolescents, lower HRQoL in three PedsQL and seven CHQ scales was found (p < 0.05). Variance in HRQoL scales explained by obesity ranged from 8% (CHQ Physical Functioning) to 28% (CHQ Global Health). BMI z-score was inversely correlated with five PedsQL and 10 CHQ scales while the percentage of scale variance explained by BMI z-score ranged from 7% (CHQ Physical summary scale) to 33% (CHQ Global Health). CONCLUSION: HRQoL in obese adolescents is less than in normal weight controls, and is partially explained by obesity-related comorbidity. Overall HRQoL was inversely associated with BMI. Hence, HRQoL is an important indicator of impact of obesity and effect of interventions, complementary to clinical variables.

Why do diabetic patients not attend appointments with their dietitian?

PURPOSE: Determining the prevalence of and possible reasons for nonattendance of diabetic nutritional care clinics. METHODS: Data were collected by means of a telephone survey and a review of patient records among 293 (166 attendees and 127 nonattendees) patients undergoing outpatient treatment at a university hospital. The t-tests, chi-square tests and logistic regression analysis were used to identify potential determinants of nonattendance. The theoretical framework was primarily based on the Health Belief Model. RESULTS: In univariate analysis, nonattendance at the clinic was associated with a number of factors such as not visiting other care givers, risk perceptions, body-mass index, self-rated health, health locus of control, satisfaction with the dietitian, feelings of obligation to attend, and beliefs about the effectiveness of the treatment. In multivariate analysis only health locus of control and obligation to attend the visit were significant predictors of attendance. A significant number of respondents further reported that they perceived their visits to the dietitian to be of little use. CONCLUSION: One in three diabetic patients undergoing outpatient treatment skipped one or more visits to their dietitian. Patient education to improve attendance should focus primarily on convincing patients that they can contribute to their own health, and may stress the obligation the patients have when making an appointment with the dietitian.