Academic journal article Childhood Obesity

School-Based Health Center-Based Treatment for Obese Adolescents: Feasibility and Body Mass Index Effects

Academic journal article Childhood Obesity

School-Based Health Center-Based Treatment for Obese Adolescents: Feasibility and Body Mass Index Effects

Article excerpt

[Author Affiliation]

Kathy Love-Osborne. 1 Department of Pediatrics, Denver Health and Hospitals Authority, Denver, CO. 2 Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO.

Rachel Fortune. 3 Department of Pediatrics, Yale School of Medicine, New Haven, CT.

Jeanelle Sheeder. 2 Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO. 4 Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO.

Steven Federico. 1 Department of Pediatrics, Denver Health and Hospitals Authority, Denver, CO. 2 Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO.

Matthew A. Haemer. 2 Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO. 5 Department of Pediatrics, Children's Hospital Colorado, Aurora, CO.

Address correspondence to: Kathy Love-Osborne, MD, Associate Professor of Pediatrics, Denver Health and Hospitals Authority, 501 28th Street, Denver, CO 80205, E-mail: Kathryn.love-osborne@dhha.org

Introduction

Obesity is associated with medical comorbidities, including type 2 diabetes (T2D) and cardiovascular disease.1 Obese adolescents may have worse attendance and school performance as well as more disciplinary problems, compared to normal weight peers.2 Screening obese adolescents for comorbidities of obesity has been recommended.1 Yet, in most practices, documentation of obesity as a diagnosis is poor, with rates of recommended laboratory screening less than 50%.3-5

Treatment of obesity in adolescents is difficult, with many interventions showing mixed or negative results.6 Although achieving weight loss may not always be possible, evidence in adults has suggested that stopping weight gain lowers the risk for T2D.7 A study in obese children similarly demonstrated that participants that maintained weight were less likely to develop T2D.8 Several logistical challenges create barriers to treating obese adolescents. One problem is that office-based settings are likely to reach only a subset of adolescents in need of services. Multidisciplinary treatment programs typically have long wait lists and high attrition rates in the range of 25-50% dropout after the first visit.9,10 Missing school has been reported as a reason for dropping out of obesity treatment programs.9 The capacity of traditional office-based obesity treatment to have a significant impact on the current obesity epidemic is limited by reach of services, and effectiveness is largely untested. Inner-city schools have a higher-than-average percentage of the student body that are overweight or obese, and adolescents served by school-based health centers (SBHCs) are more likely to be from minority groups and be uninsured.11

Most school-based obesity interventions have been delivered to all students.12 One randomized, controlled trial (RCT) showed improved BMI outcomes with an intervention that integrated physical activity (PA) into a required health course.13 There have been few individual RCTs studying treatment of obese teens in the school setting.14 SBHCs have been utilized to improve delivery of obesity preventive services.15 They have been shown to provide opportunities for increased access to adolescents, compared with the traditional office-based setting, and therefore have the potential to deliver an individualized intervention to teens and reduce attrition rates.16 One small SBHC study did show successful BMI outcomes with the use of motivational interviewing.17

Motivational interviewing (MI) techniques have been shown to be useful in many health conditions, including obesity. …

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