Fostering Behaviour Change in Obese Adolescents

 

Learning Aims

1. Gain sufficient knowledge and skills to support adolescents and their families in changing behaviours to increase physical activity to initiate and maintain weight loss.
2.  To develop a set of competencies and skills and apply a variety of psychological techniques to foster patient centred behavioural change in adolescents
3. Demonstrate understanding and empathy of adolescents attitudes towards obesity, to build a rapport and raise the issue of weight loss sensitively
4. To ensure that the adolescent has sufficient information to allow them make an informed decision about the need to increase physical activity through a change in behaviour and awareness of the support options available
5. Be able to clarify your role as a physiotherapist and recognise the boundaries of your scope of practice in an at risk adolescent population
   
   

Background

Size of the problem

Global obesity levels have been on the rise over the past 3 decades; this is true for both males and females for all age groups,. According to recent figures, the average age at which individuals in the UK are becoming obese is decreasing. Researchers found clear trends with time, highlighting not only is the prevalence of obesity increasing but it is also becoming more common at an earlier age (Seidell and Halberstadt 2015).

Statistics

Obesity has more than doubled in children and quadrupled in adolescents in the past 30 years (CDC 2015) 31% of boys and 28% of girls aged 2-15 were classified as either overweight or obese in 2011 (National Obesity Forum, 2015) In 2012, more than 1/3 of children and adolescents were overweight or obese (CDC 2015) Latest figures for England show that ⅕ of children joining primary school are now overweight/obese (BBC 2015) Studies have shown adolescent obesity is directly associated with both maternal and paternal BMI and parental obesity is an independent risk factor for child/adolescent obesity (Svensson et al 2010) It has been reported that if one parent is obese, there is a 50% chance that their child will be also and if both parents are obese the risk rises to 80% (Aacap 2011).

Health Implications

It is known that obese children and adolescents often go on to be obese adults, putting them at risk of morbidity, disability and premature mortality in adulthood. Obesity can have significant effects on both our physical and mental health. Some of the obesity-related diseases often do not develop until later in life, such as degenerative arthritis, heart disease, stroke and various forms of cancer. However, there is a long list of other serious obesity-related medical conditions which can arise during the adolescent years, including:

•Cardiovascular (CVD) risk factors

◦Hypercholesterolemia

◦High triglyceride levels

◦Hypertension

•Musculoskeletal problems

•Obstructive sleep apnoea (OSA)

•Asthma

•Pancreatitis

•Type 2 diabetes

Psychosocial contributing factors to obesity in adolescents – the patient’s perspective

As physiotherapists, it is important that we take into consideration the whole picture and are able to grasp the patient’s perspective when any patient presents to us in clinical practice. This is essential when planning specific interventions for patients (Niemen et al 2012).

There are a variety of reasons why an adolescent may become overweight or obese. Psychosocial stressors which can result in emotional eating include bullying, experiencing neglect/maltreatment (Whitaker et al 2007), or living in an environment where there is a lack of consistency, food-limiting or general adult supervision (Cohen 2002).

When young people become stressed, they are more likely to overeat or comfort eat. Other examples of stressors can be parents divorcing/separating and physical or mental abuse, resulting in the adolescent turning to food as a coping mechanism. Chronic stress can lead to poor sleeping patterns, tiredness and a lack of motivation to participate in regular physical activity. This creates a vicious cycle as insufficient sleep is associated with the development of obesity (Ievers-Landis et al 2008).

Overweight adolescents are often made fun of and bullied, making it challenging for them to make friends. There is a often a negative stigma attached to obesity, especially in the thin-obsessed culture we live in. Teasing and bullying, which make the adolescent feel uncomfortable, can make it hard for them to lose weight and can cause them to gain more weight as they may turn to food for comfort. Low self-esteem and a fear of being bullied can make adolescents less likely to exercise (Washington 2011).

It is often a combination of some of these things which can cause an adolescent to become obese, and it is vital that the physiotherapist takes these contributing factors into consideration when communicating with the patient.

Psychosocial effects of obesity

As briefly mentioned above, overweight and obese adolescents often endure harsh psychosocial consequences as a result of their weight. These include depression, bullying, social isolation, low self-esteem, negative body image and overall reduced quality of life.

Sometimes it can be difficult to determine whether depression is the cause or result of the obesity. This is where communication with the patient can be vital in order to determine the relationship between their obesity and depression. It has been established that the longer the adolescent is overweight or fails to lose weight, the higher the risk of developing depression and other mental health disorders. Depression leaves adolescents and people of all ages feeling less motivated to participate in physical activity (Pine et al 2001).

A negative body image can affect both mood and eating patterns, and can be emotionally damaging for young people, particularly in the world we live in today. It is important for young people especially to grow through adolescence being comfortable in their own skin and with their own identity. Adolescents who find it difficult to manage their weight can experience periods of very low self-esteem. As physiotherapists, it is essential that we use appropriate language and continue to encourage and motivate this type of patient (Vaidya 2006).

All of the above can result in the adolescents experiencing reduced quality of life, and a reduced ability to cope and manage daily life. Again, low quality of life is associated with poor physical activity engagement and a reduced perception of themselves as a person as a whole, feeding the vicious cycle of obesity (Niemen et al 2012).

Models of Change

Trans-theoretical Model

Interventions