adapting pediatric obesity care to better suit adolescent patients design of a treatment CORD-Papers-2022-06-02 (Version 1)

Title: Adapting pediatric obesity care to better suit adolescent patients: Design of a treatment platform and results compared with standard care in the national patient quality register
Abstract: BACKGROUND: Obesity constitutes a critical risk for adolescent health. This study aimed at identifying youthfriendly components of obesity treatment. METHODS: In this feasibility study an adolescent obesity treatment platform was implemented at two Pediatric outpatient clinics in Sweden. Body mass index (BMI) BMI zscore and the category of obesity (International Obesity Task Force) were compared before and after the intervention and with data on standard care from the Swedish Childhood Obesity Treatment Register. RESULTS: The study included 99 participants (49 females) aged 1318 years from 1 September 2014 to 31 December 2016. A pediatric nurse met the participants on average 6.5 times in the average inclusion period of 15 months. Physical activity sessions attracted 63 participants. Acceptance Commitment Therapy and In Real Life groups attracted 24 participants. At inclusion 62 participants had obesity and 37 severe obesity and 71/99 (72%) remained in the same category. The mean BMI increased from 32.0 to 33.4 kg/m(2) (p < 0.01) but 56/94 (60%) participants lowered their BMI or increased less than 1 kg/m(2) and 73% stayed to the end of the study. Participants who were new to treatment and participants coming for more than eight visits to the nurse did not increase in BMI. BMI did not change for the 221 out of 641 register patients who had two recordings of BMI in the study period. CONCLUSIONS: The platform was successful in increasing retention and 60% of participants lowered or maintained their BMI. Still seven out of ten adolescents with obesity or severe obesity remained in the same weight category.
Published: 2021-06-23
Journal: Obes Sci Pract
DOI: 10.1002/osp4.539
DOI_URL: http://doi.org/10.1002/osp4.539
Author Name: Janson Annika
Author link: https://covid19-data.nist.gov/pid/rest/local/author/janson_annika
Author Name: Bohlin Anna
Author link: https://covid19-data.nist.gov/pid/rest/local/author/bohlin_anna
Author Name: Johansson BrittMarie
Author link: https://covid19-data.nist.gov/pid/rest/local/author/johansson_brittmarie
Author Name: TryggLycke Sofia
Author link: https://covid19-data.nist.gov/pid/rest/local/author/trygglycke_sofia
Author Name: Gauffin Fredrika
Author link: https://covid19-data.nist.gov/pid/rest/local/author/gauffin_fredrika
Author Name: Klaesson Sven
Author link: https://covid19-data.nist.gov/pid/rest/local/author/klaesson_sven
sha: 48e977e27ab7aa3c701395c69c65efa678403bd4
license: cc-by-nc
license_url: https://creativecommons.org/licenses/by-nc/4.0/
source_x: Medline; PMC
source_x_url: https://www.medline.com/https://www.ncbi.nlm.nih.gov/pubmed/
pubmed_id: 34877009
pubmed_id_url: https://www.ncbi.nlm.nih.gov/pubmed/34877009
pmcid: PMC8633929
pmcid_url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8633929
url: https://doi.org/10.1002/osp4.539 https://www.ncbi.nlm.nih.gov/pubmed/34877009/
has_full_text: TRUE
Keywords Extracted from Text Content: participants Attribution-NonCommercial 56/94 patients adolescents Sweden. Sweden provides people participants left Stockholm region 30%-80 H,I partici- children patient-driven Covid-19 1-2 patient line patients adolescents SMS participants child-well body persons female
Extracted Text Content in Record: First 5000 Characters:Background: Obesity constitutes a critical risk for adolescent health. This study aimed at identifying youth-friendly components of obesity treatment. Methods: In this feasibility study, an adolescent obesity treatment platform was implemented at two Pediatric outpatient clinics in Sweden. Body mass index (BMI), BMI z-score, and the category of obesity (International Obesity Task Force) were compared before and after the intervention and with data on standard care from the Swedish Childhood Obesity Treatment Register. : The study included 99 participants (49 females) aged 13-18 years from 1 September 2014, to 31 December 2016. A pediatric nurse met the participants on average 6.5 times in the average inclusion period of 15 months. Physical activity sessions attracted 63 participants. Acceptance Commitment Therapy and In Real Life groups attracted 24 participants. At inclusion, 62 participants had obesity and 37 severe obesity, and 71/99 (72%) remained in the same category. The mean BMI increased from 32.0 to 33.4 kg/m 2 (p < 0.01), but 56/94 (60%) participants lowered their BMI or increased less than 1 kg/m 2 and 73% stayed to the end of the study. Participants who were new to treatment and participants coming for more than eight visits to the nurse did not increase in BMI. BMI did not change for the 221 out of 641 register patients who had two recordings of BMI in the study period. The platform was successful in increasing retention, and 60% of participants lowered or maintained their BMI. Still, seven out of ten adolescents with obesity or severe obesity remained in the same weight category. adolescent health, bariatric surgery, developmentally appropriate health care, neuropsychiatric disorders, obesity treatment, youth-friendly care This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. One in five adolescents in the world lives with overweight or obesity, 1 and obesity constitutes one of the most critical risks for adolescent health. [2] [3] [4] The risk of an adolescent patient to remain with obesity in adulthood is around 80%. 5 Interventions promoting lifestyle modification are most commonly used, but have been less successful for adolescent patients than for younger children. [6] [7] [8] Pharmacotherapy is rarely used outside investigational trials, and few medications have indications for patients below 18 years of age. Emerging anti-obesity drugs may become an option for adolescent patients. 9, 10 Bariatric surgery is increasingly suggested for adolescents with severe obesity but remains controversial and underutilized. 11, 12 Apart from remaining a cornerstone of treatment, promoting healthy behaviors, such as physical exercise and nonsmoking, can help to mitigate the complications of obesity. 13 Adolescence is a unique period in life, and, importantly, the influence of family will decrease. Developmentally Appropriate Health care has been suggested as a term for adapting health care to the young person's social, psychological, and biological age, "youthfriendly" care. 14 Although treatment for younger children is often family-based or even addressing just the parents, 7 the role of the parents in supporting their adolescents with obesity is not clear. A randomized study showed no advantage of improving parentadolescent communication in treating adolescent patients with obesity, and there was a trend favoring a greater decrease in body mass index (BMI) for adolescents whose parents were minimally involved in their weight control efforts. 15 Analyzing 15 qualitative studies, Jones et al. showed that although adolescents said that they benefited from positive family support; sometimes, parents created a barrier to weight loss. This lack of family support appeared more common in adolescents reporting no success. 16 In a meta-analysis of 28 randomized controlled studies on patients of 12-17 years of age in treatment for obesity, Al-Khudairy et al. showed a reduction of the BMI z-score of 0.13 units in the intervention compared with the control groups. For the six studies with 18-24 months follow-up, the BMI z-score was reduced by 0.36 units. There were no differences between interventions with or without parental involvement. 6 In another review, parents of children and adolescents with obesity were described as ambivalent in their attitudes, caught between the desire to do something about their child's overweight and fear to harm or add to the child's burden. 17 This balancing act may become even more difficult with the increasing age of the child. A long-term relationship with the health care provider has been important for treating other chronic diseases such as type-1 diabetes mellitus. 18 Analyzing the prominent domain of support, Jones et al. noted that professional support appeared to be highly
Keywords Extracted from PMC Text: youth‐friendly Covid‐19 persons long‐term per‐capita revenues people 51/94 add‐on female participants body Sweden provides patients youth‐friendly" 56/94 z‐score (Figure 3B Patient children Patients adolescents patient‐driven participants left Britt‐Marie 5–7 1–2 family‐based role‐plays SMS BORIS patient self‐esteem Stockholm region 83/94 Sweden follow‐up child‐well Fredrika Gauffin " line
Extracted PMC Text Content in Record: First 5000 Characters:One in five adolescents in the world lives with overweight or obesity, 1 and obesity constitutes one of the most critical risks for adolescent health. 2 , 3 , 4 The risk of an adolescent patient to remain with obesity in adulthood is around 80%. 5 Interventions promoting lifestyle modification are most commonly used, but have been less successful for adolescent patients than for younger children. 6 , 7 , 8 Pharmacotherapy is rarely used outside investigational trials, and few medications have indications for patients below 18 years of age. Emerging anti‐obesity drugs may become an option for adolescent patients. 9 , 10 Bariatric surgery is increasingly suggested for adolescents with severe obesity but remains controversial and underutilized. 11 , 12 Apart from remaining a cornerstone of treatment, promoting healthy behaviors, such as physical exercise and non‐smoking, can help to mitigate the complications of obesity. 13 Adolescence is a unique period in life, and, importantly, the influence of family will decrease. Developmentally Appropriate Health care has been suggested as a term for adapting health care to the young person's social, psychological, and biological age, "youth‐friendly" care. 14 Although treatment for younger children is often family‐based or even addressing just the parents, 7 the role of the parents in supporting their adolescents with obesity is not clear. A randomized study showed no advantage of improving parent–adolescent communication in treating adolescent patients with obesity, and there was a trend favoring a greater decrease in body mass index (BMI) for adolescents whose parents were minimally involved in their weight control efforts. 15 Analyzing 15 qualitative studies, Jones et al. showed that although adolescents said that they benefited from positive family support; sometimes, parents created a barrier to weight loss. This lack of family support appeared more common in adolescents reporting no success. 16 In a meta‐analysis of 28 randomized controlled studies on patients of 12–17 years of age in treatment for obesity, Al‐Khudairy et al. showed a reduction of the BMI z‐score of 0.13 units in the intervention compared with the control groups. For the six studies with 18–24 months follow‐up, the BMI z‐score was reduced by 0.36 units. There were no differences between interventions with or without parental involvement. 6 In another review, parents of children and adolescents with obesity were described as ambivalent in their attitudes, caught between the desire to do something about their child's overweight and fear to harm or add to the child's burden. 17 This balancing act may become even more difficult with the increasing age of the child. A long‐term relationship with the health care provider has been important for treating other chronic diseases such as type‐1 diabetes mellitus. 18 Analyzing the prominent domain of support, Jones et al. noted that professional support appeared to be highly valued than support from peers and family. There was a general desire from adolescents to work more closely with professionals. 16 The need for highly specialized multi‐disciplinary teams may be challenging for smaller units, and networking with external providers, such as dieticians or physiotherapists, may be an option. In treatments for children with obesity, attrition is high at 30%–80%. 19 A Regional Roadmap for Obesity in the Stockholm region was developed and ratified by the health care and political authorities. 20 The Roadmap clarified the rights of patients of all ages to find obesity treatment, provided the terms of reference for health care providers, and mapped the referral links. In other contexts, the primary health care providers treat obesity, 21 , 22 but the Roadmap stated that children with International Obesity Task Force (IOTF)‐BMI 30 should be referred to second line treatment at Pediatric outpatient clinics. The primary health care providers, school health care, and child‐well clinics should identify children with overweight and provide essential advice to prevent a progression to obesity and refer children with obesity to the Pediatric outpatient clinics. For this study, a multi‐professional reference group collaborated in the design, and two Pediatric outpatient clinics were the targets of the intervention. A relationship with a designated health care provider was suggested to be meaningful and visits to the selected pediatric study nurses were to be the core of the project. The nurses aimed to assist the participants in their increasing autonomy and the natural process of diminishing parental support. The rationale of this study was to address one of the identified gaps in the health care system: the observed poor results for treatments of obesity in adolescent patients. The main objective of the treatment platform was to upgrade the existing pediatric care to improve the coverage of care and treatment results for adolescents with obes
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