Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany.
Division of Pediatric Endocrinology, Department of Medicine, Boston Children's Hospital, Boston, MA, USA.
Int J Obes (Lond). 2019 Jan;43(1):103-115. doi: 10.1038/s41366-018-0237-4. Epub 2018 Oct 27.
Adolescent extreme obesity is associated with somatic and psychiatric comorbidity, low quality of life, and social dysfunction. Nevertheless, few adolescents seek obesity treatment, thus many may elope appropriate care. We examine whether previous treatment seeking relates to disease burden, and whether previously non-treatment seeking adolescents accept diagnostic and therapeutic offers. This information is important to inform intervention strategies.
The Youth with Extreme obesity Study (YES) is a prospective, multicenter cohort study. We developed a novel recruitment strategy to span medical and vocational ascertainment settings and directly compare previously treatment seeking and non-treatment seeking youth. Participants aged 14-24 years; BMI ≥ 30 kg/m were enrolled at four medical- and one job centers. We present comorbidity and psycho-social baseline data by sex, obesity WHO grade I-III, and treatment-seeking status, defined as self-reported previous participation in a weight-loss program.
Of 431 participants, 47% were male; mean age 16.6 (standard deviation 2.3) years, BMI 39.2 (7.5) kg/m. Somatic comorbidity increased with obesity grade, p < 0.05: hypertension (42, 55, 64%), dyslipidemia (28, 24, 37%,), dysglycemia (9, 19, 20%,), elevated transaminases (15, 26, 30%). Quality of life (EQ5 D) decreased (74, 71, 70). Rates of psychiatric disorders were stable: depression 11%, attention deficit disorder 6%, substance use disorder 2%, self-injurious behavior 5%, suicide attempt 3%. Only 63% (56, 64, 69%) reported previous treatment seeking. Acceptance of the diagnostic (89%) or therapeutic (28%) program, medical or psychosocial situation did not differ by treatment seeking status. Acceptance of the therapeutic program was generally low, but high at the job center (92%).
Irrespective of previous treatment seeking, adolescent extreme obesity was associated with high comorbidity and psychosocial burden. Acceptance of the diagnostic program overall and the therapeutic program at the job center were high. This underscores the need of innovative, accessible programs beyond the currently offered care.
青少年极端肥胖与躯体和精神共病、生活质量低和社会功能障碍有关。然而，很少有青少年寻求肥胖治疗，因此许多人可能会错过适当的治疗。我们研究了以前的治疗寻求是否与疾病负担有关，以及以前不寻求治疗的青少年是否接受诊断和治疗。这些信息对于制定干预策略非常重要。
青少年极度肥胖研究（YES）是一项前瞻性、多中心队列研究。我们开发了一种新的招募策略，涵盖了医疗和职业发现环境，并直接比较了以前接受治疗和未接受治疗的青少年。参与者年龄在 14-24 岁之间，BMI≥30kg/m，在四家医疗中心和一家职业中心参加了研究。我们按性别、肥胖 WHO 分级 I-III 和治疗寻求状态（定义为自我报告的以前参加过减肥计划）报告了共病和心理社会基线数据。
在 431 名参与者中，47%为男性；平均年龄 16.6（标准差 2.3）岁，BMI 为 39.2（7.5）kg/m。躯体共病随肥胖程度增加而增加，p<0.05：高血压（42%、55%、64%）、血脂异常（28%、24%、37%）、血糖异常（9%、19%、20%）、转氨酶升高（15%、26%、30%）。生活质量（EQ5 D）下降（74%、71%、70%）。精神障碍的发生率稳定：抑郁症 11%，注意缺陷障碍 6%，物质使用障碍 2%，自伤行为 5%，自杀企图 3%。只有 63%（56%、64%、69%）报告了以前的治疗。诊断（89%）或治疗（28%）计划、医疗或心理社会状况的接受率不因治疗寻求状态而不同。治疗计划的接受率总体上较低，但在职业中心较高（92%）。
无论以前是否接受过治疗，青少年极端肥胖都与高共病和心理社会负担有关。总体上，诊断计划和职业中心的治疗计划的接受率较高。这突显了需要创新、可及的方案，以补充目前提供的治疗。
