Pediatric Obesity Consequences and Interventions: Characteristics Associated with Successful Weight Management in Children and Adolescents with Obesity

Abstract

Over the past three decades, pediatric obesity rates have tripled in the United States and affected 18.5% of children and adolescents. Obesity can affect all aspects of children and adolescents' life including their physical and psychological health. Lifestyle modification interventions that target behavior change for weight loss are effective treatments for obesity. Despite the effectiveness of these interventions, there is variability in weight loss among individuals, with some children being more successful with weight loss outcomes. There is a lack of consistent baseline factors to assist in identifying for whom these behavioral interventions may be most effective as a treatment for obesity. This dissertation is aimed to investigate the factors associated with better treatment outcomes and to create awareness among health care professionals regarding the need for individualized intervention for treating youth with severe obesity. The current series of studies were conducted to 1) investigate the impact of pediatric metabolic syndrome and obesity on the development of type 2 diabetes and cardiovascular diseases, 2) identify the factors that can influence weight management interventions for successful weight reduction among children and adolescents with obesity, and 3) examine the potential relation between executive function and obesity-related behaviors and the effect of executive function on the treatment outcomes among adolescent bariatric candidates. Results from Study 1 demonstrate that nearly 13% of children and adolescents with obesity and metabolic syndrome developed at least one of the associated diseases including hypertension, cardiovascular diseases, or type 2 diabetes later in their childhood or adolescence. The number of metabolic syndrome factors was significantly associated with the disease risk and the duration of being diagnosed with the diseases. The results from Study 2 showed that among all the potential factors, early weight loss response was the strongest predictor of treatment response for weight reduction at 6 months. These findings suggest that children and adolescents who lose more weight initially during treatment will continue to lose significantly more weight post-intervention. Findings from Study 3 revealed that executive function is associated with multiple obesity-related behaviors in adolescents with severe obesity during a bariatric preoperative intervention. Candidates with poorer executive function skills in daily life reported higher dysregulated eating behaviors, lower physical activity levels, and less confidence in resisting overeating. Overall, these findings highlight the importance of early evaluation of individual and treatment-level factors associated with weight loss, facilitating individualized intervention, and improved long-term outcomes.