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Introduction
Overweight and obesity in childhood are associated with negative psychosocial health, orthopaedic complications, asthma, and a strong increase in metabolic abnormalities (1,2). Elevated insulin levels are the first metabolic abnormalities observed in obese children. Insulin resistance can lead to glucose intolerance and type 2 diabetes mellitus. Child obesity also increases the risk for metabolic syndrome, which is a group of cardiovascular risk factors including increased waist circumference, hypertension, dyslipidaemia and impaired fasting glucose levels (3). Therefore, the prominent public health goal is primary prevention of child obesity. In addition, effective treatments are required for existing child obesity since 80% of obese children become obese adults (4,5). Notwithstanding the high prevalence of child obesity, little evidence regarding effective child obesity treatments has been published (6). Most studies included 7-12-year-old children and only a few studies evaluated treatment of adolescent obesity (6-8). Cognitive behavioural modification techniques have shown promising results regarding lifestyle changes in child obesity (9), and were used to develop a new multidisciplinary group treatment for obese adolescents (Go4it) (10). This study describes the long-term effect of the Go4it group treatment for obese adolescents on anthropometrics, body composition, and metabolic components in a randomised controlled trial.
Materials and Methods
Subjects and design
The present study is a randomised controlled trial evaluating the effect of the Go4it multidisciplinary group treatment for obese adolescents, at 6 and 18 months follow-up.
Adolescents were referred by their general practitioner or school doctor to the outpatient paediatric obesity clinic of the VU University Medical Center Amsterdam. At their first visit, the paediatric-endocrinologist interviewed all adolescents concerning their medical history, weight development and ethnicity (11). Subjects were categorized as of western ethnicity when both parents were Dutch or with at least one parent born outside the Netherlands, but inside Europe (including former Yugoslavia and Soviet Union), North America, Oceania, Indonesia or Japan. Subject with at least one parent born in Turkey, Africa, Latin America or Asia were classified as non-western. The physical examination included height, weight, waist circumference, blood pressure and pubertal Tanner stage (12).
The subjects and their parents received an information brochure about the study. Within 2 weeks, the research assistant checked their willingness to participate. Subjects were eligible when they met the following inclusion criteria: 1) age between 11-18 years; 2) overweight or obesity according to the
Effectiveness of Go4it
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