"Since weight gain in adolescence has been associated with a number of health problems in adulthood, we wanted to find a program that could offer teens an effective weight-loss strategy," says lead author Elissa Jelalian, PhD, a child psychologist with the BHCRC and Brown Medical School.
Seventy-six overweight adolescents (ages 13 to 16) were randomly assigned to one of two treatment plans for 16 weeks: cognitive-behavioral group treatment with Adventure Therapy based on Outward Bound (an educational program that promotes adventure and peer-building activities), or cognitive-behavioral group treatment in conjunction with aerobic exercise.
"We found that the older teens in our sample lost more weight through the Adventure Therapy regimen, and many kept it off at the 10 month follow-up," says Jelalian.
While average weight loss was similar for both groups, the authors saw significant differences between the groups six months after completion of the active intervention. Over twice as many adolescents in the Adventure Therapy group maintained their weight loss. Even more impressive, they found that older adolescents in the adventure therapy group demonstrated more than four times the weight loss of their counterparts in the aerobics group at follow-up.
"This study supports the idea that at ages 15 and 16, adolescents may benefit significantly from peer support. The Adventure Therapy model embraces positive peer encouragement which is why it's so effective," says Jelalian.
Rather than participating in a supervised exercise session together, adolescents assigned to the Adventure Therapy group were asked to work together in cooperative games, trust-building exercises, and problem solving challenges. The final challenge was for adolescents to participate in a ropes course.
Obesity in children and adolescents is a significant public health concern, the authors write. Data from the most recent National Health and Nutrition Examination Survey data (NHANES 1999-2000) indicate that approximately 15 percent of children and adolescents are overweight. The recent Surgeon General's "Call to Action" describes overweight and obesity as a public health epidemic, with specific focus on the impact of overweight for children and adolescents.
"The obesity epidemic our country is facing has created a tremendous need for innovative, effective weight loss strategies for overweight teens," says co-author Elizabeth Lloyd-Richardson, PhD, psychologist at The Miriam Hospital and Brown Medical School. The rise in prevalence of pediatric obesity has been associated with a rise in the diagnosis of non-insulin-dependent diabetes, as well as risk factors for heart disease. Weight increases during adolescence have also been associated with fasting insulin, HDL-cholesterol, and systolic blood pressure in young adulthood.
"Evidence suggests that losing even small amounts of weight (5 to 10 percent of body weight) can have a significant impact on health," says co-author Rena Wing, PhD, director of the Weight Control and Diabetes Research Center at The Miriam Hospital and Brown Medical School.
Furthermore, childhood and adolescent obesity are significant predictors of overweight status in adulthood and pose a risk factor for adult morbidity and mortality, particularly for males, the authors write.
Founded in 1931, Bradley Hospital (www.bradleyhospital.org) was the nation's first psychiatric hospital operating exclusively for children. Today, it remains a premier medical institution devoted to the research and treatment of childhood psychiatric illnesses. Bradley Hospital, located in Providence, RI, is a teaching hospital for Brown Medical School and ranks in the top third of private hospitals receiving funding from the National Institutes of Health. Its research arm, the Bradley Hasbro Children's Research Center (BHCRC), brings together leading researchers in such topics as: autism, colic, childhood sleep patterns, HIV prevention, infant development, obesity, eating disorders, depression, obsessive-compulsive disorder (OCD) and juvenile firesetting. Bradley Hospital is a member of the Lifespan health system.
The Miriam Hospital, established in 1926 in Providence, RI, is a not-for-profit hospital affiliated with Brown Medical School. Nationally recognized as a top hospital in cardiovascular care, The Miriam Hospital (www.miriamhospital.org) offers particular expertise in cardiac catheterization, angioplasty and women's cardiac care. One of 20 designated Center for AIDS Research (CFAR) sites, The Miriam is a leader in the treatment, research and prevention of HIV/AIDS, attracting $17 million of the world's HIV/AIDS research dollars. The Miriam Hospital has been awarded Magnet Recognition for Excellence in Nursing Services twice and is committed to excellence in patient care, research and medical education. The Miriam is a founding member of the Lifespan health system.
Journal
International Journal of Obesity