Abstract
|
This
PhD thesis on adolescent obesity focuses on the role of medical professionals
and the interventions that they provide for obesity. We undertook a
feasibility and acceptability study to examine HELPclinic, a novel brief
weight management intervention delivered by health professionals in a
specialist obesity service. The intervention was shown to be feasible and
acceptable. Four overlying themes were captured in participant interviews:
HELPclinic relationships enabled discussions of a difficult topic; lack of
novel medical approaches polarised participants' acceptance of HELPclinic;
School vs HELPclinic - it's hard to do both; and ongoing support is crucial.
Qualitative interviews with young people and their families taking
anti-obesity drugs (AOD) resulted in three theoretic models to explain their
experiences of AOD, relating to commencement, relationship between dosing and
side-effects, and drug cessation. Use of anti-obesity drugs is challenging
for many adolescents. Multiple factors were identified that could be targeted
to improve concordance and maximise efficacy. A survey of GP AOD prescribing
found low prescribing prevalence. Metformin was largely initiated by
specialists for co-morbidities associated with obesity, and orlistat was
largely initiated by GPs and outside NICE guidance. GPs reported lower
confidence in AOD prescribing and wanted more support. 3 A systematic review
of the psychological/social outcomes of bariatric surgery in adolescents
found a small evidence base with few high quality studies and outcomes rare
beyond 2 years post-surgery. Quality of life and depressive symptoms improved
after surgery. We present the first UK report of the outcomes of a bariatric
surgery clinical pathway. Of fifty patients assessed, 12% were not eligible for
surgery, 14% actively opted out,16% were lost to follow-up and 58% underwent
surgery. Mean age at surgery was 18.3 years and mean BMI 53.1 kg/m2. BMI
outcomes and complications post-surgery were similar to those published in
research cohorts. Follow-up was inconsistent and challenging.
|