Page 67 - Go4it

Background
Obesity is one of the most common chronic disorders in children and adolescents, and its prevalence continues to increase rapidly. Of Dutch children aged 2-21 years old, 13-15% were overweight, and 2% were classified as obese in 2009 (1). Obesity is also one of the most stigmatizing and least socially accepted conditions in childhood (2). The most widespread consequences of adolescent obesity are psychosocial (3). Early adolescence may be a particularly vulnerable period for reductions in Health Related Quality of Life (HRQoL) in overweight/obese youth since heightened awareness of social exclusion, and participation limitations occur (4,5). As in a not overweight population, there are adolescents with a higher or lower quality of life (QoL).
The World Health Organization defines QoL as ‘individuals perceptions of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns’. It incorporates the person’s physical health, psychological state, level of independence, social relationships, and their relationship to salient features of their environment in a complex way (6).
Negative self-image and a reduced self-esteem in overweight children, which can begin as early as the age of five, can ultimately result in sadness, loneliness, nervousness and high-risk behaviour’s as children develop into obese adolescents (7). Obesity is also predictive of being the victim of bullying in adolescents (8). These widespread psychosocial consequences of childhood obesity in adolescents impair their HRQoL (2). Schwimmer et al. showed that obese children and adolescents (5-18 years old), who were newly referred to the clinic, reported significantly lower QoL in all domains compared with normal weight children and adolescents (2).
Notwithstanding the high prevalence of child obesity, little evidence exists regarding effective child obesity treatments (9). Most studies included children age 7-12 years old, and only a few studies have evaluated treatment of adolescent obesity (9-12). Often, outpatient treatment for the obese is focused on nutrition education and physical activity (9,13). Wille et al. (14) and Vignolo et al. (15) showed improvement on the effect of their inpatient and outpatient treatment programs not only on diet and physical activity, but also on the HRQoL of children aged 6-16 and 6-12 years, respectively. Breat et al. showed promising results of cognitive behavioural modification techniques regarding lifestyle changes in obese children (16). Based on these positive experiences, and the fact that there is no effective treatment available for this age group, we developed a multidisciplinary group treatment for obese Dutch adolescents (Go4it) (17). Understanding HRQoL can contribute to a better awareness of the patients' needs, as well as improve care and treatment. This study describes the long-term effects of the Go4it group treatment for obese adolescents on HRQoL aspects in a randomised controlled trial. We hypothesised that at baseline our study sample would have lower HRQoL compared to a normal weight reference
Quality of life
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