Medically-supervised pediatric obesity treatment linked to improved psychosocial health, but access to care is limited

SILVER SPRING, Md. – Medically guided treatment of pediatric obesity is associated with improved psychosocial health and reduced symptoms of depression, anxiety and eating disorders. However, access to supervised pediatric weight management is limited with fewer than 50 facilities in the United States, according to a new article published online in Obesity, the flagship journal of The Obesity Society.

“Currently, 21% of adolescents in the United States are obese. All clinicians, from generalists to specialist services, should be aware of the psychosocial comorbidities associated with obesity, and the importance of structured and supervised support to address them,” said Hiba Jebeile, postdoctoral research associate, The University of Sydney Children’s Hospital Westmead Clinical School and Research Dietitian, Institute of Endocrinology and Diabetes, The Children’s Hospital of Westmead in Australia Jebeile is the lead and corresponding author of the study.

Researchers explain that adolescent obesity is associated with poor psychosocial health compared to healthy weight peers, including reduced quality of life, poor self-esteem and body image, and a greater risk of developing depression and eating disorders. In addition, supervised behavioral weight management approaches are associated with improved weight-related outcomes and cardiometabolic health, including reduced cholesterol, insulin resistance and obstructive sleep apnea.

In the new review, researchers found that medically supervised behavioral weight management is also associated with improved psychosocial health, such as improved quality of life, self-esteem and body image; in addition to reduced symptoms of depression, anxiety and eating disorders. Specific intervention characteristics may contribute to improved psychological well-being, such as incorporating components of physical activity, frequent contact with research personnel, and longer intervention periods, but further research is needed to investigate this.

Treatment modalities for obesity under medical supervision may include lifestyle interventions, anti-obesity drugs and bariatric surgery, or a combination of therapies, all of which can be given in a clinical setting. Lifestyle interventions include dietary changes, increased physical activity, improvement in sleep hygiene, and behavior modification strategies; and appear to be safe for participants with regard to psychosocial health. Trials of bariatric surgery show some early improvements with a need for ongoing psychological support after surgery. Data on the effect of anti-obesity pharmacotherapy on psychosocial health are lacking in the current literature.

Researchers also emphasized in their review that health care providers rarely provide a formal diagnosis of obesity or a comprehensive list of tools and resources for sustainable, sustainable treatment. This, in turn, makes adolescents more likely to use self-directed approaches to weight management. Weight loss attempts were varied, with 84% reporting exercise as the most common approach, followed by drinking extra water by 52% and reducing dietary intake by 49%, according to the review.

When assessing specific dietary behaviors used by adolescents, one study found that 95.4% reported healthy weight-control behaviors (increased physical activity, fruit and vegetable consumption, and reduced fat), 76% were involved in unhealthy practices (fasting, skipping meals , smoking cigarettes to suppress appetite) ) and 17.9% reported using extreme practices such as taking diet pills, laxatives or self-induced vomiting. Self-directed dietary approaches have been associated with adverse outcomes, including binge eating, the development of depression, and further weight gain. In addition, the study authors noted that adolescents may be influenced by social media, peers and parents in how they perceive their weight.

“If adolescents don’t have good access to evidence-based care, those seeking weight loss often turn to unhealthy and potentially harmful strategies, such as disordered eating or fad diets, in an effort to manage their weight,” says Michelle Cardel , an obese and nutrition scientist, adjunct professor in the Department of Health Outcomes and Biomedical Informatics, University of Florida, College of Medicine, Gainesville, Florida, and director of Global Clinical Research and Nutrition, WW International. “However, evidence-based weight management interventions result in clinically significant improvements in weight loss and cardiometabolic health parameters, while simultaneously improving key psychosocial factors such as depression, anxiety, body image and eating disorder risks.” Ted Kyle of ConscienHealth added: “The research tells us that access to care for youth with obesity is important for their psychological health. However, for people with severe obesity, such access is poor because there are so few programs with sufficient resources to treat these patients.” Cardel and Kyle are both co-authors of the paper.

The study authors noted that early data on psychosocial health and obesity treatment offer promising results; however, larger randomized controlled trials and longer term data are needed. Future research should include both physiological and psychosocial outcomes to assess the impact of interventions on the holistic health of obese adolescents.

Senior author of the study Ania Jastreboff, MD, PhD, is an associate professor of medicine and pediatrics (endocrinology), Yale University School of Medicine, New Haven, Conn.

The paper, titled “Addressing Psychosocial Health in the Treatment and Care of Adolescents with Obesity,” will be published in the September 2021 print issue.

Jebeile is supported by the Sydney Medical School Foundation (University of Sydney); Cardel was an unpaid consultant for Novo Nordisk and has received research support from the National Heart Lung-Blood Institute and Wellcare, Inc.; Kyle has consulted for Gelesis, Novo Nordisk, Johnson & Johnson and Nutrisystem; and Jastreboff has served as an advisor to Novo Nordisk, Eli Lilly, Boehringer Ingelheim, Intellihealth, Scholar Rock and Pfizer and has received research support from the American Diabetes Association, Novo Nordisk, Eli Lilly and the National Institute of Diabetes and Digestive and Kidney Diseases.

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