A common fear I hear a lot from parents who have teens who struggle with their weight is that they are scared their teens might develop body image issues after enrolling in a program that helps them change their habits.
In this episode, I present a research study that examined whether an online based program for teens can work. In particular, in this study, researchers looked not only at the effect of the program on weight loss, but also the effect it had on eating disorder symptoms.
"Reduction of overweight and eating disorder symptoms via the Internet in adolescents: A randomized controlled trial."
Angela Celio Doyle et al, J Adolesc Health. 2008 August
Dr Gourgari is a pediatric endocrinologist, certified in obesity medicine expert and weight loss coach for teens with more than 15 years of experience. She helps teens build healthy habits that last, so they can feel happier, be more confident and love their body again .
To get a free copy of 30 healthy and easy recipes for teens that are high in protein, visit
https://lifestyleforteens.com/recipes
To learn more about the LIFT Program, visit lifestyleforteens.com/program
A common fear I hear a lot from parents who have teens who struggle with their weight is that they are scared their teens might develop body image issues after enrolling in a program that helps them change their habits.
In this episode, I present a research study that examined whether an online based program for teens can work. In particular, in this study, researchers looked not only at the effect of the program on weight loss, but also the effect it had on eating disorder symptoms.
"Reduction of overweight and eating disorder symptoms via the Internet in adolescents: A randomized controlled trial."
Angela Celio Doyle et al, J Adolesc Health. 2008 August
Dr Gourgari is a pediatric endocrinologist, certified in obesity medicine expert and weight loss coach for teens with more than 15 years of experience. She helps teens build healthy habits that last, so they can feel happier, be more confident and love their body again .
To get a free copy of 30 healthy and easy recipes for teens that are high in protein, visit
https://lifestyleforteens.com/recipes
To learn more about the LIFT Program, visit lifestyleforteens.com/program
Are you getting frustrated with what to feed a teenager who is always hungry? Everybody knows that teenagers have a huge appetite. It seems like you need to feed them constantly to satisfy their hunger. It's even more difficult where teenagers who struggle with their weight truly want to make changes like cut down on junk food or stop ever eating, and they can't. There is frustration, isolation, stress, and that's why I decided to create a recipe collection of 30 easy and healthy meals for teenagers. They are all high in protein to satisfy your teenager's hunger and they can all be ready in less than 30 minutes. If you want to grab a free copy, go to lifestell14scom for the last recipes.
Speaker 2:This is the Lifestyle and Weight Loss for Teens podcast. If you are a mom and want to help your child who is struggling to lose weight, you are in the right place. If you are looking for healthy lifestyle tips, Dr Gorgary is here to help you understand the science around safe weight loss in teens and children, because what works for adult weight loss is not always the best for children. This podcast is for educational purposes only. Dr Gorgary does not provide medical, psychological or nutrition therapy advice. You should not use this information to diagnose or treat any health problems without consulting your own medical practitioner and now your host, Dr Jenny Gorgary.
Speaker 1:Hi everyone, this is Dr Gorgary again. I am here with you again to discuss another topic that I hope you will find helpful. Again, the purpose of this podcast is to encourage you to make healthy choices so that you can build the lifestyle that you want, so you can achieve a healthy weight and be happy and enjoy your life, whether you are a teenager or whether you are a parent of a teenager. I hope you will find this helpful. So let's get started, because I don't like to waste your time. So the topic of today's research is reduction of overweight and eating disorder symptoms via the Internet in Adolescent, a randomized control trial. That was the title of the research that was published. So this was published in the Journal of Andolescent Health in 2008. Dr Angela Doyle was the first author of this research who actually wrote this manuscript. This study was from the Department of Psychiatry at the University of Chicago, and there were also some other investigators in this study from New York University, stanford University and Washington University.
Speaker 1:So let's just start with a little background information. Why did the authors decided to take this initiative and study this Internet-based program and how that affects the perception of adolescents and teenagers about their body image, and also study the effect of this Internet-based program into their weight and healthy eating habits. So we all know it is challenging to treat overweight and obesity in children and adolescents, and one of the challenges of course there are many challenges. One of the challenges is that oftentimes there may be barriers of the teenagers and their parents to go to an appropriate provider or educator or whoever delivers this program. So having an Internet-based program was more likely to decrease those barriers that have to do with transportation or with financial limitations and could be more of like a cost-effective intervention. So that's why they decided to create this Internet-based model to try to see whether that would improve the treatment of pediatric obesity and overweight. No-transcript. They decided to undertake this challenge and they designed this program, and I'm going to explain a little and shortly how exactly they did that and what was the results. Another key point here is that we know that overall, teenagers tend to spend a lot of time on the internet and it's something that most teenagers have access to at their homes or at their schools, and it was thought that it could be more appealing to the adolescents to have an intervention delivered to them through the internet than having to go to an office. So all this makes sense, right? So let's see exactly how they did this study.
Speaker 1:So they asked participants in mainly the San Diego and San Luis areas whether they wanted to participate in an internet-based program that was targeted to lose weight. That was their aim of the program. They put advertising in the newspaper and local advertisement and they wanted to recruit children that they were between the ages of 12 to 18. They were overweight and, of course, they had internet access, either at their home or at school or at the library.
Speaker 1:They exclude participants that they had other endocrine problems. Let's say if somebody had diabetes, for example, that would be an exclusion. Or if they were getting medications that the, let's say like cortisol, so that they were taking medications and that was the reason why they were overweight. So if they had one of these contraindications they could not be enrolled in the program. Or if there was a medical reason for which they were not allowed to have to be physically active. Let's say somebody had broken their leg so they couldn't do exercise, so that would that person was excluded from the study. Or if they also had a clinical, established diagnosis of a eating disorder. Let's say somebody had anorexia or anorexia nervosa or bulimia nervosa or binge ending disorder. These participants were also excluded because one of the things they wanted to assess is whether this intervention through the internet increased the symptoms of eating disorder. So if they enrolled kids that they already had an eating disorder then they wouldn't really be able to assess that. So those were like the exclusion criteria of the study. So there was a total of 155 adolescents that expressed interest in participating in this internet-based study and from those, 83 were actually deemed eligible by the primary research team to either be randomized to a group that would get the intervention or get a control group, which is, as we have discussed previously, when you this is the study design, where half of the people get the actual intervention, half of the people don't get the intervention, and then the researchers compare what is the result on the group that got the intervention versus what is the result on the group that didn't get the intervention, and that's how you can evaluate whether your intervention is effective.
Speaker 1:So the way this selection was made was really random. So the researchers had already some, let's say, envelopes that had allocated which group every person would go. It was a random selection of those envelopes that every participant would get and then, if the participant was selected to get the intervention through the internet, then they would get a brief orientation about what the internet program would look like. They would get a pedometer and they would also get a caloric and fat guide for common foods and beverages. Now if somebody got the envelope where he or she was allocated to the usual care, then the parents would receive still some basic information about their nutrition, basic information about physical activity, but they did not receive the extra information about how to change the behavior and how to do the program through the internet. And of course, to be fair to the group that was randomly allocated to the usual care, they also offered this group four months. They followed them the opportunity to participate in the program after the whole program and the whole study was over, so that they didn't feel they missed out on the intervention.
Speaker 1:The researchers called this Intervention Student Bodies II Internet Program. It was a 16-week program delivered through the Internet where they would give weekly content that had basic education about the portion size, about the recommendations for daily activity. They would also give them exercises where they would do some self-monitoring and they would do some cognitive exercises for improving body image. Then, at the end of the first eight weeks of the program, we're really focused on making these changes in their behavior that would give them healthier lifestyle choices. After that, towards the last, the other half was mainly focused to improving their body image. They were expected to spend approximately one or two hours per week the group that was in this Internet program and certainly no more than 30 minutes per day. On top of that, there was a moderator in the group that emailed every participant a weekly e-mail and newsletter that was giving them feedback about their food, their physical activity, their weight journals, and all of the participants had access to this web-based program where they could keep records of their thoughts, their negative thoughts about their body image or what they were not doing right. They also had access to a portal where they could have a synchronous discussion with other adolescents that were also participating in the group so they can get some group support, and that was moderated by a member of the team.
Speaker 1:The participants adherence to the intervention group was encouraged by giving the opportunity to win a $20 gift card if they were able to adhere to all of the program requirements. There was also an opportunity for brief phone calls to check in about what were the difficulties with the programs and also there were weekly reminders sent out to them. Parents received also a monthly newsletter, again to encourage them to create positive and constructive home environment in an effort to increase and support as much as possible the adolescents. There was also somebody from the team to answer any questions and give extra guidance in case that was needed. That was really the main concept and the main design of the study At the end of the program.
Speaker 1:So they followed at the beginning after at the end of the program, which was, as I mentioned, 16 weeks, then after four months, they did not give the program anymore. However, they still ask them to come for another visit to continue to measure their height and weight and get some other measurements about how they felt, to see what was the long lasting the four months, what were the effects, whether those effects of the program continue to be the case, continue to be present after four months. They also gave them a needing disorder questioner that would also ask them some of these questions about how they felt and whether they had any eating disorder issues that could probably have been exacerbated by participating in this program. The main thing they were interested, of course, was what was the change in their weight. Let's see what they found. Are you ready for always this? This is my favorite part, where I go over the results.
Speaker 1:What did the researchers found? First of all, let me just tell you a brief description of the group that participated in this. As I mentioned, there was a total of 40 participants in the usual care and 40 participants in the intensive care. The average age of the people that participated in the intervention group was 14.9 years and the usual care was 14.1 years or so, not really different. Their average body mass index was 34.8 in the intervention group and 33.6 in the usual care. That is plus or minus 7.6 in the intervention group and plus or minus 6.3 in the usual care group. 65 percent of girls were participated in the intervention group, 60 percent in the usual care group, and there was a good mix of different races. So they had white, black and Hispanic. The white were 52.5 percent in one group and 47.5 in the usual care group. The black population was 27.5 percent in the intervention group and 25 percent in the other group, and 7.5 Hispanic in one group and 17.5 in the other group. So that was another strength of the study that it had participants from all different ethnic backgrounds and majority of them had access from their home, with only three participants that had internet access from other places. So let's go over what were the results of the study.
Speaker 1:So the researchers found that from baseline until the end of the program there was a significant change in the body mass index Z-score in the group that had intervention compared to the group that did not have intervention. But when they look at the formats after the end of the program there was not significant difference. But that happened because the group that was not receiving the intervention actually did better during the four months after the end of the program. So therefore the difference was limited and was not significant. However, the group that actually improved their body mass index during those four months was able to maintain that difference Even at the end of the program.
Speaker 1:And when we look at the actual weight differences, the group that had the intervention on average lost 0.14 pounds from baseline. Then when the program stopped, they gained on average four pounds. Now the usual care group gained 4.7 pounds on average during the first 16 week when it was the duration of the program, from baseline to post the program, and then they gained an additional 3.7 pounds from the end of the program until the fall-up four months after the end of the program Remember these are children, that they were still growing. Even though the weight loss per se was not significant, the actual body mass index, which is a measurement of a healthy weight that takes into account the height as well, improved significantly. I've talked about this before. We know that this is a huge advantage all teenagers have when they are trying to get to a healthier weight that even if they are able to maintain the weight and not gain an extra weight, that will translate to significant improvements and that will translate to getting to a healthier weight. Overall, the body mass index got better in the group that received the internet-based intervention and continued to be the same after four months of the program.
Speaker 1:In the group that did not receive the intervention just to receive the standard of care, they did not have a significant improvement during the first four weeks, but they did get an improvement after the first on the fall-up period. The other interesting thing which I think is important to bring out is that when they evaluated the changes in the eating-related skills the participants that received the intervention through the internet, they reported greater use of eating-related skills compared to the group that did not receive that. There was not a significant difference in the eating-related disorder questionnaire, which basically means that it was neither worse nor better, which means that this program did not increase eating disorder behavior in the group that received the intervention. I know it has been a concern for a lot of parents and some teenagers that they may get a eating disorder while they participate in this kind of programs. However, this particular study did not prove that to be true and it is possible that it's also not going to be proven true for other interventions that are similar to this program.
Speaker 1:Another important thing that I think this study showed us is that the satisfaction of the participant with the group was quite high. It was 63.2 of the participants felt that they were satisfied with the discussion group. 79 percent reported satisfaction with the overall group. It's also worth mentioning that there was also approximately 30 percent of the participants that did not actually follow the program and they followed less than 10 percent of the program. It is possible that if these participants were also following the program, then the results of the program would have been more robust. What does that tell us? It tells us that we need to find better ways to increase the engagement of the teenagers with web-based programs.
Speaker 1:If we wanted to get better results using this internet-based programs, potentially one way to increase that would be to have the parents be more involved in this program, potentially give more incentives to the lessons that are adhered to the program. It's certainly a topic where more reasons can be done to help us better understand what would increase the adherence of adolescents to these programs. The limitations of this program, of course, is that it was a relatively small size sample and they only looked at the four months after the end of the program, so we don't know what happens after a year. We don't know if the results would continue to be true if there was a bigger sample. However, I have to say it was a good sample. It gives us a signal that internet-based programs may be a good way to approach lifestyle changes, to approach this fight towards the complications future complications of pediatric obesity, and they're certainly promising, especially if they're well designed and supervised by a personnel that have experience in this field.
Speaker 1:So the take-home message again from this study is that behavioral intervention, especially those that may use the internet, could be beneficial in addressing the struggle towards making healthier lifestyle choices and involvement of the parents or incorporating methods to make the adherence to this program increase. It could be one of the ways to get more robust results. So that was all I had to do to deliver to you today. I hope you really enjoy this episode, and if you have any thoughts about it or questions, please feel free to reach out to me, and I will be talking to you again next week. Okay, take care you all. Bye-bye.
Speaker 2:If you enjoyed listening to this podcast, I invite you to come check out the LIFT program. It's Dr Gorgary's 12-week coaching program for teens and their moms, where we take all this information, we apply it to your daily life and we work together so your teenager learns how to create a healthy lifestyle so they can feel happier, more confident, less stressed and love their body again. Visit the website at lifestylefertinescom and click on the work with me and free resources to learn more about this program and get free help to start this journey right away. Thanks for tuning in and we'll catch you in the next episode of Lifestyle and Weight Loss for Teens.