Page 126 - Go4it

Chapter 8
adolescents of western ethnicity (6,7). Parental recognition and acknowledgement of their child’s weight are critical steps in the success of interventions aimed at preventing overweight (3).
(Non) Compliance – Adolescents and their parents
The effectiveness of an intervention is dependent on the compliance to the program. For Go4it this involves compliance of both the adolescents and their parents.
- Adolescents
In the case of the Go4it intervention, adequate compliance of the adolescents - defined as attended ≥ 5 of the 7 Go4it sessions - was problematic. Mean compliance was 59%. Unfortunately, we have no data on the quality of participation. Main reasons for not attending the Go4it sessions included lack of motivation, previous unsuccessful dieting experiences, travel distance and time issues. Besides this, another important reason for not attending the Go4it sessions were unrealistic weight loss goals. More than once the adolescents wanted to lose more than 20 kg in the period of the 7 Go4it sessions conflicting with healthy weight loss practices. Because of these unrealistic goals they lost interest and motivation when weight loss occurred more slowly. Our level of attrition was 44% (49% in the intervention group and 37% in the control group) at 18 months. This is comparable to previous studies concerning obesity treatment in adolescents (12-56%) (8-10). In future research more attention and effort should be devoted to realistic goal setting, barriers perceived by the adolescents for changing habits, motivations for weight loss and attending this program to improve compliance.
- Their parents
Support from parents was also a reason for non-compliance. This was surprising because mainly the parents initiated the consultation in the VU University Medical Center. The main reasons for non-compliance of parents were lack of success in their child’s weight loss. Some parents disagreed with our lifestyle recommendations or found it old fashioned. A quote of a parent: “the dietician thinks that children have to eat a sandwich, but that is not right, our children eat pizza or a filled roll”. In future interventions more effort should be devoted to active involvement of parents including realistic goal setting with respect to weight loss practices.
Enrolment
The enrolment of adolescents went slowly. To enroll a sufficient number of adolescents to start the intervention sessions within 2 months after inclusion we started with randomly assigning more subjects to the intervention (60%) than the control group (40%). One reason for the slow enrolment was that fewer
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