Page 60 - Go4it

Chapter 4
reduction of ≥0.25 (19). This is of particular importance since severely obese adolescents (BMIsds >2.5) with prediabetes are at very high risk of developing type 2 diabetes mellitus (20). At 18 months, in comparison with baseline, in the control group 2 additional subjects were considered pre-diabetic, while in the intervention group 2 subjects improved from pre-diabetic to ‘normal’.
There are only 6 comparable randomised controlled trials evaluating treatment programs for obese adolescents (21-25). The 2009 Cochrane review on treatment programs for obese children included 64 randomised controlled trials (6). Seventeen of the 64 studies included adolescents, based on a mean age at or above 12 years. Twelve of the 17 studies were lifestyle interventions with a behavioural component as the main focus of the intervention. Seven of the 12 studies were pooled in a meta-analysis, which showed a BMIsds change of -0.14 at 12 months. One of the 7 studies had a follow-up period longer than 12 months and showed that the significant effect of the internet-based behavioural program at 12 months was not sustained up to 18 and 24 months (25).
The present study can be compared to the randomised controlled trial in obese children 8-16 years of age by Savoye et al. (18,23), although the age group is younger and BMIsds lower (+2.5 vs. +3). Savoye et al. compared the effect of an intensive lifestyle intervention program to a control group at 12 and 24 months. The intervention group received a family-based program, including exercise, nutrition, and behaviour modification. Lifestyle sessions were offered twice weekly for the first 6 months, then twice monthly for the second 6 months and no active intervention for the last 12 months. The control group received counselling every 6 months. The intervention by Savoye et al. resulted in a significant long-term (24 months) effect of -0.16 BMIsds, which is identical to the effect of -0.16 for Go4it at 18 months (18). The advantage of Go4it was the lower intensity, and, therefore, lower cost, with 11 sessions for Go4it versus 60 sessions for Savoye et al. (18). Nguyen et al. reported on a randomised controlled trial in obese adolescents of 13-16 years of age, although again with a lower BMIsds compared to the present study (+2 versus +3) (26). Nguyen et al. compared the effect of a lifestyle modification program (Loozit) with or without 2-weekly additional therapeutic contact, including telephone coaching and short- message-service. The Loozit intervention consisted of 7-weekly sessions, including parents, during the initial 2 months and 3-monthly booster sessions up to 24 months (in total 14 sessions). The effect of Loozit, with or without additional therapeutic contact, on BMIsds, was -0.13 at 24 months. This intervention showed a slightly smaller effect size while based on a higher intensity (14 vs. 11 sessions) and longer intervention period (24 vs. <12 months, including booster sessions). Overall the long-term effect size of the Go4it intervention appears to be in line with, or even more favourable than, other interventions for obese adolescents. This study has several strengths and original features including: the randomised controlled trial design, long-term follow-up, a relatively easy to implement intervention, and robust outcome
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