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Obesity treatment—more than food and exercise: a qualitative study exploring obese adolescents' and their parents' views on the former's obesity  [cached]
Anders Lindelof,Claus Vinther Nielsen,Birthe D. Pedersen
International Journal of Qualitative Studies on Health & Well-Being , 2010, DOI: 10.3402/qhw.v5i2.5073
Abstract: The aim of this study was to explore obese adolescents' and their parents' views on the former's obesity; especially to gain knowledge about barriers and motivational factors that influence obese adolescents' ability to lose weight. This is a qualitative study involving field observation and semi-structured interviews with obese adolescents and their parents. The analysis takes a phenomenological–hermeneutic approach. Fifteen obese adolescents aged 13–16 years and their parents/grandparents participated in this study (one father, seven mothers, five sets of parents and two sets of grandparents). The results showed that obese adolescents' are aware that they have unhealthy eating habits and they wish they were able to attain to a healthier diet. Although in poor physical shape, obese adolescents perceive their daily level of exercise as moderate. Obese adolescents blame themselves for being obese and blame their parents for an unhealthy diet, and for being unsupportive regarding exercise. Parents blame their obese child of lacking will power to change eating and exercise habits. As a consequence, the homely atmosphere is often characterised by quarrels and negative feelings. The conclusion is that despite obese adolescents' intention of reducing weight, underlying issues interfere with this goal. This is particularly related to quarrels with parents, self-blame and misguided understanding of eating and exercising habits. These matters need to be addressed when treating obesity among adolescents.
7th to 9th grade obese adolescents? perceptions about obesity in tamaulipas, Mexico
Martínez-Aguilar, Ma. de la Luz;Flores-Pe?a, Yolanda;Rizo-Baeza, Ma. de las Mercedes;Aguilar-Hernández, Rosa Ma.;Vázquez-Galindo, Laura;Gutiérres-Sánchez, Gustavo;
Revista Latino-Americana de Enfermagem , 2010, DOI: 10.1590/S0104-11692010000100008
Abstract: the objective was to explore obese adolescents’ perceptions about obesity among students in the seventh to ninth grade of a public school in tamaulipas, mexico. this is a qualitative study. participants were 24 adolescents with a body mass index equal to or greater than the 95th percentile. semistructured interviews were conducted until data saturation was reached and the meaning was understood. the adolescents defined obesity according to standards of measurement. they identified the hereditary factor as the main obesity cause, tended to underestimate obesity and had low self-esteem. they reported problems to do physical exercise and get clothes in order to improve their image, and feel rejected by their peers in school. it was identified that these adolescents have psychological defense mechanisms against obesity and that some of them are making efforts to lose weight. obesity entails social and psychological health implications for persons suffering from this problem. interventions should be put in practice.
Relationship Between Obesity and 8-hydroxy-2-deoxy Guanosine as an Oxidative Marker in Obese Adolescents of Giza  [PDF]
Amany Elwakkad,Nayera Elmorsi Hassan,Hiba Sibaii,Salwa el Zayat
Journal of Medical Sciences , 2011,
Abstract: This study was conducted to assess the relationship between obesity markers (Body mass index (BMI), fat percentage) and DNA oxidation marker 8-hydroxy-guanosine (OHG) , as a predictor for future clinical problems in obese adolescents of Giza. The study was conducted on 103 adolescents aged 13-18 years (22 boy, 81 girl). BMI was calculated as body weight (kg) divided by height (m2) squared and obesity was defined as BMI of 95 percentile. Fat percentage was determined by using Biological impedance technique. Oxidative stress markers as 8- hydroxyl guanosine, superoxide and glutathione were measured. The adolescents were divided according to BMI into two groups. Group I with BMI >95 percentile and less than 97 percentile (obese) and Group II with BMI >97 percentile (severely obese). Significant differences were detected between the two groups (Group I and II) of the study as regard obesity markers (BMI, fat%) and oxidative stress markers (lipid oxidation, superoxide dismutase enzyme activity, glutathione peroxidase enzyme activity, 8-hydroxyl guanosine) (p<0.0005). Significant positive correlations were detected between obesity markers and oxidative stress markers among adolescent severely obese cases (group II). Obesity is highly associated with states of oxidative stress in adolescents, with elevated levels of oxidative stress markers, with a positive relation with 8-hydroxy-guanosine and obesity markers and other oxidative markers, suggesting that this marker might play an important role in the prediction of future development of some clinical diseases.
Moderate Weight Reduction in an Outpatient Obesity Intervention Program Significantly Reduces Insulin Resistance and Risk Factors for Cardiovascular Disease in Severely Obese Adolescents  [PDF]
J. Grulich-Henn,S. Lichtenstein,F. H?rster,G. F. Hoffmann,P. P. Nawroth,A. Hamann
International Journal of Endocrinology , 2011, DOI: 10.1155/2011/541021
Abstract: Background. Metabolic risk factors like insulin resistance and dyslipidemia are frequently observed in severly obese children. We investigated the hypothesis that moderate weight reduction by a low-threshold intervention is already able to reduce insulin resistance and cardiovascular risk factors in severely obese children. Methods. A group of 58 severely obese children and adolescents between 8 and 17 years participating in a six-month-long outpatient program was studied before and after treatment. The program included behavioral treatment, dietary education and specific physical training. Metabolic parameters were measured in the fasting state, insulin resistance was evaluated in an oral glucose tolerance test. Results. Mean standard deviation score of the body mass index (SDS-BMI) in the study group dropped significantly from +2.5 ± 0.5 to 2.3 ± 0.6 ( ) after participation in the program. A significant decrease was observed in HOMA (6.3 ± 4.2 versus 4.9 ± 2.4, , and in peak insulin levels (232.7 ± 132.4 versus 179.2 ± 73.3?μU/mL, ). Significant reductions were also observed in mean levels of hemoglobin A1c, total cholesterol and LDL cholesterol. Conclusions. These data demonstrate that already moderate weight reduction is able to decrease insulin resistance and dyslipidemia in severely obese children and adolescents. 1. Introduction During the last decade a steady rise in the prevalence of obesity in children and adolescents has been observed worldwide [1, 2] and in several age-groups the extent of obesity was also on the increase. Concurrently certain diseases, characteristically occurring in middle-age adults in association with enhanced body fat mass (e.g., metabolic syndrome and type 2 diabetes), have emerged in children and adolescents with severe obesity, suggesting a coherence between both trends [3, 4]. Likewise, further investigations have shown that obese children and adolescents have a high risk between 30 and 80% for the persistence of overweight into adulthood, and that morbidity and mortality are higher in those obese adults who became overweight during childhood compared to those whose weight-gain evolved later in life [5]. On the other hand epidemiological studies showed that the majority of severely obese adults became overweight when they were still children. A tremendous increase in obesity-related morbidity and furthermore an immense rise in the medical costs associated with it, are to be expected, if this trend continues [6]. For instance, at present type 2 diabetes mellitus is already predominant in some pediatric diabetes
High prevalence of obesity among women who enrolled in HIV prevention trials in KwaZulu-Natal, South Africa: healthy diet and life style messages should be integrated into HIV prevention programs
Handan Wand, Gita Ramjee
BMC Public Health , 2013, DOI: 10.1186/1471-2458-13-159
Abstract: A total of 5,495 HIV-negative women from KwaZulu-Natal, South Africa enrolled in three microbicide trials during the period of 2002--2008 were categorised as normal weight (body mass index (BMI: 18.6-<25), overweight (BMI: 25-<30) or obese (BMI: 30+). Incidence of HIV and other sexually transmitted infections such as Chlamydia and gonorrhoea were also estimated and compared by BMI groups. Combined data was analysed using STATA 10.0.Approximately 70% of the sample population was classified as being overweight or obese. Older age and lack of education were determined to be significant predictors of obesity. Women who were 35 years or older were more than three times as likely to be overweight and more than 12 times as likely to be obese compared to the youngest group. The highest HIV and STI incidence rates were observed among those with BMI <25 kg/m2 (normal weight) (8.1 and 19.8 per 100 person-year respectively) compared to women with BMI more than 25 kg/m2 (P<0.001, both).Effective obesity prevention strategies are needed to re-formulate HIV prevention programmes by incorporating healthy diet and life style messages to target those who are at highest risk not just for HIV infection but also for non-communicable diseases.
Multidisciplinary Approach to the Treatment of Obese Adolescents: Effects on Cardiovascular Risk Factors, Inflammatory Profile, and Neuroendocrine Regulation of Energy Balance  [PDF]
Ana Raimunda Damaso,Aline de Piano,Raquel Munhoz da Silveira Campos,Flávia Campos Corgosinho,Wolfgang Siegfried,Danielle Arisa Caranti,Deborah Cristina Landi Masquio,June Carnier,Priscila de Lima Sanches,Patrícia Le?o da Silva,Cláudia Maria Oller Nascimento,Lila Missae Oyama,Alexandre Damaso Aguilera Dantas,Marco Túlio de Mello,Sergio Tufik,Lian Tock
International Journal of Endocrinology , 2013, DOI: 10.1155/2013/541032
Abstract: The prevention of obesity and health concerns related to body fat is a major challenge worldwide. The aim of this study was to investigate the role of a medically supervised, multidisciplinary approach, on reduction in the prevalence of obesity related comorbidities, inflammatory profile, and neuroendocrine regulation of energy balance in a sample of obese adolescents. A total of 97 postpuberty obese adolescents were enrolled in this study. Body composition, neuropeptides, and adipokines were analysed. The metabolic syndrome was defined by the International Diabetes Federation (IDF). The abdominal ultrasonography was performed to measure visceral, subcutaneous fat and hepatic steatosis. All measures were performed at baseline and after one year of therapy. The multidisciplinary management promoted the control of obesity reducing body fat mass. The prevalence of metabolic syndrome, asthma, nonalcoholic fatty liver disease (NAFLD), binge eating, and hyperleptinemia was reduced. An improvement in the inflammatory profile was demonstrated by an increase in anti-inflammatory adiponectin and reduction in proinflammatory adipokines, plasminogen activator inhibitor-1, interleukin-6 concentrations, and in the Lep/Adipo ratio. Moreover, a reduction in the AgRP and an increase in the alfa-MSH were noted. The multidisciplinary approach not only reduced obesity but also is efficacious in cardiovascular risk factors, inflammatory profile, and neuroendocrine regulation of energy balance. 1. Introduction The prevalence of overweight and obesity has increased in many low- and middle-income countries [1]. It is estimated that 50% of the adult Brazilian population is overweight, with an obesity rate of 12.5% and 16.9% for men and women, respectively [2]. Similar trends were observed in adolescents, whereby 21% present some degree of overweight and obesity. Previously, it has been showed that obese adolescents present a high degree of nonalcoholic fatty liver disease (NAFLD), metabolic syndrome, asthma, binge eating symptoms, disruption in the neuroendocrine regulation of energy balance, and other impairments, reducing the effectiveness of weight management [3–9]. In obese Brazilian adolescents it was observed that 27.16% present diagnoses of metabolic syndrome (MS). The most frequently altered parameter was HOMA-IR [4, 10]. This result suggests a heightened pro/inflammatory state, considering that insulin resistance (IR) is an independent predictor of alterations in the carotid intima-media thickness (IMTc), a subclinical surround of atherosclerosis in obese adolescents
Protocol for: Sheffield Obesity Trial (SHOT): A randomised controlled trial of exercise therapy and mental health outcomes in obese adolescents [ISRCNT83888112]
Amanda J Daley, Robert J Copeland, Neil P Wright, Jerry KH Wales
BMC Public Health , 2005, DOI: 10.1186/1471-2458-5-113
Abstract: SHOT is a randomised controlled trial where obese young people are randomised to receive; (1) exercise therapy, (2) attention-control intervention (involving body-conditioning exercises and games that do not involve aerobic activity), or (3) usual care. The exercise therapy and attention-control sessions will take place three times per week for eight weeks and a six-week home programme will follow this. Ninety adolescents aged between 11–16 years referred from a children's hospital for evaluation of obesity or via community advertisements will need to complete the study. Participants will be recruited according to the following criteria: (1) clinically obese and aged 11–16 years (Body Mass Index Centile > 98th UK standard) (2) no medical condition that would restrict ability to be active three times per week for eight weeks and (3) not diagnosed with insulin dependent diabetes or receiving oral steroids. Assessments of outcomes will take place at baseline, as well as four (intervention midpoint) and eight weeks (end of intervention) from baseline. Participants will be reassessed on outcome measures five and seven months from baseline. The primary endpoint is physical self-perceptions. Secondary outcomes include physical activity, self-perceptions, depression, affect, aerobic fitness and BMI.The prevalence of obesity has reached alarming levels in Britain with several studies [1] reporting that the number of young people who are overweight and obese has increased notably over the past decade. This dramatic increase in overweight has not been confined to British children and adolescents; pediatric overweight is also increasing in other western countries [2,3]. While obesity is known to have many physiological consequences, the psychopathology of this condition has not featured prominently in the literature. Overweight children have increased odds of experiencing poor health related quality of life, particularly in the domains of psychosocial health, self-esteem and ph
Evaluation of microalbuminuria in obese adolescents
AN Okpere, IC Anochie, FU Eke
Nigerian Journal of Paediatrics , 2012,
Abstract: Background: Obesity is a risk factor for metabolic syndrome with insulin resistance. Its effect on renal and cardiovascular diseases is reported in developed countries, but rarely established among adolescents in developing countries. Subjects and methods: A crosssectional study of 846 adolescents selected from 12 secondary schools in Port Harcourt, Nigeria. Obese subjects with Body Mass Index (BMI) equal to or greater than the 95th percentile for age and sex on the United States CDC growth chart were selected and studied. Urine samples of subjects without overt proteinuria were tested for microalbuminuria using the micral test strips. Results: Seventy-three of the subjects were obese giving the prevalence of obesity to be 8.6%. Microalbuminuria was present in 23 (35.4%) of the 65 obese subjects without overt proteinuria. The proportional prevalence was higher in females (42.9%), in age group 10-14years (42.2%), in subjects with hypertension (57.1%), and family history of hypertension (50.0%) and diabetes mellitus (37.5%) [p > 0.05]. Conclusion: There is high prevalence of adolescent obesity, and a high prevalence of microalbuminuria among obese adolescents in Port Harcourt. We recommend efforts at reducing obesity as a means of preventing renal disease in adolescents.
Action-oriented obesity counseling attains weight stabilization and improves liver enzymes among overweight and obese children and adolescents  [PDF]
Allison C. Sylvetsky, Jean A. Welsh, Stephanie M. Walsh, Miriam B. Vos
Open Journal of Pediatrics (OJPed) , 2012, DOI: 10.4236/ojped.2012.23037
Abstract: Introduction: Pediatricians are encouraged to promote behavior modification to reduce childhood obesity and its co-morbidities, yet the effectiveness of office counseling is unclear. We aimed to evaluate if a low-intensity intervention (action-oriented counseling) in a clinic setting results in weight stabilization, and if the effect is modified by a diagnosis of non-alcoholic fatty liver disease (NAFLD). We hypothesized that patients with NAFLD would be more motivated to adhere to the lifestyle goals set in clinic, due to the diagnosis of an obesity-related condition; and, would therefore achieve greater weight reduction compared to similarly overweight and obese patients without a diagnosis of NAFLD. Methods: A retrospective chart review was conducted on 73 (35 male, 38 female) overweight and obese patients (BMI ≥ 85th percentile) attending a pediatric GI clinic between January 2006 and October 2011. Analysis was conducted to determine if lifestyle goals discussed with the patient at each clinic visit were associated with improved BMI, BMI z-score, and liver enzymes. Treatment outcomes among NAFLD patients and similarly obese patients without NAFLD were compared using t-tests and chi-square tests. Results: Of the children evaluated, 74.0% achieved a reduction or stabilization in BMI z-score after 3 months of follow-up. Among NAFLD patients, liver enzymes improved in 72% of those who were able to stabilize or reduce their BMI and among 43% of those who gained weight. Treatment outcome did not significantly differ based on having a diagnosis of NAFLD, although there was a trend towards greater improvements. Conclusion: Our study suggests that action oriented counseling including goal-setting in a low intensity, clinic based approach is effective in improving patient BMI, in the presence or absence of an obesity-related co-morbidity, such as NAFLD. Further, we demonstrated that lifestyle modification led to improvement of liver enzymes in NAFLD patients and may result in other clinically relevant improvements. Longer studies will be needed to determine if the improvements are sustained.
Carotid Intima-media thickness in childhood and adolescent obesity relations to abdominal obesity, high triglyceride level and insulin resistance  [cached]
Jie Fang, Jian Ping Zhang, Cai Xia Luo, Xiao Mei Yu, Lan Qiu Lv
International Journal of Medical Sciences , 2010,
Abstract: Aim: To investigate risk factors which impact on common carotid artery intima media thickness (IMT). Methods: A total of 86 obese children and adolescents and 22 healthy children and adolescents with normal weight were enrolled. Moreover, 23 of 86 obese children and adolescents were diagnosed with metabolic syndrome (MetS). The clinical, biochemical data and the IMT of the common carotid artery were measured in all subjects. Results: Obese and obese with MetS subjects demonstrated a significantly (p < 0.01) thicker intima media (0.69mm, 0.66mm) as compared to the control group (0.38mm), but there was no significant difference of IMT between obese and MetS group. IMT was correlated to body weight, body mass index, waist circumference, waist to hip ratio, systolic blood pressure, diastolic blood pressure, fasting insulin, homoeostasis model assessment-insulin resistance, triglyceride, high-density lipoprotein- cholesterol, low-density lipoprotein-cholesterol, alanine aminotransferase, aspartate aminotransferase and fatty liver. Waist circumference, waist to hip ratio, triglyceride and homoeostasis model assessment-insulin resistance were independent determinants of mean IMT level. Conclusion: Obesity especially abdominal obesity, high TG and insulin resistance may be the main risk predictors of increased IMT.
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