Page 125 - Go4it
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Behavioural and social-emotional functioning
Our sample of obese adolescents experienced serious behaviour problems and social-emotional malfunctioning, which was confirmed by their parents. Mean YSR and CBCL scores for total and all subscales were significantly higher than the reference group, except for the Externalizing scale of the YSR. Parents reported more problems than their children on all scales. There were no significant differences between western and non-western adolescents, except for the attention problem score (Chapter 2).
Tools for estimation of energy needs and fat-free mass
Prediction of resting energy expenditure (REE) in obese adolescents based on equations is subject to significant errors. An adequate prediction equation thus far, accurately predicted the REE in only 74% of obese adolescents. The often- used Schofield-weight (10-18 years) equation (1) accurately predicted the REE in only 50% of obese adolescents. For this reason, indirect calorimetry remains the method of choice for accurate assessment of REE in obese adolescents (Chapter 5). For the assessment of fat-free mass (FFM) with BIA, the Gray-FFM equation appears to be most adequate, with accurately predicted FFM in 63% of obese adolescents. However, 63% is still not at an acceptable accuracy level. Thus, DXA measurement remains the method of choice for FFM in obese adolescents between 11-18 years (Chapter 6).
Methodological concerns
Participants
Inclusion criteria for participating in the trial were: 11-18 years, overweight or obese, no diabetes mellitus, no syndromes and speaking Dutch. We asked all the eligible adolescents and their parents visiting our outpatient ward to participate. We achieved a participation rate of 65% among adolescents. For several reasons, 67 adolescents chose not to participate. Participants and nonparticipants were similar according to ethnicity, weight and BMI at the first appointment.
Go4it was more effective in adolescents of western ethnicity (2). Thus, Go4it needs further adaptation to the non-western target group. Potential explanations for the differences between western and non-western adolescents are that parents from Turkish or Moroccan descent may underestimate the actual weight status of their children as well as the importance of a healthy weight (3,4). Kocken et al. showed that the Turkish parents more often believed that genetic factors cause overweight than Dutch parents. Although overweight and obesity were 3 times as high in the children of Turkish descent, parental beliefs in Turkish parents about overweight prevention and management did not reflect a sense of urgency about changes in their child’s behaviour (5). Besides this, children of non-western ethnicity are generally less physically active than
General discussion
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