Family-based intervention helps improve weight in overweight/obese adolescents

The LITE (Lifestyle Intervention for Teenagers) programme, a family-based behavioural lifestyle intervention, demonstrates acceptability, feasibility as well as short-term clinical effectiveness in improving some clinical outcomes and adolescents’ perception of family support, according to a Singapore study.

“Participants in the LITE programme showed significant decreases in weight, waist circumference, waist-height ratio and systolic blood pressure (SBP) and increased dietary intake of vegetables at the end of 3 months … compared to usual care,” the researchers said.

This two-arm randomized controlled trial enrolled overweight and obese adolescents who attended a tertiary care weight management clinic. Sixty-one participants were randomly assigned to either the LITE programme (n=31) or usual care (n=30).

The primary outcome was body mass index (BMI) z-score, and secondary outcomes included anthropometric measurements, metabolic profile, parenting and adolescents’ perception of family support, which were measured at baseline, 3 and 6 months. Feasibility and acceptability of the intervention were also assessed.

Participants in the LITE programme, compared to those in the usual care group, had greater reduction in weight (–0.18±2.40 vs 1.48±1.97 kg; p=0.107), waist circumference (–0.96±3.11 vs 2.43±2.70 cm; p=0.016), waist–height ratio (–0.01±0.02 vs 0.01±0.02; p=0.040) and SBP (–3.81±13.7 vs 5.69±13.1; p=0.119) at 3 months. No significant between-group difference was found in BMI z-score. [Singapore J Med 2019;doi:10.11622/smedj.2019122]

Significant improvements were seen at 6 months in adolescents’ perception of family support for eating habits in the LITE group relative to the usual care group, but there was no significant difference in anthropometric measurements. In addition, the LITE programme achieved a high attendance rate (67.7 percent) and was well received.

“The lack of significant differences in waist circumference, waist–height ratio and SBP between the two groups at 6 months is consistent with the previously reported difficulty of maintaining a healthy lifestyle,” the researchers said. [Int J Obes Relat Metab Disord 2003;27:987-1005]

“Another possibility was that the monthly booster sessions were more poorly attended (51.6 percent) than the weekly sessions (79.8 percent), as the booster sessions were held on Friday evenings as opposed to the weekly sessions on Saturday mornings,” they added.

Common barriers for not attending the booster session according to parents and adolescents were school and work commitments.

Furthermore, “[r]eductions in waist circumference and waist–height ratio are of clinical importance, as [these] were shown to have a stronger correlation with cardiometabolic outcomes compared to BMI in a systematic review,” the researchers said. [Nutr Res Rev 2010;23:247-269]

The group setting in the LITE programme indicates its potential to be scalable in a community setting, which can be facilitated by a nonspecialist who is trained by a multidisciplinary weight management team using standardized resources, according to the researchers.

“Suggestions from adolescents and parents have provided valuable input for further development of the LITE programme to enable a modified programme to be evaluated in a larger-scale randomized trial,” they added.