Summary Background To date, few studies have investigated perceived barriers among those who participate in and drop out of family‐based behavioural treatment (FBT) for paediatric obesity. Examining experienced barriers during treatment, and their role in participation and completion of treatment has important implications for clinical practice. Objectives To compare perceived barriers to participating in a family‐based behavioural social facilitation treatment (FBSFT) for obesity among families who completed and did not complete treatment. Methods Data were analysed from 90 families of children and adolescents (mean ( M) age = 12.8 years, standard deviation ( SD) = 3.05) with severe obesity enrolled in a 17‐session FBSFT program. After completing 12 sessions or at the time of dropout, parents and therapists completed the Barriers to Treatment Participation Scale (BTPS), a 5‐point Likert scale (1 = never a problem, 5 = very often a problem) which includes four subscales: 1. Stressors and obstacles that compete with treatment , 2. Treatment demands and issues , 3. Perceived relevance of treatment , 4. Relationship with the therapist . Results Families who did not complete treatment scored significantly higher on the BTPS subscales stressors and obstacles that compete with treatment ( M = 2.03, SD = 0.53 vs. M = 1.70, SD = 0.42), p = 0.010 and perceived relevance of treatment ( M = 2.27, SD = 0.48 vs. M = 1.80, SD = 0.50), p < 0.001 than families who completed treatment. No other significant differences between groups were observed. Conclusion Families are more likely to drop out of FBSFT when experiencing a high burden from life stressors or when treatment is not meeting the expectations and perceived needs of the family.
Summary The aim of this systematic review is to answer the question: Is substantial, stable, and long‐term weight loss a viable goal for adults with obesity? To answer this question, we conducted a broad systematic search of non‐surgical and non‐pharmacological obesity treatment studies with the following strict criteria: (a) minimum 3‐year follow‐up, (b) 5% body mass lost, (c) no continued interventions in the follow‐up‐period, (d) prospective design, and (e) less than 30% attrition from the start of the follow‐up period. While the search revealed a very large number of published articles, only eight studies met the inclusion criteria. Several of the nonincluded studies report a majority of participants achieving satisfactory weight loss and little regain, especially among studies with continued interventions during the follow‐up period. In contrast, the eight high‐quality studies included in this study demonstrate a trend of weight regain towards pretreatment baseline. This review concludes that the majority of high‐quality follow‐up treatment studies of individuals with obesity are not successful in maintaining weight loss over time. The results suggest that excess weight can be lost but is likely regained over time, for the majority of participants.
The purpose of the FABO-study is to evaluate the effect of family-based behavioral social facilitation treatment (FBSFT), designed to target children's family and social support networks to enhance weight loss outcomes, compared to the standard treatment (treatment as usual, TAU) given to children and adolescents with obesity in a routine clinical practice. Randomized controlled trial (RCT), in which families (n = 120) are recruited from the children and adolescents (ages 6–18 years) referred to the Obesity Outpatient Clinic (OOC), Haukeland University Hospital, Norway. Criteria for admission to the OOC are BMI above the International Obesity Task Force (IOTF) cut-off ≥ 35, or IOTF ≥ 30 with obesity related co-morbidity. Families are randomized to receive FBSFT immediately or following one year of TAU. All participants receive a multidisciplinary assessment. For TAU this assessment results in a plan and a contract for chancing specific lifestyle behaviors. Thereafter each family participates in monthly counselling sessions with their primary health care nurse to work on implementing these goals, including measuring their weight change, and also meet every third month for sessions at the OOC. In FBSFT, following assessment, families participate in 17 weekly sessions at the OOC, in which each family works on changing lifestyle behaviors using a structured cognitive-behavioral, socio-ecological approach targeting both parents and children with strategies for behavioral maintenance and sustainable weight change. Outcome variables include body mass index (BMI; kg/m2), BMI standard deviation score (SDS) and percentage above the IOTF definition of overweight, waist-circumference, body composition (bioelectric impedance (BIA) and dual-X-ray-absorptiometry (DXA)), blood tests, blood pressure, activity/inactivity and sleep pattern (measured by accelerometer), as well as questionnaires measuring depression, general psychological symptomatology, self-esteem, disturbed eating and eating disorder symptoms. Finally, barriers to treatment and parenting styles are measured via questionnaires. This is the first systematic application of FBSFT in the treatment of obesity among youth in Norway. The study gives an opportunity to evaluate the effect of FBSFT implemented in routine clinical practice across a range of youth with severe obesity. ClinicalTrails.gov NCT02687516 . Registered 16th of February, 2016
Introduction According to the most widely influential treatment guidelines from the National Institute for Health and Clinical Excellence and the American Psychiatric Association, existing evidence for adult AN treatment is weak, and more treatment studies are needed. Objectives/aims The primary objective of this project is to gain knowledge about the effectiveness of CBT-E in the treatment of Anorexia Nervosa (AN). Secondary objectives are to prospectively examine baseline predictors of treatment outcome/drop-out and to examine variables related to treatment process and patient engagement as predictors of outcome/drop-out. Thirdly, in a multidisciplinary approach, to focus on selected pathophysiological mechanisms including disturbed neuropsychological functioning, changes in the gut microbiota, immunological and genetic measures in patients with severe AN in different stages of the disease, and further to investigate to what extent they are related to treatment outcome. Methods The sample consists of patients aged ≥ 16 years with AN admitted to outpatient treatment (CBT-E) at Section for Eating Disorders, Haukeland University Hospital, Bergen, Norway. Outcome measures include BMI, self-reported eating disorder symptoms (EDE-Q), depression (BDI), anxiety (BAI) general psychiatric symptomatology (SCL-90-R, M.I.N.I 6.0), health related quality of life (CIA, RAND-36), physical activity (accelerometers) and neuropsychological functioning. The main measurement points are at the start of treatment, 3 months, end of treatment and one year follow-up. Baseline predictors of treatment outcome and drop-out will be examined as well as the association between early adherence, behavioral change, therapeutic alliance and treatment outcome. In addition biochemical, genetic and bacteriological assessments will be conducted. Disclosure of interest The authors have not supplied their declaration of competing interest.
Summary To compare the effectiveness of family‐based behavioural social facilitation treatment (FBSFT) versus treatment as usual (TAU) in children with severe obesity. Parallel‐design, nonblinded, randomized controlled trial conducted at a Norwegian obesity outpatient clinic. Children aged 6–18 years referred to the clinic between 2014 and 2018 were invited to participate. Participants were randomly allocated using sequentially numbered, opaqued, sealed envelopes. FBSFT ( n = 59) entailed 17 sessions of structured cognitive behavioural treatment, TAU ( n = 55) entailed standard lifestyle counselling sessions every third month for 1 year. Primary outcomes included changes in body mass index standard deviation score (BMI SDS) and percentage above the International Obesity Task Force cut‐off for overweight (%IOTF‐25). Secondary outcomes included changes in sleep, physical activity, and eating behaviour. From pre‐ to posttreatment there was a statistically significant difference in change in both BMI SDS (0.19 units, 95% confidence interval [CI]: 0.10–0.28, p < .001) and %IOTF‐25 (5.48%, 95%CI: 2.74–8.22, p < .001) between FBSFT and TAU groups. FBSFT participants achieved significant reductions in mean BMI SDS (0.16 units, (95%CI: −0.22 to −0.10, p < .001) and %IOTF‐25 (6.53%, 95% CI: −8.45 to −4.60, p < .001), whereas in TAU nonsignificant changes were observed in BMI SDS (0.03 units, 95% CI: −0.03 to 0.09, p = .30) and %IOTF‐25 (−1.04%, 95% CI: −2.99 to −0.90, p = .29). More FBSFT participants (31.5%) had clinically meaningful BMI SDS reductions of ≥0.25 from pre‐ to posttreatment than in TAU (13.0%, p = .021). Regarding secondary outcomes, only changes in sleep timing differed significantly between groups. FBSFT improved weight‐related outcomes compared to TAU.
To examine the relationship between sleep duration and body mass index (BMI) in Norwegian children (aged 10-12).Children and parents of a population of primary school children (N=9 430) were invited to complete a questionnaire containing questions about usual bedtimes, wake-up times, self and parent evaluations of pubertal maturation, parental education and economic status, and parent-reported height and weight of the child. Sixty per cent of parents and children participated. BMI was available for 4 158 children, 44% of the original sample.A U-shaped relationship was found between sleep duration and age- and gender-adjusted BMI. Shorter and longer sleep durations were significantly related to high BMI. The percentage of obesity and overweight was higher in the shortest sleep duration group compared with intermediate sleep durations. Crude logistic regression analyses showed a significant association between early pubertal maturation and both obesity and overweight. Socio-economic status was significantly related to overweight. Short sleep duration showed a significant association with obesity but not with overweight. In an adjusted logistic regression model, short sleep duration was still significantly associated with obesity when controlling for physical maturation and socio-economic status.High BMI was associated with short and long self and parent-reported duration of sleep. The percentage of obesity/overweight was higher in the shortest sleep duration group than for intermediate sleep durations. Short sleep duration was significantly associated with obesity but not with overweight. Adjusting for physical maturation and socio-economic status, short sleep duration still showed a significant association with obesity.
Summary Background Ample evidence attests to the relationship between short sleep duration, sleep problems and childhood obesity. However, few studies have examined the association between sleep timing and obesity in children. Objectives To investigate how sleep duration, problems and timing relate to obesity and obesogenic behaviours in children. Methods Eighty‐five children (58.8% girls) with severe obesity and mean (SD) age of 12.1 (2.9) years, were matched by age and sex with peers with normal weight (n = 85,12.0 [2.8] years). Sleep and moderate‐to‐vigorous physical activity (MVPA) were measured via accelerometer for seven consecutive days. Children self‐reported emotional eating on the Dutch eating behavior questionnaire. Parents reported children's screen time and sleep problems. Results Children with severe obesity had significantly later mean mid‐sleep time, overall (36 minutes later, P < .001), on school nights (36 minutes later, P < .001) and weekend nights (39 minutes later, P = .002) compared to children with normal weight. Children with obesity had more sleep problems ( P = .030), but no differences emerged in sleep duration or social jetlag. After adjusting for demographic factors, mid‐sleep time was positively related to screen time ( P = .030). Mid‐sleep time and sleep duration were inversely related to time in MVPA ( P s ≤ .041). There were no other significant associations between the sleep variables and the obesogenic behaviours. Conclusions Later sleep timing was related to obesogenic behaviours in children and may represent an obesity risk factor.
ABSTRACT The Eating Disorders In weight-related Therapy (EDIT) Collaboration brings together data from randomised controlled trials of behavioural weight management interventions to identify individual participant risk factors and intervention strategies that contribute to eating disorder risk. We present a protocol for a systematic review and individual participant data (IPD) meta-analysis which aims to identify participants at risk of developing eating disorders, or related symptoms, during or after weight management interventions conducted in adolescents or adults with overweight or obesity. We systematically searched four databases up to March 2022 and clinical trials registries to May 2022 to identify randomised controlled trials of weight management interventions conducted in adolescents or adults with overweight or obesity that measured eating disorder risk at pre- and post-intervention or follow-up. Authors from eligible trials have been invited to share their deidentified IPD. Two IPD meta-analyses will be conducted. The first IPD meta-analysis aims to examine participant level factors associated with a change in eating disorder scores during and following a weight management intervention. To do this we will examine baseline variables that predict change in eating disorder risk within intervention arms. The second IPD meta-analysis aims to assess whether there are participant level factors that predict whether participation in an intervention is more or less likely than no intervention to lead to a change in eating disorder risk. To do this, we will examine if there are differences in predictors of eating disorder risk between intervention and no-treatment control arms. The primary outcome will be a standardised mean difference in global eating disorder score from baseline to immediately post-intervention and at 6- and 12-months follow-up. Identifying participant level risk factors predicting eating disorder risk will inform screening and monitoring protocols to allow early identification and intervention for those at risk.
We analysed the distribution of the body mass index standard deviation scores (BMI-SDS) in children and adolescents seeking treatment for severe obesity, according to the International Obesity Task Force (IOTF), World Health Organization (WHO) and the national Norwegian Bergen Growth Study (BGS) BMI reference charts and the percentage above the International Obesity Task Force 25 cut-off (IOTF-25).This was a cross-sectional study of 396 children aged four to 17 years, who attended a tertiary care obesity centre in Norway from 2009 to 2015. Their BMI was converted to SDS using the three growth references and expressed as the percentage above IOTF-25. The percentage of body fat was assessed by bioelectrical impedance analysis.Regardless of which BMI reference chart was used, the BMI-SDS was significantly different between the age groups, with a wider range of higher values up to 10 years of age and a more narrow range of lower values thereafter. The distributions of the percentage above IOTF-25 and percentage of body fat were more consistent across age groups.Our findings suggest that it may be more appropriate to use the percentage above a particular BMI cut-off, such as the percentage above IOTF-25, than the IOTF, WHO and BGS BMI-SDS in paediatric patients with severe obesity.
Enhanced cognitive behavioral therapy (CBT-E) is a promising treatment option for outpatients with anorexia nervosa (AN). We aimed to determine the effectiveness of CBT-E as a standard treatment for adult outpatients with AN from the specialized eating-disorder unit of a public hospital with responsibilities to their catchment area.This study had an open, longitudinal design. Thirty three (of planned 100) outpatients aged > 16 years suffering from AN were included to receive 40 sessions of CBT-E. Eating-disorder psychopathology and body mass index (BMI) were assessed before and after treatment, while comorbid psychiatric symptoms and trauma experiences were evaluated at the baseline, and therapeutic alliance was assessed after 4 weeks of treatment.A high proportion (69%) of patients dropped out of the treatment. Patient recovery was considered when they reached BMI > 18.5 and Eating Disorder Examination Questionnaire (EDE-Q) score < 2.5, and 27% of all patients recovered.Patients who completed the treatment had mostly satisfactory outcomes. Considering the high dropout rate, it is necessary to improve the strategies for engaging patients in therapy. Several aspects of CBT-E as a standard treatment are discussed regarding the high dropout rate. Trial registration ClinicalTrials.gov. Identifier: NCT02745067. Registered: April 20, 2016. https://clinicaltrials.gov/ct2/showNCT02745067.Anorexia nervosa (AN) is difficult to treat, and no specific treatment approach has been demonstrated to be superior for adult outpatients. However, outcome data indicate that enhanced cognitive behavioral therapy (CBT-E) is a viable and promising treatment option for adults with AN, and its efficacy has been indicated in cohort studies and randomized controlled trials. The present study aimed to determine the effectiveness of CBT-E as a standard treatment for adult outpatients with AN from the specialized eating-disorder unit of a public hospital with responsibilities to their catchment area. Outpatient CBT-E was administered to 33 patients in a course of 40 sessions. Although 27% of the included patients had satisfactory treatment outcomes (healthy weights and reduced eating-disorder symptoms), more than two-thirds of all patients terminated treatment early. Several aspects of CBT-E as a standard treatment are discussed regarding this high dropout rate.
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