Page 77 - Go4it

adolescents in our study reported slightly lower mean body esteem scores. Unlike the 2 subscales of the PedsQLTM4.0, we found no significant intervention effect on the CHQ. The PedsQLTM4.0 addresses more serious problems and includes more subscales than the CHQ. The PedsQLTM4.0 may, therefore, be more sensitive to subtle changes.
Strength and limitations
Most outpatient programs in adolescents that combine education on healthy nutrition and physical activity with cognitive behavioural therapy primarily evaluated effects on weight status. Few have evaluated effects on HRQoL. Other strengths of our study are the randomised controlled trial design, the relatively easy to implement outpatient intervention and the relatively long-term follow- up. Another strength is the information from 3 questionnaires, providing the opportunity to examine intervention effects on various aspects of HRQoL. A limitation of our study may be selection bias because participants were obese adolescents referred to a medical obesity outpatient clinic in Amsterdam. Our findings may not be generalisable to the larger group of obese adolescents seen or treated by general health practitioners in smaller cities in the Netherlands. The majority (59%) of our study sample was living in Amsterdam, where almost 50% of the population is of non-western descent, this is in contrast to other regions of the Netherlands where generally 30% of the population is from non- western descent (www.zorgatlas.nl). In our study sample, only 34% were of Dutch origin and the majority of the non-western adolescents were from Turkish descent. However, we found no differences in intervention effects between adolescents from different ethnicities. In addition, our study sample consists of obese adolescents seeking treatment. These adolescents had a higher level of psychopathology than those not seeking treatment (34). Elevated levels of psychopathology are related with impaired HRQoL (35). Another limitation is that our study had insufficient power to detect a significant difference in HrQol since the power calculation was based on the primary outcome, i.e. BMIsds. Therefore, we focused on effect estimates and confidence intervals rather than statistical significance. Also, a limitation of our trial is the low adherence to the Go4it program. Many adolescents were not motivated to attend the Go4it sessions every other week. Even after signing the informed consent form, some adolescents and their families were not willing to participate. We encouraged participant compliance by sending reminders using text messages and phone contact one week before sessions. The main reasons for, not attending the Go4it sessions were the travel distance and the limited time of working parents and schoolchildren. Therefore, we recommend implementation of Go4it in a setting closer to the home environment, such as the child health care environment or school setting. The dropout rates of 20 and 44% at the 6 and 18 months follow- up, respectively, are comparable to previous studies in obese adolescents (12- 47%) (13,36-39). In summary, obese adolescents experienced lower quality of
Quality of Life
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