In English, Vaikuttava korkeakoulu 2.3.2023

Adolescence presents a window of opportunity for action in weight management: Exploring the reasons and possible interventions

Teksti | Meri Vuorinen , Susan Keino

Overweight and its associated health problems is an emerging global pandemic of public health significance that is threatening to erode several years of efforts to improve nutritional status of the general public. It does not discriminate based on gender, age, race or geographic boundaries. Excess weight, especially obesity is the most visible form of malnutrition yet neglected. It’s a disease that impacts an individuals’ overall well-being and diminishes quality of life.  Thus, the need for urgent action and immediate action. This paper focuses on adolescent, as it presents a window of opportunity for focused and targeted innovative interventions before adulthood. Digital technology is widely used among the youth and if explored more it can offer solutions to a wide array of challenges. In this paper we will also explore the use of such innovations in weight management among the youth.

illustration.
Photo: Andres Ayrton / Pexels

Overweight, which occurs when there is an excess of adipose tissue at a given body as a result of inappropriate matching of energy intake to expenditure (Cottrell & Ozanne 2008), has reached epidemic proportions in many countries (Uzogara 2016). Nearly 30 % of global population were overweight in 2014, and if the incidence continues, almost half of the adult population will be overweight or obese by 2030 (Dobbs et al., 2014; Tremmel et al., 2017).  There are 1.3 billion adolescents in the world making up 16% of the world’s population (UNICEF 2022). Africa contributes to about 23 % of  global population of adolescent (Mtongwa, Festo & Elisaria 2021) and this is expected to rise to 28 % in 2040, whereas in Europe the population of those under 20 years is declining (UN 2012; European Union 2021). The increasing child and adolescent overweight will spell doom for the future generation if no immediate action to halt its spread.  The European region of the World Health Organization (WHO) carries the highest burden of childhood overweight and obesity in all the WHO regions (Executive Board 2017; Wickramasinghe et al., 2021). The United Nations recently indicated that the obesity levels in Europe have reached epidemic proportions and no member state is on track to reach the target of halting the rise by 2025 (WHO, Regional Office for Europe 2022). Geographic distribution of the overweight and obesity clearly indicates a unique nutritional challenge unlike other forms of malnutrition which concentrate in specific areas of poverty and food insecurity, overweight knows no boundaries or boarders.

WHO defines adolescence as the phase of life between childhood and adulthood, and an important stage of human development in terms of laying foundations for good health (WHO 2022). Adolescent is a time of rapid physical, emotional, intellectual and social changes as the body matures these include rapid physical development and further developments in personality, social attitudes and social skills (WHO 2022). As they grow and develop, young people are influenced by outside factors such as parents, peers, community culture, religion, school, world events and the media (Spano 2004). This transition period between childhood and adulthood occupies a greater portion of the life course and is characterized by unprecedented social forces including marketing and digital media (Sawyer et al., 2018). Peer groups also influence their personal interests and style (Spano 2004).  In addition to these changes, adolescent, also have hormonal and emotional changes that occur at this age which may contribute to them being susceptible to uncontrolled eating behaviors leading to excess weight gain.  Hormonal changes may affect mood, and this may lead to one resorting to food as a comfort. Due to the need to be belong and associate with their peers, adolescents always find themselves doing what others do. It is very common to find the youth hanging out in the malls and eating places and are susceptible to changing dietary habits to be with their peers.

There are several reasons why adolescent overweight needs to be halted through successful weight management before they reach adulthood.  One of the reasons is the intergenerational cycle of overweight. The intergenerational cycle indicates that if a mother is overweight, they have higher probability of delivering an overweight baby and this child may grow up to be an overweight adult. And if the child is a girl, the probability of this girl growing up and delivering an overweight child herself is high and the cycle continues. Several studies have demonstrated that there is a strong relationship between maternal obesity and obesity among their offspring, indicating a transmission from mother to child (Claydon et al., 2019; Dong et al., 2022; Mohamed et al., 2022). Secondly, an overweight adolescent has higher chance of transitioning to be an overweight adult as opposed to an overweight child. A study in Norway by Kvaavik, estimated that the probability of a 4 -year old child to become an obese adult is 20%, while the probability of an adolescent being obese adult is 80% (Simmonds et al., 2016). This means that interventions during adolescents play a significant role in reducing the burden of overweight among adults. Thirdly, overweight is a public health threat responsible for many diseases, disability and deaths.  Fourthly, other than overweight being a public health threat, it also carries an economic burden.  In 2014, the economic burden of obesity was estimated to be USD 2.0 trillion or 2.8 % of global Gross Domestic Product (Tremmel et al., 2017). Consequentially, adolescents who are overweight and obese may develop psychological issues such as poor self-esteem, anxiety, inability to make and maintain friends (Kansra, Lakkunarajah & Jay, 2021).  Most complications arising from adolescent overweight occur in adulthood, making this transitional developmental phase important in terms of weight management to avoid spillover of risks being carried to adulthood. For example adolescent mental health issues are more likely to place individuals in an increased risk for more difficult cases as adults (Collins & Muñoz-Solomando 2018).  Therefore, by addressing overweight and obesity early enough, and more so during adolescent period we will be sparing a generation of lifelong disease burden as well as reduce the economic burden of the disease, which is high as one reach adulthood and old age.

Adolescence period presents a window of opportunity for action in nutrition intervention since it is the transitional period between childhood and adulthood (WHO, 2005). Several studies on weight management have reported successes in controlling weight among adolescents stories in that adolescents are more likely to respond to interventions than other age groups (Rancourt et al., 2018; Steinbeck et al., 2018). Although weight management is a continuous process, children and adolescent seem to master and maintain weight management routines, however among successful adults, the process had to start during childhood (Joki et al., 2020). Adolescents respond to weight management interventions and seek to reduce and control their weight for reasons such as appearance and acceptance by peers (Silva et al., 2018). Of importance to note is that most weight control studies report that age is not significant while treating adolescent and reporting success in weight loss (Rancourt et al., 2018). This is because studies treat adolescents as homogenous groups despite differences in developmental changes between early, mid and late adolescents (Rancourt et al., 2018). Successful interventions for adolescent weight management include dietary intake, physical activity, however delivery of treatment through internet and telephone are novel and most welcome ideas among this group (Butryn et al., 2010).  These traditional overweight interventions targeting diet and exercise improvements have reported inconclusive result on effectiveness. A Cochrane review and meta-analysis (conducted mostly in high-income countries) showed that school-based obesity prevention interventions had modest to no effect on the BMI (Hodder et al., 2022). However, interventions with multidisciplinary approach including family support and guided behavior modification seem to reduce BMI with overweight and obese adolescent (Boff et al., 2017).

Whereas, the Global Food Security Index, indicate that the Finnish people have the highest food security in the world (Global Food Security Index 2022), however dietary habits among underlying challenges are pushing up the numbers of overweight among adolescents. In Finland, the prevalence and trends among adolescents indicate that 29% boys and 17% girls are overweight (WHO 2013). To control the spread of overweight and obesity in Finland, several strategies have been put in place. One such strategy was the National Obesity Programme between 2012-2018 (The wellbeing through nutrition and physical activity) coordinated by The National Institute for Health and Welfare with the overall aim to achieve a downward trend in obesity. Another one is On the Move: The National Strategy for Physical Activity Promoting Health and Wellbeing, 2020. Leveraging on these programmes, and the recommendations as well as lessons learnt, there is need to find more innovative ways to reduce overweight. In addition, there is no single intervention that can work against overweight and that there is need for a collaborative approach and more so within early education, schools, and other stakeholders working with parents and children.  Treating childhood and adolescent obesity should be based on multi-professional expertise of medicine, nutritional science, behavioral sciences, and physiotherapy (The Finnish Medical Society Duodecim, 2021). Such approach is used in an ongoing adolescent weight management-project (Nuorten paino hallintaan) at Laurea University of Applied Sciences, aiming to develop a school-based multidisciplinary and multi-professional cognitive-behavioral method-based strategy to decrease overweight among 13–18-year-olds. Within this project we want to draw attention not only the physical health but also to the psychological and social issues related to obesity and overweightness, such as loneliness, depression, and risk of being bullied (Rankin et al., 2016).

In the school-environment adolescent overweightness can easily be seen mainly from the physical point of view in which case addressing the complex issue is the responsibility of the school nurses. This is one of the emerged challenges of implementing multi-professionalism in schools and educational institutions even when we have found that there is a common will to target adolescent overweightness. One of the unexpected observations in our preliminary findings is that among the adolescent, the term weight management is not in fact a neutral term, but a term already loaded with prejudices and stigma making the weight talk difficult. Within the project we are testing the feasibility of a digital weight management application as part of a school health care system. This offers a novel way for the adolescents to reflect their thoughts and experiences regarding weight and well-being at their own pace. Rising overweight statistics show that there is a need for novel and innovative approach including multi-disciplinary and multi-profession strategies to change the course of overweight among adolescents.

Targeting adolescents is a move aimed at intervening against the spiraling overweight cases and to prevent the tipping of overweight scale towards adulthood as well reduce direct impacts that range from health and economic to indirect impacts such as social and physical. Adolescents, being digitally inclined as opposed to adults make them the best group to target with digital innovations in weight management now and in future. Research and best practice have shown that innovations must utilize multi-disciplinary and multi-professional approaches to improve overall outcome.

Authors:

Susan Keino1,2  and Meri Vuorinen1*

  1. Laurea University of Applied Sciences, Otaniemi Campus, Metsänpojankuja 3.02130 Finland
  2. Moi University, School of Public Health, P.O Box 4606, 30100, Eldoret, Kenya

*Corresponding Author: Meri.Vuorinen(at)laurea.fi; Tel: +358504316237

References:

URN http://urn.fi/URN:NBN:fi-fe2023030229223
Meri Vuorinen
meri.vuorinen(at)laurea.fi
Senior Lecturer
Susan Keino
susan.keino(at)laurea.fi
Specialist

Adolescent health Digital technology Obesity Overweight Weight management
Jaa sivu