Page 50 - Go4it

Chapter 4
definition of Cole et al. (13). Exclusion criteria were: not Dutch-speaking, obesity as a result of a known syndrome or organic cause (hypothyroidism), mental retardation, physical limitations and diagnosed type 2 diabetes mellitus. The research assistant randomly assigned subjects to the intervention (60%) or control group (40%), using SPSS for random selection. This asymmetric distribution was chosen to recruit a sufficient number of adolescents to start the intervention sessions within a reasonable period. Randomisation was stratified by sex and age group (11-14 years, 15-18 years). The randomisation could not be blinded to the researcher and participants. Recruitment of adolescents occurred from May 2006 to June 2008. The primary outcome was BMI standard deviation score at 18 months follow-up. The medical ethical committee for human studies of the VU University Medical Center Amsterdam approved the protocol. Adolescents, as well as their parents, gave written informed consent.
Intervention
Go4it is a multidisciplinary group treatment for obese adolescents based on the programs of Braet et al., (9), Epstein et al., (7) and the educational materials of the Dutch Obesity Intervention in Teenagers (DOiT) (14). During 7 sessions (duration 90 minutes) with an interval of 2-3 weeks the adolescents received education on healthy dietary, sedentary and physical activity behaviour. The group size was 8-12 adolescents. They received cognitive behavioural therapy in which they learned how to improve their lifestyle and how to maintain energy balance. Go4it was carried out in an outpatient clinic involving a dietician, paediatrician/endocrinologist and psychologist.
In addition, 2 separate parallel sessions for parents were organised corresponding with the first and fourth session of the adolescents. Four booster group sessions were scheduled 6, 14, 26, and 36 weeks after the 3-months intervention period, in order to encourage the adolescents to maintain or further improve their energy balance behaviour and discuss problems and questions. Throughout the program, the adolescents remained in the same peer group. The control group received the regular care in the Netherlands (valid for year 2006- 2009), consisting of referral to a dietician in the home care setting. Adolescents had to make this appointment themselves. We asked the control group whether they had participated in any other treatment program during the study period. Reasons for non-compliance were collected by phone and questionnaire. Details of the intervention, including sample size calculation, have been published elsewhere (10).
Anthropometrics, body composition and metabolic components
After an overnight fast, the subjects attended the outpatient clinic. Height was measured with an accuracy of 0.1 cm with an electronic stadiometer (KERN250D, De Grood Metaaltechniek, Nijmegen, the Netherlands). Body weight was measured (in underwear) within 0.1 kg with a calibrated electronic flat scale
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