Login to MyKarger

New to MyKarger? Click here to sign up.



Login with Facebook

Forgot your password?

Authors, Editors, Reviewers

For Manuscript Submission, Check or Review Login please go to Submission Websites List.

Submission Websites List

Institutional Login
(Shibboleth or OpenAthens)

For the academic login, please select your country in the dropdown list. You will be redirected to verify your credentials.

Original Article

Open Access Gateway

A Structured, Manual-Based Low-Level Intervention vs. Treatment as Usual Evaluated in a Randomized Controlled Trial for Adolescents with Extreme Obesity - the STEREO Trial

Mühlig Y.a · Scherag A.b · Bickenbach A.c · Giesen U.a · Holl R.d · Holle R.e · Kiess W.f · Lennerz B.g · Lütke Brintrup D.h · Moss A.g · Neef M.f · Ose C.h · Reinehr T.i · Teuner C.M.e · Wiegand S.c · Wolters B.i · Wabitsch M.g · Hebebrand J.h

Author affiliations

aDepartment of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; bResearch Group Clinical Epidemiology, Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany; cAmbulatory Obesity Center, Charité - University Hospital Berlin, Berlin, Germany; dInstitute for Epidemiology and Medical Biometry, Ulm University, Ulm, Germany; eInstitute of Health Economics and Health Care Management, Helmholtz Zentrum München - German Research Center for Environmental Health, Munich, Germany; fHospital for Children and Adolescents, Department of Women and Child Health, University of Leipzig, Leipzig, Germany; gDivision of Pediatric Endocrinology and Diabetes, Interdisciplinary Obesity Unit, Department of Pediatrics and Adolescent Medicine, University of Ulm, Ulm, Germany; hInstitute for Medical Informatics, Biometry and Epidemiology and Center for Clinical Trials Essen (ZKSE), University Hospital Essen, University of Duisburg-Essen, Essen, Germany; iVestische Childrens Hospital Datteln, University Witten/Herdecke, Datteln, Germany

Corresponding Author

Dr. rer. medic. Yvonne Mühlig

Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy

LVR-Klinikum Essen, University of Duisburg-Essen

Wickenburgstraße 21, 45147 Essen, Germany

yvonne.muehlig@lvr.de

Related Articles for ""

Obes Facts 2017;10:341-352

Do you have an account?

Login Information





Contact Information











I have read the Karger Terms and Conditions and agree.



Abstract

Background: To compare efficacy and safety of a manual-based low-level psychological intervention with treatment as usual (weight loss treatment). Methods: A two-armed randomized controlled trial without blinding and computer-based stratified block randomization included adolescents and young adults (14.0-24.9 years) with a BMI ≥ 30 kg/m2 at five German university hospitals. Primary outcomes were adherence (participation rate ≥ 5/6 sessions) and quality of life (DISABKIDS-37) 6 months after randomization. Secondary outcomes included depression, self-esteem, and perceived stress scores. Results: Of 397 screened adolescents, 119 (mean BMI 40.4 ± 7.0 kg/m2, 49.6% female) were randomized to the manual-based low-level intervention (n = 59) or treatment as usual (n = 60). We observed no group difference for adherence (absolute risk reduction 0.4%, 95% CI -14.7% to 15.5%; p = 1.0) or health-related quality of life (score difference 8.1, 95% CI -2.1 to 18.3; p = 0.11). Among all secondary outcomes, we detected explorative evidence for an effect on the DISABKIDS-37 ‘social exclusion' subscale (score difference 15.5; 95% CI 1.6-29.4; p = 0.03). 18/19 adverse events occurred in 26 participants, none were classified as serious. Conclusion: Adherence to a coping-oriented intervention was comparable to weight loss treatment, although it was weak in both interventions. Psychological interventions may help to overcome social isolation; further confirmation is required.

© 2017 The Author(s) Published by S. Karger GmbH, Freiburg


References

  1. Ng M, Fleming T, Robinson M, : Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013:a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014;384:766-781.
  2. Oude Luttikhuis H, Baur L, Jansen H, Shrewsbury VA, O´Malley C, Stolk RP, Summerbell CD: Interventions for treating obesity in children (review). Cochrane Database of Syst Rev 2009;3:1-57.
  3. Mühlig Y, Wabitsch M, Moss A, Hebebrand J: Weight loss in children and adolescents - a systematic review and evaluation of conservative, non-pharmacological obesity treatment programs. Dtsch Arztebl Int 2014;111:818-824.
  4. Knop C, Singer V, Uysal Y, Schaefer A, Wolters B, Reinehr T: Extremely obese children respond better than extremely obese adolescents to lifestyle interventions. Pediatr Obes 2013;10:7-14.
  5. Han JC, Lawlor DA, Kimm SYS: Childhood obesity - 2010: progress and challenges. Lancet 2010;375:1737-1748.
  6. Hebebrand J, Herpertz-Dahlmann B: Psychological and psychiatric aspects of pediatric obesity. Child Adolesc Psychiatr Clin N Am 2009;18:49-65.
  7. Puhl RM, Latner JD: Stigma, obesity, and the health of the nation‘s children. Psychol Bull 2007;133:557-580.
  8. Puhl RM, Heuer CA: Weight bias: a review and update. Obesity (Silver Spring) 2009;17:941-964.
  9. Giel KE, Thiel A, Teufel M, Mayer J, Zipfel S: Weight bias in work settings - a qualitative review. Obes Facts 2010;3:33-40.
  10. Wasserman H, Inge TH: Bariatric surgery in obese adolescents: opportunities and challenges. Pediatr Ann 2014;43:e230-e236.
  11. Papadia FS, Adami GF, Marinari GM, Camerini G, Scopinaro N: Bariatric surgery in adolescents: a long-term follow-up study. Surg Obes Relat Dis 2007;3:465-468.
  12. Lennerz BS, Wabitsch M, Lippert H, Wolff S, Knoll C, Weiner R, Manger T, Kiess W, Stroh C: Bariatric surgery in adolescents and young adults-safety and effectiveness in a cohort of 345 patients. Int J Obes (Lond) 2013;182:1-7.
  13. Walpole B, Dettmer E, Morrongiello BA, McCrindle BW, Hamilton J: Motivational interviewing to enhance self-efficacy and promote weight loss in overweight and obese adolescents: a randomized controlled trial. J Pediatr Psychol 2013;38:944-953.
  14. Bean MK, Powell P, Quinoy A, Ingersoll K, Wickham EP 3rd, Mazzeo SE: Motivational interviewing targeting diet and physical activity improves adherence to paediatric obesity treatment: results from the MI Values randomized controlled trial. Pediatr Obes 2014;10:118-125.
  15. Theim KR, Sinton MM, Goldschmidt AB, van Buren DJ, Doyle AC, Saelens BE, Stein RI, Epstein LH, Wilfley DE: Adherence to behavioral targets and treatment attendance during a pediatric weight control trial. Obesity (Silver Spring) 2013;21:394-397.
  16. De Niet J, Timman R, Bauer S, van den Akker E, Buijks H, de Klerk C, Kordy H, Passchier J: The effect of a short message service maintenance treatment on body mass index and psychological well-being in overweight and obese children: a randomized controlled trial. Pediatr Obes 2012;7:205-219.
  17. Wabitsch M, Moss A, Reinehr T, Wiegand S, Kiess W, Scherag A, Holl R, Holle R, Hebebrand J: Medical and psychosocial implications of adolescent extreme obesity - acceptance and effects of structured care, short: Youth with Extreme Obesity Study (YES). BMC Pub Health 2013;13:789.
  18. Wabitsch M, Moss A (federführend für die Arbeitsgemeinschaft Adipositas im Kindes- und Jugendalter): Evidenzbasierte Leitlinie zur Therapie der Adipositas im Kindes- und Jugendalter. S3-Leitlinie, Version 2009. www.aga.adipositas-gesellschaft.de/fileadmin/PDF/Leitlinien/Leitlinie-AGA-S3-2009.pdf (last accessed July 31, 2017).
  19. Schmidt S, Petersen C, Mühlan H, Simeoni, MC, Debensason D, Thyen U, Müller-Godeffroy E, Vidalis A, Tsanakas J, Hatziagorou E, Karagianni P, Koopmann H, Baars R, Chaplin J, Power M, Atherton C, Hoare P, Quittan M, Schuhfried O, Bullinger M: The DISABKIDS Questionnaires. Quality of life questionnaires for children with chronic conditions. Handbook. Lengerich, Pabst Science Publishers, 2006.
  20. Ravens-Sieberer U, Gosch A, Rajmil L: KIDSCREEN-52 quality-of-life measure for children and adolescents. Expert Rev Pharmacoecon Outcomes Res 2005;5:353-364.
  21. Beck AT, Steer RA, Brown GK: Manual for the Beck Depression Inventory-II. San Antonio, Psychological Corporation, 1996.
  22. Collani G, Herzberg PY: Eine revidierte Fassung der deutschsprachigen Skala zum Selbstwertgefühl von Rosenberg. Zeitschrift für Differentielle und Diagnostische Psychologie 2003;24:3-7.
  23. Fliege H, Rose M, Arck P, Walter OB, Kocalevent RD, Klapp BF: The Perceived Stress Questionnaire (PSQ) reconsidered: validation and reference values from different clinical and healthy adult samples. Psychosom Med 2005;67:78-88.
  24. Maurer W, Hothorn L, Lehmacher W: Multiple comparisons in drug clinical trials and preclinical assays: a priori ordered hypothesis; in Vollmar J (ed): Biometrie in der chemisch-pharmazeutischen Industrie, vol 6. Stuttgart, Fischer, 1995, pp. 3-18.
  25. Finne E, Reinehr T, Schaefer A, Winkel K, Kolip P: Overweight children and adolescents - is there a subjective need for treatment? Int J Public Health 2009;54:112-116.
  26. Röbl M, de Souza M, Schiel R, Gellhaus I, Zwiauer K, Holl RW, Wiegand S: The key role of psychosocial risk on therapeutic outcome in obese children and adolescents. Results from a longitudinal multicenter study. Obes Facts 2013;6:297-305.
  27. Halloran K, Padwal RS, Johnson-Stoklossa C, Sharma AM, Birch DW: Income status and approval for bariatric surgery in a publicly funded regional obesity program. Obes Surg 2011;21:373-378.
  28. Schulz KF, Altman D, Moher D, for the CONSORT Group: CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMC Med 2010;8:18.
  29. Kromeyer-Hauschild K, Wabitsch M, Geller F, Ziegler A, Geiß HC, Hesse V, Hippel V, Jaeger U, Johnsen D, Kiess W, Korte W, Kunze D, Menner K, Müller M, Niemann-Pilatus, A, Remer T, Schaefer F, Wittchen HU, Zabransky S, Zellner K, Hebebrand J: Perzentile für den Body Mass Index für das Kindes- und Jugendalter unter Heranziehung verschiedener deutscher Stichproben. Monatsschr Kinderheilk 2001;149:807-818.
  30. Max Rubner Institut, Bundesforschungsinstitut für Ernährung und Lebensmittel: Nationale Verzehrsstudie II, Ergebnisbericht Teil 1, 2008. www.mri.bund.de/fileadmin/Institute/EV/NVS_II_Abschlussbericht_Teil_1_mit_Ergaenzungsbericht.pdf (last accessed July 31, 2017).

Article / Publication Details

First-Page Preview
Abstract of Original Article

Received: February 01, 2017
Accepted: April 03, 2017
Published online: August 09, 2017
Issue release date: August 2017

Number of Print Pages: 12
Number of Figures: 1
Number of Tables: 2

ISSN: 1662-4025 (Print)
eISSN: 1662-4033 (Online)

For additional information: https://www.karger.com/OFA

References

  1. Ng M, Fleming T, Robinson M, : Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013:a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014;384:766-781.
  2. Oude Luttikhuis H, Baur L, Jansen H, Shrewsbury VA, O´Malley C, Stolk RP, Summerbell CD: Interventions for treating obesity in children (review). Cochrane Database of Syst Rev 2009;3:1-57.
  3. Mühlig Y, Wabitsch M, Moss A, Hebebrand J: Weight loss in children and adolescents - a systematic review and evaluation of conservative, non-pharmacological obesity treatment programs. Dtsch Arztebl Int 2014;111:818-824.
  4. Knop C, Singer V, Uysal Y, Schaefer A, Wolters B, Reinehr T: Extremely obese children respond better than extremely obese adolescents to lifestyle interventions. Pediatr Obes 2013;10:7-14.
  5. Han JC, Lawlor DA, Kimm SYS: Childhood obesity - 2010: progress and challenges. Lancet 2010;375:1737-1748.
  6. Hebebrand J, Herpertz-Dahlmann B: Psychological and psychiatric aspects of pediatric obesity. Child Adolesc Psychiatr Clin N Am 2009;18:49-65.
  7. Puhl RM, Latner JD: Stigma, obesity, and the health of the nation‘s children. Psychol Bull 2007;133:557-580.
  8. Puhl RM, Heuer CA: Weight bias: a review and update. Obesity (Silver Spring) 2009;17:941-964.
  9. Giel KE, Thiel A, Teufel M, Mayer J, Zipfel S: Weight bias in work settings - a qualitative review. Obes Facts 2010;3:33-40.
  10. Wasserman H, Inge TH: Bariatric surgery in obese adolescents: opportunities and challenges. Pediatr Ann 2014;43:e230-e236.
  11. Papadia FS, Adami GF, Marinari GM, Camerini G, Scopinaro N: Bariatric surgery in adolescents: a long-term follow-up study. Surg Obes Relat Dis 2007;3:465-468.
  12. Lennerz BS, Wabitsch M, Lippert H, Wolff S, Knoll C, Weiner R, Manger T, Kiess W, Stroh C: Bariatric surgery in adolescents and young adults-safety and effectiveness in a cohort of 345 patients. Int J Obes (Lond) 2013;182:1-7.
  13. Walpole B, Dettmer E, Morrongiello BA, McCrindle BW, Hamilton J: Motivational interviewing to enhance self-efficacy and promote weight loss in overweight and obese adolescents: a randomized controlled trial. J Pediatr Psychol 2013;38:944-953.
  14. Bean MK, Powell P, Quinoy A, Ingersoll K, Wickham EP 3rd, Mazzeo SE: Motivational interviewing targeting diet and physical activity improves adherence to paediatric obesity treatment: results from the MI Values randomized controlled trial. Pediatr Obes 2014;10:118-125.
  15. Theim KR, Sinton MM, Goldschmidt AB, van Buren DJ, Doyle AC, Saelens BE, Stein RI, Epstein LH, Wilfley DE: Adherence to behavioral targets and treatment attendance during a pediatric weight control trial. Obesity (Silver Spring) 2013;21:394-397.
  16. De Niet J, Timman R, Bauer S, van den Akker E, Buijks H, de Klerk C, Kordy H, Passchier J: The effect of a short message service maintenance treatment on body mass index and psychological well-being in overweight and obese children: a randomized controlled trial. Pediatr Obes 2012;7:205-219.
  17. Wabitsch M, Moss A, Reinehr T, Wiegand S, Kiess W, Scherag A, Holl R, Holle R, Hebebrand J: Medical and psychosocial implications of adolescent extreme obesity - acceptance and effects of structured care, short: Youth with Extreme Obesity Study (YES). BMC Pub Health 2013;13:789.
  18. Wabitsch M, Moss A (federführend für die Arbeitsgemeinschaft Adipositas im Kindes- und Jugendalter): Evidenzbasierte Leitlinie zur Therapie der Adipositas im Kindes- und Jugendalter. S3-Leitlinie, Version 2009. www.aga.adipositas-gesellschaft.de/fileadmin/PDF/Leitlinien/Leitlinie-AGA-S3-2009.pdf (last accessed July 31, 2017).
  19. Schmidt S, Petersen C, Mühlan H, Simeoni, MC, Debensason D, Thyen U, Müller-Godeffroy E, Vidalis A, Tsanakas J, Hatziagorou E, Karagianni P, Koopmann H, Baars R, Chaplin J, Power M, Atherton C, Hoare P, Quittan M, Schuhfried O, Bullinger M: The DISABKIDS Questionnaires. Quality of life questionnaires for children with chronic conditions. Handbook. Lengerich, Pabst Science Publishers, 2006.
  20. Ravens-Sieberer U, Gosch A, Rajmil L: KIDSCREEN-52 quality-of-life measure for children and adolescents. Expert Rev Pharmacoecon Outcomes Res 2005;5:353-364.
  21. Beck AT, Steer RA, Brown GK: Manual for the Beck Depression Inventory-II. San Antonio, Psychological Corporation, 1996.
  22. Collani G, Herzberg PY: Eine revidierte Fassung der deutschsprachigen Skala zum Selbstwertgefühl von Rosenberg. Zeitschrift für Differentielle und Diagnostische Psychologie 2003;24:3-7.
  23. Fliege H, Rose M, Arck P, Walter OB, Kocalevent RD, Klapp BF: The Perceived Stress Questionnaire (PSQ) reconsidered: validation and reference values from different clinical and healthy adult samples. Psychosom Med 2005;67:78-88.
  24. Maurer W, Hothorn L, Lehmacher W: Multiple comparisons in drug clinical trials and preclinical assays: a priori ordered hypothesis; in Vollmar J (ed): Biometrie in der chemisch-pharmazeutischen Industrie, vol 6. Stuttgart, Fischer, 1995, pp. 3-18.
  25. Finne E, Reinehr T, Schaefer A, Winkel K, Kolip P: Overweight children and adolescents - is there a subjective need for treatment? Int J Public Health 2009;54:112-116.
  26. Röbl M, de Souza M, Schiel R, Gellhaus I, Zwiauer K, Holl RW, Wiegand S: The key role of psychosocial risk on therapeutic outcome in obese children and adolescents. Results from a longitudinal multicenter study. Obes Facts 2013;6:297-305.
  27. Halloran K, Padwal RS, Johnson-Stoklossa C, Sharma AM, Birch DW: Income status and approval for bariatric surgery in a publicly funded regional obesity program. Obes Surg 2011;21:373-378.
  28. Schulz KF, Altman D, Moher D, for the CONSORT Group: CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMC Med 2010;8:18.
  29. Kromeyer-Hauschild K, Wabitsch M, Geller F, Ziegler A, Geiß HC, Hesse V, Hippel V, Jaeger U, Johnsen D, Kiess W, Korte W, Kunze D, Menner K, Müller M, Niemann-Pilatus, A, Remer T, Schaefer F, Wittchen HU, Zabransky S, Zellner K, Hebebrand J: Perzentile für den Body Mass Index für das Kindes- und Jugendalter unter Heranziehung verschiedener deutscher Stichproben. Monatsschr Kinderheilk 2001;149:807-818.
  30. Max Rubner Institut, Bundesforschungsinstitut für Ernährung und Lebensmittel: Nationale Verzehrsstudie II, Ergebnisbericht Teil 1, 2008. www.mri.bund.de/fileadmin/Institute/EV/NVS_II_Abschlussbericht_Teil_1_mit_Ergaenzungsbericht.pdf (last accessed July 31, 2017).
ppt logo Download Images (.pptx)


Figures
Thumbnail

Tables
Thumbnail
Thumbnail

Open Access License / Drug Dosage / Disclaimer

This article is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND). Usage and distribution for commercial purposes as well as any distribution of modified material requires written permission. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.