Original article
Psychosocial Interventions in the Treatment of Severe Adolescent Obesity: The SHINE Program

https://doi.org/10.1016/j.jadohealth.2016.06.014Get rights and content

Abstract

Purpose

Psychosocial interventions (PSIs) are characterized by three phases: (1) an initial in-depth assessment, (2) an intensive multifaceted intervention to stem a condition, and (3) an extensive maintenance program. PSIs are often used for treatment of mental health conditions; however, applicability in the treatment of adolescent obesity is unknown. This article sought to evaluate the service-level outcomes of a PSI for young people (aged 10–17) with severe obesity.

Methods

A retrospective evaluation of participants attending the Self Help, Independence, Nutrition and Exercise program between 2011 and 2016 (n = 435; age: 13.1 ± 2.1 years, male: 51%, white: 87.4%, body mass index [BMI]: 33.5 ± 7.5 kg/m2, standardized BMI [BMI SDS]: 3.1 ± .5 units). Anthropometric measurements (BMI and waist circumference) were collected at baseline, 3, 6, 9, and 12 months. Psychosocial measures (anxiety, depression, and self-esteem) were collected at baseline and 3 months. Participant retention was also assessed.

Results

After 3 months, 95% of participants remained with a mean BMI SDS reduction of .19 units (95% confidence interval: .17, .21). Anxiety, depression, and self-esteem improved by 50%, 54%, and 38%, respectively. BMI SDS reductions of .29, .35, and .41 units were found at 6, 9, and 12 months. Fifty-four percent of participants chose to attend the final intervention phase. A higher baseline BMI SDS and a greater reduction in BMI SDS predicted final intervention phase attendance.

Conclusions

The Self Help, Independence, Nutrition and Exercise PSI demonstrated positive mean reductions in all measurements across all time points. In contrast to other community-based weight management services, these results suggest the utility of, and further exploration of, PSIs in the treatment of severe adolescent obesity.

Section snippets

Study design and setting

A retrospective service evaluation of the SHINE program was undertaken. No control or comparator group data were available. Eligible participants were either severely obese (BMI SDS ≥2.67 units [99.6th percentile]) or obese (BMI SDS ≥2.00 units [98th percentile]) with associated comorbidities (e.g., hypertension, depression, and type 2 diabetes) [15], [16]. Phase 1 to phase 3 lasts 15 months, but families may use the service ad hoc until the child's 18th birthday. Families pay a weekly

Participant characteristics

The majority of participants commencing SHINE were white (88.2%), with a mean age of 12.9 ± 2.0 years. Fifty-one percent were male and 27.1% had a diagnosed learning disability. Regarding BMI SDS classification: 19.0% were obese, 56.2% severely obese, and 24.8% very severely obese. Table 1 details characteristics of program initiators (n = 347) and noninitiators (n = 435).

Phase 2 outcomes

At 3 months, mean BMI SDS had reduced by 6.2% (BMI SDS reduction: .19 units, 95% confidence interval [CI]: .17, .21) from

Discussion

Evidence relating to the evaluation of adolescent WMPs is limited, particularly when assessing those implemented within the United Kingdom [23]. Of those with published results, the programs are often tier 2 community-based interventions lasting between 3 and 6 months (e.g., MEND, GOALS, Families for Health). SHINE, a tier 3 community-based WMP specifically for severely obese adolescents, was evaluated here to examine the applicability of a long-term PSI for treating severe obesity.

Acknowledgments

The authors thank the participants who attended the SHINE program. Findings of this article are also to be presented at the International Society of Behavioural Nutrition and Physical Activity, Cape Town, South Africa, June 8th–11th 2016.

References (40)

  • E.L. van den Akker et al.

    A cognitive behavioral therapy program for overweight children

    J Pediatr

    (2007)

  • Child weight data factsheet

    (2014)
  • A.S. Singh et al.

    Tracking of childhood overweight into adulthood: A systematic review of the literature

    Obes Rev

    (2008)
  • P. Nieman et al.

    Psychosocial aspects of child and adolescent obesity

    Pediatr Child Health

    (2012)

  • Developing a specification for lifestyle weight management services: Best practice guidance for tier 2 services

    (2013)

  • National mapping of weight management services

    (2015)

  • Managing overweight and obesity among children and young people: Lifestyle weight management services

    (2013)
  • P. Upton et al.

    The effectiveness of local child weight management programmes: An audit study

    Child Care Health Dev

    (2013)
  • J. Dalen et al.

    A conceptual framework for the expansion of behavioral interventions for youth obesity: A family-based mindful eating approach

    Child Obes

    (2015)
  • A.K. Forsman et al.

    Psychosocial interventions for the promotion of mental health and the prevention of depression among older adults

    Health Promot Int

    (2011)
  • C. Gamble et al.

    The use of psychosocial interventions

    Nurs Times

    (2003)
  • C.J. Lonigan et al.

    Empirically supported psychosocial interventions for children: An overview

    J Clin Child Psychol

    (1998)
  • D. Yach et al.

    Improving diet and physical activity: 12 lessons from controlling tobacco smoking

    BMJ

    (2005)
  • G.A. Bray

    Obesity is a chronic, relapsing neurochemical disease

    Int J Obes Relat Metab Disord

    (2003)
  • K. Sharman et al.

    SHINE: A stepped care approach to the management of severe obesity in young people

    Prim Health Care

    (2016)
  • T.J. Cole et al.

    Body mass index reference curves for the UK, 1990

    Arch Dis Child

    (1995)
  • T.C. Hoffmann et al.

    Better reporting of interventions: Template for intervention description and replication (TIDieR) checklist and guide

    BMJ

    (2014)
  • H.D. McCarthy et al.

    The development of waist circumference percentiles in British children aged 5.0-16.9 years

    Eur J Clin Nutr

    (2001)
  • L.J. Ells et al.

    Prevalence of severe childhood obesity in England: 2006–2013

    Arch Dis Child

    (2015)
  • M. Rosenberg

    Society and the adolescent self-image

    (1965)

    • Cited by (15)

    • Spanish collaborative study: Description of usual clinical practice in infant obesity

      2018, Anales de Pediatria

    • Management of obesity in children and adolescents: Lifestyle and exercise options

      2018, Encyclopedia of Endocrine Diseases

    • The effect of psychological interventions targeting overweight and obesity in school-aged children: a systematic review and meta-analysis

      2023, BMC Public Health

    • Effects of aquatic exercise on lipid metabolism body composition and peripheral blood Irisin level in obese middle school

      2023, Chinese Journal of School Health

    • Evidence Base Update on Behavioral Treatments for Overweight and Obesity in Children and Adolescents

      2023, Journal of Clinical Child and Adolescent Psychology

    • The Association of Malnutrition, illness duration, and pre-morbid weight status with anxiety and depression symptoms in adolescents and young adults with restrictive eating disorders: a cross-sectional study

      2021, Journal of Eating Disorders
    View all citing articles on Scopus

    Conflicts of Interest: J.N. and D.R. are independent to the SHINE program and do not hold any conflicts of interest. K.S. is the managing director of SHINE Health Academy. P.D., and the Sheffield Children's Hospital, accept referrals from SHINE when more specialist services are required (i.e., tier 4, bariatric surgery, or pharmacotherapy). SHINE also accept referrals from Sheffield Children's Hospital. Leeds Beckett University completed the evaluation of the data and consulted with K.S. and P.D. in the development of the article.

    View full text
    © 2016 Society for Adolescent Health and Medicine. All rights reserved.