Page 69 - Go4it

adolescents. The first session was focussed on increasing awareness of the current lifestyle. Besides dietary and activity journals, step counters (pedometers) were used to increase awareness of the actual behaviour. Next, adolescents were instructed to set goals with respect to improving their physical activity and dietary behaviour. Additionally cognitive- behavioural therapy characteristics (mainly based on problem-solving techniques) were used, for example, learning how to improve their lifestyle, learning to cope with teasing, to improve self-esteem, and how to maintain energy balance. Go4it works with homework tasks, and the education is interactive. Go4it was carried out in an outpatient clinic involving a dietician, psychologist, and a paediatric- endocrinologist. They were also all involved in the development of Go4it.
In addition, 2 separate parallel sessions for parents were organised corresponding to the first and fourth session of the adolescents. These parental sessions consisted of education concerning healthy dietary behaviour and physical activity, the health risks of overweight and how to support their obese children in improving their behaviour. Four booster group sessions for the adolescents 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, discuss problems and answer questions. Throughout the program, the adolescents remained in the same peer group. Special materials were developed for this program: an information book, a workbook, and a dietary and activity diary. In addition, specific worksheets for every session were developed. The control group received the current regular care in the Netherlands, consisting of referral to a dietician in the home care setting. Adolescents had to make an appointment themselves. Reasons for non- compliance were collected by phone and questionnaire. Details of the intervention have been published elsewhere (17).
Study protocol
After an overnight fast, subjects attended the outpatient clinic. Height was measured with an accuracy of 0.1 cm with an electronic stadiometer (KERN 250D, De Grood Metaaltechniek, Nijmegen, the Netherlands). Body weight was measured (in underwear) within 0.1 kg with a calibrated electronic flat scale (SECA 861, Schinkel, Nieuwegein, the Netherlands). Weight and height were used to calculate BMI (kg/m2). For the calculation of BMI standard deviation scores (BMIsds) or z-scores, a reference database of Dutch children was used (www.growthanalyser.org; version 3.5). The researcher conducted all measurements. The adolescents filled in the questionnaires (PedsQLTM4.0, CHQ and the BES) in the morning during a visit to the obesity clinic. The adolescents completed the questionnaires’ independently, and the research assistant entered the data. Baseline measurements took place between November 2006 and August 2008. Measurements were repeated after 6 and 18 months.
Quality of life
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