Page 14 - Go4it
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Chapter 1
 The development of Go4it
Along with a paediatrician, a psychologist, a nurse and a dietician we reviewed the existing programs and selected the most promising elements for Go4it. There were several treatment programs in the Netherlands targeting obese adolescents, but these were not described, and their effectiveness was unknown. We decided to base our program Go4it on the programs of Braet et al. (25), Epstein et al. (26) and the materials of the Dutch Obesity Intervention in Teenagers (DOiT) (25,27). The intervention of Braet et al. is a 10-months multicomponent inpatient treatment program. Focussing on attaining a healthy lifestyle by increasing physical activity and a healthy diet within a cognitive– behavioural framework, for obese adolescents in Belgium. Epstein et al. performed four group interventions in overweight and obese children, aged 6-12 years and their parents (26). These interventions existed of weekly treatment meetings for 8-12 weeks, and monthly meetings continuing for 6-12 months from the beginning of the program. Elements of these group interventions were the Traffic Light Diet to help reduce caloric intake and improve nutrient density, food diaries and behaviour modification techniques.
The 'DOiT' intervention is a school-based overweight prevention program for the pre-vocational educational level and developed and evaluated according to the Intervention Mapping protocol (27). DOiT was effective in improving hip- and waist circumference and sum of skinfolds in adolescents (mean age 12.7 years) (28,29).
We intended to develop an intervention that would be relatively easy to implement in the child health care and primary health care setting. Easy to implement implies at least low implementation costs, ready to use materials and no training sessions for dieticians. It also affected choices in the design of the intervention, which had to be evidence or at least theory-based and effective but also practical and affordable. These requirements have resulted in an outpatient program of limited duration (i.e. 3 months). Go4it included no exercise program, but participants were encouraged to seek and participate in existing training programs in their neighbourhood. A pilot study (period 2004-2005) showed promising effects of the Go4it program (30). During this pilot, we noticed the lack of knowledge of healthy food choices among adolescents and their parents. For this reason, we adjusted the Go4it treatment program paying more attention to healthy eating and including a second parent session.
Multidisciplinary group treatment Go4it
Go4it is a low intensity, multidisciplinary group treatment. In 7 sessions, with an interval of 2-3 weeks, the adolescents were educated on a healthy diet, physical activity, sedentary behaviour, energy balance and how to improve their lifestyle regarding a healthy weight and maintenance of energy balance (see Figure 3 for additional information). The first sessions focused on increasing awareness of their current lifestyle and the risk of overweight. Besides dietary and activity
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