MANAGING ADOLESCENT OBESITY:

THE IMPACT OF AN INTERVENTION INCLUDING PEERS IN THE

WEIGHT-RELATED QUALITY OF LIFE
Graa Cunha Coutinho(1);Helena Fonseca(2);Antnio Labisa Palmeira(3); Antnio Quaresma(4)
(1)Centro Hospitalar Lisboa Norte-Hospital Sta Maria (2)Centro Hospitalar Lisboa Norte-Hospital de Sta Maria
(3)Universidade Lusfona de Humanidades e Tecnologias (4)Universidade Lusfona de Humanidades e Tecnologias

CONTEXT

OBJECTIVES

Obesity is a multifactorial, chronic disease, which compromises the health and the healthy development, being crucial to develop effective interventions. 1,2 The adolescent obesity has been linked to
the persistence into adulthood and to the adverse consequences for health in adolescence. 1,2

To evaluate the impact of an Adolescent Obesity Management Program (TOP) on the weight-related
quality of life (WRQOL) and to assess the relationship between WRQOL and anthropometric measures, gender and the presence/absence of a peer in the intervention.

METHODS
Tab.1 The most prevalent physical and psycosocial co-morbidities.. 3,4,5
Psychosocial co-morbidities are considered particularly worrying for its high prevalence, and because
of the fact that they occur in a developmental phase as vulnerable as adolescence. 3,4,5
The health-related quality of life (HRQOL) includes physical, mental and social well-being.6 The literature has shown that HRQOL of obese participants is lower in all domains (physical, social, emotional
and academic) compared with normal weight peers and similar to peers with cancer.7
The HRQOL allows comparisons between different pathologies. However, as different health conditions have different impacts on various dimensions of quality of life (QoL), the weight-related quality of life (WRQOL) was developed and validated as a measurement tool to assess QoL specifically
among obese adolescents. 8
The Cochrane review points to a greater effectiveness of lifestyle behavioral interventions in obese
children, when compared with standard interventions, identifying the interaction between the family and the clinician as a feature of intervention associated with a high rate of success.9

DISCUSSION

As in other studies, it was observed that an intervention based on behavioral change, healthy diet
and regular physical activity is effective in reducing the BMI Z-score of obese adolescents. In the
TOP Program there was a statistically significant decrease of 0,18 of the BMI Z-score in the total
sample.1
The benefits of this intervention in obese adolescents are not only in decreasing the BMI Z-score,
but also in improving the adolescent quality of life and well-being. These results raise the question
of what might be the most effective intervention in adolescent obesity. One that only decreases
the BMI Z-score or one in which there is also an improvement in the quality of life and adolescent
well-being?
Contrary to the expectations, there were no significant differences between the group with a peer
and the control group. Both groups statistically showed similar behavior, in opposition to that described in the literature.10,11 One explanation, could be that the two groups participated together
in the sessions, what provided a space for young people to meet and develop friendships that might
have diluted the effect of bringing a peer for the intervention. This result, however, can still raise

References

The study was an experimental, non-randomized, non-blinded controlled trial, including two groups
of obese adolescents: 1) Experimental group (n=29), intervention during six months with the participation of a peer of their choice; and 2) Comparison group (n=27), same intervention but without the
presence of a peer.
The intervention comprised a medical assessment, dietary and physical activity (PA) counseling, every three months, weekly educational and PA sessions, and holiday camps.
Eligibility criteria. Inclusion criteria: Obese adolescents with a BMI greater than or equal to the 95th
percentile, aged between 14 and 17, with caucasian origin, agreeing with commitment. Exclusion criteria: a) cognitive impairment; b) pregnancy; c) serious illness; d) other factors with contraindication
for regular PA.
Selection of the sample: a) Centro Hospitalar Lisboa Norte- Hospital Santa Maria at the Pediatric
Obesity Clinic, Department of Pediatrics ; b) Schools: direct registration in TOP Site.
The WRQOL was measured by a self-reported questionnaire (Impact of Weight on Quality Of Life Kids
IWQOL-Kids), which is comprised of a global index (total-score) and four sub-domains: body-esteem
(BE), physical comfort (PC), social life (SL) and family relations (FR). Anthropometric measurements
(waist circumference (WC), height and weight) were assessed using standard anthropometric procedures by a healthcare professional.

the question of whether group interventions, with only obese adolescents, will have a similar effect
to those where the adolescents come with a peer.
Limitations:
Non-randomized study, small sample, sessions together for the two groups, reduced intervention
time.
To better understand the impact of the TOP programme on the quality of life of obese adolescents
we plan to analyze the data at 12 months of the intervention.

CONCLUSION

The results point to the importance of combining anthropometric measurements with quality of
life assessment, in order to better evaluate the effectiveness of an intervention in the field of adolescent obesity.

[1] Oude Luttikhuis H, et al. Intervention for Treating Obesity in Children. The Cochrane Database of Systematic Reviews 2009; Issue1:1-19. [2] Fonseca H, et al. How Much Does Overweight Impact the Adolescent Development Process?. Child Care Health Development 2010; 1,37: 135-142. [3] Jelalian E, Steele RG. Handbook of Childhood and
Adolescent Obesity. New York: Springer, 2008; ISBN: 978-0-387-76922-6. [4] Matos MG, et al. Indicadores de Sade dos Adolescentes Portugueses, Relatrio Preliminar HBSC 2006. Lisboa: Aventura Social e Sade, CMDT/IHMT/UNL 2006. [5] Fonseca H, Matos MG. Perception of Overweight and Obesity among Portuguese Adolescent: an Overview of Associated Factors. European Journal of Public Health 2005; 3, 15: 323-328. [6] World Health Organization. Quality of life Assessment: an Annotated Bibliography. Geneva: WHO 1994. [7] Schwimmer JB, Burwinkle TM, Varni JW. Health-Related Quality of Life of Severely Obese Children and Adolescent. Journal of the American Medical
Association 2003; 289:1813-1819. [8] Kolotkin, RL, et al. Assessing Weight-related Quality of Life in Adolescent. Obesity 2006; 14:448-457. [9] Waters E, et al. Interventions for preventing obesity in children. The Cochrane Database of Systematic Reviews 2011. [10] Riazi A, et al. Health-related Quality of life in a Clinical Sample of Obese Children
and adolescent. Health and Quality of life Outcomes 2010; 8:134-140. [11] Ali MM, Amialchuk A, Heiland FW. Weight-related Behavior among Adolescent: The Role of Peer Effects. Plos One 2011; 6, issue 6:1-8.