Addressing psychosocial health issues in obese adolescents could be crucial

Tackling issues such as low self-esteem, depression, anxiety and poor social relationships could be key when dealing with severe adolescent obesity, Leeds Beckett University research suggests.

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The prevalence of childhood obesity – and more specifically, severe obesity – has increased rapidly throughout the last three decades in the UK. With an estimated 2.9% of girls and 3.9% of boys suffering with severe obesity, leading to potential cardiovascular disease, type 2 diabetes and other health conditions, SHINE – an established Tier 3 weight management programme based in Sheffield – has partnered with Leeds Beckett researcher James Nobles to assess the effectiveness of their work. Tier 3 refers to programmes delivered by specialist providers and targeted at children with more complex, severe obesity.

James, who led the research, found that SHINE’s psychosocial intervention (PSI) method, which uniquely addresses emotional issues which may impede weight loss, had proved successful when working with 10-17-year-olds. The study has been published in the latest edition of the Journal of Adolescent Health. The evaluation showed that PSIs may be able to assist young people in the management of severe obesity and possibly to a greater extent than other community-based weight management programmes.

He said: “In light of the recent UK Governments’ Childhood Obesity Plan, we have evidence here to suggest that weight management programmes – when delivered effectively, and in the right setting – can really help young people with obesity. We have an estimated 4.5 million children with overweight or obesity here in the UK, and the current government plan offers little direct help for those in need.

“Our role has been to retrospectively evaluate participants attending SHINE between 2011 and 2016. We had the data from 435 young people, most of whom had clinical obesity and/or associated co-morbidities. SHINE collects their BMI and waist circumference at the beginning of the programme and then again at the three, six, nine and 12 month mark. Psychosocial measures including anxiety, depression and self-esteem were collected at the start as well. In addition participant retention was assessed.

“We found that SHINE appeared to be effective in the real-world setting: 95% of the young people were retained at three months, and had an average BMI reduction of 1.33kg/m2 – the equivalent to a 4% change. We noted that anxiety, depression and self-esteem had improved by 50%, 54% and 38% respectively also. These promising results continued to 12 months, with average BMI reductions of 2.41kg/m2 at that time point – a 7% difference. Putting that into perspective, adult weight management services would aim for a 5% reduction in 12 weeks, 10% after 1 year – weight maintenance and slight weight loss is usually only advocated for young people.”

SHINE Managing Director Kath Sharman, added: “Factors shown to influence obesity include low levels of physical activity, sedentary lifestyles and poor dietary behaviours. However, we know that psychosocial factors, such as low self-esteem, depression, anxiety and poor social relationships, often present as underlying causes and attributes of severe obesity

“The SHINE PSI demonstrated positive mean reductions in all measurements across all time points. In contrast to other community-based weight management services, these results suggest that PSIs may be effective in the treatment of severe adolescent obesity, and that further consideration of these interventions is needed.

“Evidence relating to the evaluation of adolescent weight management programmes (WMP) is limited, particularly when assessing those implemented within the UK. The National Institute for Health and Care Excellence (NICE) recommends that WMPs focus predominantly on dietary improvement, promotion of physical activity, and behaviour modification. SHINE, while acknowledging the NICE guidelines, goes further to recognise the psychosocial aspects of obesity. A large proportion of the SHINE PSI focuses on developing social relationships, providing techniques for stress management, overcoming bullying, and improving self-esteem. As such, SHINE may be viewed to offer a more holistic approach to weight management than traditional programmes.”

Kath and James have worked on a number of additional projects related to SHINE, and this is the most recent paper in a series of three. Their other papers explored the use of a stepped-care approach when treating severe obesity, and also gave a commentary around the current Tier 3 service provision.

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