Page 59 - Go4it

Concerning compliance, 42 of the 71 subjects in the intervention group, attended at least five Go4it sessions. The reasons for not attending the Go4it sessions included lack of motivation to change dietary habits, lack of belief of parents in their child’s possible success to lose weight, previous unsuccessful dieting experiences, travel distance and the limited time of working parents and schoolchildren. Seven of the 29 subjects who attended less than 5 sessions never started the Go4it program. Of the parents, 72% attended the first parent session and 55% attended the second parent session. At 6 months, 21 (48%) subjects in the control group had never visited a dietician, 4 subjects visited a dietician once, 6 twice, 7 three or more times, and for 6 subjects it is unknown. The main reported reason for not making an appointment was lack of motivation because of previous unsuccessful dieting experiences with or without a dietician. The participants of the control group had not participated in any other treatment program during the 18 months follow-up.
Discussion
The multidisciplinary group treatment Go4it significantly reduced the standardised Body Mass Index (BMIsds) at 18 months in obese adolescents. The overall effect was a reduction in BMIsds of -0.16. Ethnicity significantly modified this treatment effect, with a significant BMIsds reduction of -0.35 in obese adolescents of western descent versus no significant treatment effect in those of non-western descent. The relatively small treatment effect on body size is promising for a number of reasons. First, the intervention aimed to raise energy balance behaviour consciousness of the participants and change their behaviour in a way that would result in long-term beneficial effects. This matter is of particular importance since most initial, and short-term results in weight management disappear over time (5). The present intervention showed a gradual BMIsds change over time, with a larger effect at 18 months versus 6 months, indicating an increase with time rather than a decrease with time. Second, Go4it was intended as a relatively low intensive low-cost outpatient program that would be relatively easy to implement in the child health care and primary health care setting. The Go4it intervention was still able to generate a long-term effect (-0.16 BMIsds ) that is essentially the same as e.g. the more intensive intervention by Savoye et al. (-0.16 BMIsds) (18). Third, for the obese adolescents from western descent the effect size was larger than expected (12% vs. 10%). Moreover, significant treatment effects in adolescents from western descent on body composition and metabolic components (systolic and diastolic blood pressure and HDL cholesterol level) show that the effect on BMIsds is not an accidental finding, but a consistent improvement in outcome parameters relevant for future health of obese adolescents. This is in line with the observations of Ford et al. that improvements in body composition and metabolic components in obese adolescents can be expected with BMIsds
Effectiveness of Go4it
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