Weight management in adolescents

Thesis

Approximately one in three adolescents in the United Kingdom is above a healthy weight. Excess weight is associated with both physical and mental health comorbidities and a high likelihood of persistence into adulthood. Behavioural weight management interventions (BWMIs) are currently considered the gold standard treatment for adolescents with excess weight; however, they are characterised by high attrition and limited effectiveness within this age group. This thesis aims to examine how we can better support adolescents to achieve and maintain a healthy weight.

I first conducted a secondary analysis of an existing childhood weight management programme delivered in both school and community settings to compare effectiveness. The findings indicated a modest advantage for school-based delivery; however, overall impacts on weight and health outcomes were limited. To explore alternatives to traditional BWMIs, I then undertook qualitative interviews with adolescents living with overweight or obesity and their parents to understand their perspectives on weight and weight management. Participants described both external pressure and an internal desire to lose weight, with adolescents’ perceptions often shaped by parental attitudes. Existing support systems were frequently viewed as insufficient and at times harmful, whereas positive role modelling was perceived as beneficial. Weight concern emerged as a common and distressing aspect of young people’s daily lives. These findings led me to examine the prevalence of weight concern, and its association with desire for support using data from a large school-based survey. This analysis showed that 41% of young people reported weight concern and 30% expressed a desire for weight management support, with weight concern strongly predicting help-seeking. Finally, I investigated the acceptability and uptake of a digital intervention in a feasibility trial of an app-based programme. Although the trial was not feasible in its current form, the intervention demonstrated promising evidence of effectiveness, suggesting that a digitally delivered approach may be viable with refinement of study procedures and intervention design.

Overall, this thesis showed that existing adolescent weight management services are often misaligned with young people’s preferences and experiences. Engagement improves when support is accessible and school-based interventions or digital options may be ways of achieving this. Weight management interventions must also acknowledge the role of weight concern and mental health, rather than focusing on weight alone.

Authors: Little, MA

• DOI: 10.5287/ora-o8jkbgn1n
• Type of award: DPhil
• Level of award: Doctoral
• Awarding institution: University of Oxford
• Language: English
• Keywords: obesity; weight; adolescents