Evidence to Guide Best Practice with Overweight Adolescents
Stephanie Van Blankenstein, College of Nursing, Arizona State University, Tempe, AZ, USA
Overweight is a national epidemic that occurs in 16% of adolescents in the United States. The rate of overweight in adolescents, defined as Body Mass Index (BMI) ≥ 95th percentile, is continuing to rise despite numerous public campaigns and programs to increase awareness and modify unhealthy lifestyle patterns. Interventions that have been efficacious in producing favorable changes in body composition include 1) low-intensity, long-duration exercise, 2) aerobic exercise combined with high-repetition resistance training, and 3) exercise programs combined with a behavioral-modification component. An encouraging approach to treating overweight has emphasis on risk factor modification rather than weight loss. This approach focuses on skill building that can continue throughout the lifespan. Physical activity is key in this process. Developing patterns of activity that can be sustained throughout the lifespan is vital. Nutrition education should focus on healthy eating patterns rather than calorie restriction.
Mixed results have been identified in numerous intervention programs with overweight adolescents regarding weight loss. Some studies have demonstrated a decrease in BMI, whereas others do not indicate a decrease in BMI. Conclusions from a meta-analysis of interventions for overweight children by Summerbell and colleagues (2005) did not find a decrease in BMI when studies combined diet and activity interventions, although behavior goals were significantly reached. Conversely, in the same meta-analysis, when diet or physical activity is individually targeted, BMI decreased. In another meta-analysis by Mazekias and colleagues of exercise studies in pediatric obesity, the authors concluded that physical activity was efficacious for reducing the percentage of body fat in overweight children and adolescents. Similar to the findings of Summerbell and colleagues, several studies did not find a decrease in BMI. The importance of body composition rather than weight as a marker of improved fitness is substantial. Best practice recommendations based on the evidence reviewed will be presented.