Institute of Epidemiology & Health Care


Novel approaches in adolescent obesity management

Author W.J. White
Author R.M. Viner
Author D. Christie
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.