Page 76 - Go4it

Chapter 5
Discussion
This study describes the effectiveness of an obesity treatment program on Health Related Quality of Life (HRQoL) aspects in obese adolescents. We found small but beneficial intervention changes on all subscales of the PedsQLTM4.0 and BES questionnaires. Two subscales of the PedsQLTM4.0, physical health and school functioning, improved significantly in favour of the intervention group. Thus, our low intensive outpatient multidisciplinary group treatment had small but beneficial effects on quality of life of obese adolescents.
Implications
As we mentioned, earlier few studies examined HRQoL among obese adolescents enrolled in outpatient programs and the effects of these programs on HRQoL (14-16). Most programs are targeting obese adolescents mainly focus on weight change (9,13). In our study we found a beneficial decrease in BMIsds at the 6 months follow-up (between group difference: -0.10 (-0.23; 0.04) and a significant decrease at the 18 months follow-up (between group difference: -0.16; 95% CI: -0.30; -0.02) (31). We found a significant but low correlation
(R = -.359) between change in BMIsds and change in physical health (PedsQLTM4.0) at the 6 months follow-up, but not at 18 months follow-up. We also found a significant effect on experienced physical health and school functioning at the 18 months follow-up. A possible reason for the improved school functioning may be the cognitive behavioural therapy elements of Go4it focussing on dealing with difficult situations and how to react to teasing. This may have provided them with tools for less distraction and better concentration at school. The improved physical health may also have resulted in fewer days of sick leave and thereby had a positive influence on school attendance. As the CHQ does not tap into school issues, we found no differences there.
Other studies
Our study is in line with previous studies showing that all mean physical and psychosocial summary scores at baseline were lower in obese adolescents in comparison with healthy peers. Therefore, they experience a lower quality of life (23,26), but similar to those reported in other obese samples (23,32). In a cross-sectional study, de Beer et al. compared HRQoL in obese Dutch adolescents to age and sex matched normal weight controls (n=62) (32). CHQ and PedsQLTM4.0 scores of obese adolescents in their sample were less than their normal weight controls and resembled the mean scores in our sample. Also, similar scores on both questionnaires’ were found among obese children aged 8-18 years old and among Dutch children suffering from a chronic health condition to those in our sample (26,33). For the BES, Dutch reference data on obese adolescents are currently not available. In a study by Mendelson et al. (28), in which body esteem among healthy Canadian adolescents was measured, adolescents reported mean scores ranging from 1.8 to 3.0. As expected, obese
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