Novel and emerging approaches to combat adolescent obesity

Figures & data

Table 1 Summary of recent preventative interventions in adolescents to combat obesity

	Study/Grade/Age/Year of publication	Theory	Design and sample	Intervention	Duration	Salient findings
1.	Fit for Life^Citation35 K–8th grade 5–14 year olds 2007	No known theory	Quasi-experimental n = 4, 241 ± 200	5 components: (1) school-based education with American Heart Association’s Heart power kits; (2) virtual reality wellness club that used booklets to track physical activity and nutrition choices; (3) point source program for county residents to make healthy food choices at restaurants; (4) occupational health initiative for parents and grandparents that included fairs and screenings; (5) community activity that included working with health agencies	4 years	No significant change in overweight or obesity rates Changes in behaviors and their antecedents not studied
2.	Policy-based School Intervention^Citation36 4th–6th grade Mean age 11.3 years 2008	Social marketing and other theories	Experimental with random assignment at group level (n = 1,349)	Five components: (1) self-assessment by using CDC School Health Index; (2) 50 hours of nutrition education per student per school year using Planet Health and Know your Body curricula; (3) nutrition policy for foods sold; (4) social marketing of healthy food products; (5) family outreach through home and school association meetings, report card nights, parent education, and weekly nutrition workshops.	2 years	50% reduction in the incidence of overweight After 2 years only 7.5% children in the intervention group were overweight as compared to 14.9% in the control group and this difference was statistically significant
3.	Nutrition in the Garden^Citation37 6th grade 10–13 year olds 2007	No known theory	Quasi-experimental (n = 99 for three groups)	Food recall workbooks were used that included age appropriate instructions and portion size illustrations 12 week nutrition education curriculum that combined nutrition with horticulture Hands-on garden-based activities that included maintaining a garden	12 weeks	Students in garden-based nutrition group increased their fruit and vegetable consumption (P < 0.001) than other two groups Significant increase in vitamin A, C, and fiber (P < 0.05)
4.	Dutch Obesity Intervention in Teenagers^Citation38 6th grade 12–14 year olds 2009	Intervention Mapping	Experimental with random assignment at school level (n = 632 in 10 intervention schools; 476 in 8 control schools)	Individual component consisting of 11 lessons in courses of biology and physical education Environmental component consisting of asking schools to offer additional physical education classes and changes in school cafeteria	20 months	At 20 months biceps skinfold thickness among girls decreased (0.07 mm; 95% CI: 1.3, 0.04 mm) At 20 months sum of 4 skinfolds among girls was lower (2.0; 95% CI: 3.9, 0.1 mm) At 20 months skinfold thickness of triceps (0.7 mm; 95% CI:1.2, 0.1 mm), biceps (0.4 mm; 95% CI: 0.8, 0.1 mm) and subscapular (0.5 mm; 95% CI: 1.0, 0.1 mm) decreased for boys
5.	School–based Obesity Prevention Program^Citation39 6th–8th grade 12–15 year olds 2008	No known theory	Only formative evaluation done (n = 78)	16 sessions during physical education classes Topics for discussion included reviewing food labels, portion size, food pyramid, and healthy food decision making. Each session also included 20–30 min of physical activity that comprised of moving and games	16 classroom sessions	Formative evaluation revealed that small group settings was successful Lack of parental involvement was a limitation
6.	Choice, Control, and Change^Citation40 7th grade 11–13 year olds 2007	Theory of planned behavior	Pre-test post-test design (n = 278)	24 lessons taught by science teachers over a period of 7–8 weeks Curriculum met some national science standards in biology and science 5 units: getting right amount of energy, making healthy food and activity choices, importance of healthy food and activity choices, impact of environment, and skills of a competent mover and eater	8 weeks	Significant decrease in sedentary activities Significant increase in frequency of fruit and vegetable intake Decrease in frequency of sweetened beverages, packaged snacks, eating at fast food restaurants and ate and drank smaller portions
7.	Present and Prevent^Citation41 Middle school Mean age 14.5 years 2008	Evaluation based on theory of reasoned action	Experimental with random assignment at group level (n = 880; 551 in experimental and 329 in delayed treatment group)	A commercially available Power Point program consisting of two 30 min slides Topics included: health problems associated with obesity, causes of obesity, importance of preventing obesity, body image, benefits of healthy weight, healthful food choices, reading food labels, portion control, changing unhealthy habits, how to increase physical activity, and overcoming barriers	1 week	Significant improvement in knowledge scores between pretest and post-test for experimental group (P < 0.01) No effect on attitudes Significant improvement in friends subjective norm between pretest and post-test for experimental group (P < 0.01) Significant improvements in behavioral intention for eating fried foods, sweets, looking at food labels, and limiting TV watching between pretest and post-test for experimental group (P < 0.01)
8.	Michigan Model (MM) Nutrition Curriculum^Citation42 Middle school Mean age 12.5 years 2008	No known theory	Quasi-experimental(n = 576; experimental = 407; control = 169)	8 lessons: (1) five food groups; (2) health benefits of each food group; (3) selling points for each food group; (4) food labels; (5) advertising claims;(6) healthy body image; (7) surviving fast food;(8) nutrition at school	1 month	Significant increase in nutrition knowledge at post test for intervention group Significant improvement in eating behaviors and efficacy expectations for intervention group Intervention group was more likely to eat fruits and vegetables
9.	USDA Fresh Fruit and Vegetable Program (FFVP)^Citation43 4th–9th grade 9–14 year olds 2008	No known theory	Quasi-experimental (n = 1,127; 784 in intervention; 343 in control)	Provision of free fresh fruit or vegetable daily	2 academic years	Intervention students when compared to control were more willing to try fruits (24.8% vs 12.8%, P < 0.01) and vegetables (25.1% vs 18.4%, P = 0.01) at school

Abbreviations: n, number; CI, confidence interval; CDC, Disease control and prevention; K, kindergarten.

Table 2 Summary of recent interventions to reduce weight in overweight and obese adolescents

	Study/Age/Setting/Year of publication	Theory	Design and sample	Intervention	Duration	Salient findings
1.	Sensible treatment of obesity in rural youth (STORY)^Citation45,Citation46 8–14 years Cooperative Extension Service Office 2008	No known theory	Three arm randomized controlled trial: (1) behavioral family-based, (2) behavioral parent-only, (3) wait-list control group (n = 93)	Delivered by Family and Consumer Sciences agent, postdoctoral psychologist, and graduate students in psychology For both intervention conditions weekly 90 min. sessions × 8 weeks then biweekly × 8 weeks Modified version of Stoplight Diet Setting dietary goals by families Increased physical activity gauged by pedometers and goal setting	10 months	At 4 months children in parent-only group had a significant decrease in BMI as compared to control (MD 0.127, 95% CI: 0.027, 0.226) while there no difference in family-based group with control At 10 months both parent-only (MD 0.115; 95% CI: 0.003, 0.220) and family-based groups (MD 0.136; 95% CI 0.018, 0.254) had decreases in BMI compared to control
2.	Weight-loss E-learning Program^Citation47 12–14 years School 2008	Positive reinforcement	Pre-test post-test (n = 37)	Two domains: information domain and interactive domain Information domain had five components: general, nutrition, exercise, pharmacy, and other Interactive domain used an active server page Regular 45 min classes, exercise twice a week for 40 min. and individual counseling sessions 20–30 min twice/thrice a semester	14 weeks	Significant decrease in BMI (P < 0.05), waist circumference (P < 0.05), and triceps skinfold thickness (P < 0.001) Improvements in three physical fitness tests Improvements in weight loss knowledge scores, body image scores, self-esteem scores, and weight loss self-efficacy scores
3.	Swiss inpatient program^Citation48 12–15 years Hospital 2008	No known theory	Pre-test post-test (n = 130)	Nutritional: Nutritionist performed a qualitative and quantitative analysis of child’s food intake; children received balanced low calorie diet Physical activity: 60–90 minute session supervised by exercise therapists Behavior modification: Modify eating and exercise behaviors	8 weeks	Significant decreases in BMI, weight, body fat, % body fat, fat free mass
4.	Telemedicine support program^Citation49 Mean age 13.7 years Hospital followed by telemedicine 2008	No known theory	Pre-test post-test (n = 140)	Phase I: 4–6 week hospitalization and given a STTP Phase II: Telemedicine program by Internet and mobile phone. Participants filled information about weight etc and physician gave feedback	12 months	In phase I the body weight decreased from 82.4 kg to 76.0 kg (P < 0.001) The acceptance of phase II telemedicine program was 93% at 6 months and 46% at 12 months BMI at admission was 30.5 kg/m^2 and at 12 months was 27.7 kg/m^2 (P < 0.05)
5.	Exercise training program^Citation50 13–14 years School 2008	No known theory	Randomized controlled trial with two groups: exercise (n = 12) and control (n = 12)	Both groups participated in 2 sessions of 40 minute physical education per session per week The exercise group participated in additional 2 sessions per week of 45–60 minutes per session of exercise training for 12 weeks	12 weeks	Significant improvements occurred in exercise group for body mass index, lean muscle mass, fitness, and other indicators Body weight increased in the control group
6.	Intervention in overweight Latino adolescents^Citation51 Mean age 15.5 years Lifestyle lab. 2009	No known theory	Randomized control trial with three groups: nutrition, nutrition plus strength training, and control (n = 54)	Nutrition only: 1 nutrition class per week × 16 weeks; goals to decrease added sugar consumption and increase fiber Nutrition plus strength training: Added strength training twice per week × 16 weeks Outpatient visit in which measures were taken 7–14 days later inpatient admission	16 weeks	There were no significant differences in sugar or fiber intake across the three intervention groups From the total 55% reduced sugar intake and 59% increased fiber intake

Abbreviations: n, number; CI, confidence interval; BMI, body mass index; STTP, structured treatment and teaching program; MD, mean difference.

GombosiROlasinRBittleJTioga county fit for life: a primary obesity prevention projectClin Pediatr200746592600

 PubMed Web of Science ®Google Scholar

FosterGDShermanSBorradalieKA policy-based school intervention to prevent overweight and obesityPediatrics2008121794802

 PubMed Web of Science ®Google Scholar

McAleeseJRankinLGarden-based nutrition education affects fruit and vegetable consumption in sixth-grade adolescentsJ Am Diet Assoc200710766266517383272

 PubMed Web of Science ®Google Scholar

SinghASChinAPawMJBrugJvan MechelenWDutch obesity intervention in teenagers: effectiveness of a school-based program on body composition and behaviorArch Pediatr Adolesc Med2009163430931719349559

 PubMedGoogle Scholar

Ward-BegnocheWGance-ClevelandBHarrisMDeanJDescription of the design and implementation of a school-based obesity prevention program addressing needs of middle school studentsJ Appl Sch Psychol200824247263

 Google Scholar

ContentoIKochPLeeHSauberliWCalabrese-BartonAEnhancing personal agency and competence in eating and moving: formative evaluations of a middle school curriculum – Choice, control, and changeJ Nutr Educ Behav2007395 SupplS179S18617826699

 PubMed Web of Science ®Google Scholar

AboodDBlackDCosterDEvaluation of a school-based teen obesity prevention minimal interventionJ Nutr Educ Behav200840316817418457785

 PubMed Web of Science ®Google Scholar

FahlmanMDakeJMcCaughtryNMartinJA pilot study to examine the effects of a nutrition intervention on nutrition knowledge, behaviors, and efficacy expectations in middle school childrenJ Sch Health200878421622218336681

 PubMed Web of Science ®Google Scholar

JamelskeEBicaLMcCartyDMeinenAPreliminary findings from an evaluation of the USDA fresh fruit and vegetable program in Wisconsin schoolsWis Med J20081075225230

 Google Scholar

JanickeDMSallinenBJPerriMGComparison of parent-only vs family-based interventions for overweight children in underserved rural settings: outcomes from project STORYArch Pediatr Adolesc Med2008162121119112519047538

 PubMedGoogle Scholar

JanickeDMSallinenBJPerriMGSensible treatment of obesity in rural youth (STORY): design and methodsContemp Clin Trials200829227028017588503

 PubMed Web of Science ®Google Scholar

HungSHHwangSLSuMJAn evaluation of a weight-loss program incorporating E-learning for obese junior high school studentsTelemed J E Health200814878379218954248

 PubMed Web of Science ®Google Scholar

KnöpfliBHRadtkeTLehmannMEffects of a multidisciplinary inpatient intervention on body composition, aerobic fitness, and quality of life in severely obese girls and boysJ Adolesc Health200842211912718207089

 PubMed Web of Science ®Google Scholar

SchielRBeltschikowWRadónSLong-term treatment of obese children and adolescents using a telemedicine support programmeJ Telemed Telecare2008141131618318923

 PubMed Web of Science ®Google Scholar

WongPCChiaMYTsouIYEffects of a 12-week exercise training programme on aerobic fitness, body composition, blood lipids and C-reactive protein in adolescents with obesityAnn Acad Med Singapore200837428629318461212

 PubMed Web of Science ®Google Scholar

VenturaEDavisJByrd-WilliamsCReduction in risk factors for type 2 diabetes mellitus in response to a low-sugar, high-fiber dietary intervention in overweight Latino adolescentsArch Pediatr Adolesc Med2009163432032719349560

 PubMedGoogle Scholar