White, WJ;
(2017)
Novel approaches in adolescent obesity management.
Doctoral thesis (PhD), UCL (University College London).
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Abstract
This PhD thesis on adolescent obesity focuses on the role of medical professionals and the interventions that they provide for obesity. We undertook a feasibility and acceptability study to examine HELPclinic, a novel brief weight management intervention delivered by health professionals in a specialist obesity service. The intervention was shown to be feasible and acceptable. Four overlying themes were captured in participant interviews: HELPclinic relationships enabled discussions of a difficult topic; lack of novel medical approaches polarised participants’ acceptance of HELPclinic; School vs HELPclinic – it’s hard to do both; and ongoing support is crucial. Qualitative interviews with young people and their families taking anti-obesity drugs (AOD) resulted in three theoretic models to explain their experiences of AOD, relating to commencement, relationship between dosing and side-effects, and drug cessation. Use of anti-obesity drugs is challenging for many adolescents. Multiple factors were identified that could be targeted to improve concordance and maximise efficacy. A survey of GP AOD prescribing found low prescribing prevalence. Metformin was largely initiated by specialists for co-morbidities associated with obesity, and orlistat was largely initiated by GPs and outside NICE guidance. GPs reported lower confidence in AOD prescribing and wanted more support. 3 A systematic review of the psychological/social outcomes of bariatric surgery in adolescents found a small evidence base with few high quality studies and outcomes rare beyond 2 years post-surgery. Quality of life and depressive symptoms improved after surgery. We present the first UK report of the outcomes of a bariatric surgery clinical pathway. Of fifty patients assessed, 12% were not eligible for surgery, 14% actively opted out,16% were lost to follow-up and 58% underwent surgery. Mean age at surgery was 18.3 years and mean BMI 53.1 kg/m2. BMI outcomes and complications post-surgery were similar to those published in research cohorts. Follow-up was inconsistent and challenging.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | PhD |
| Title: | Novel approaches in adolescent obesity management |
| Event: | UCL (University College London) |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Third party copyright material has been removed from ethesis. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Population, Policy and Practice Dept |
| URI: | https://discovery.ucl.ac.uk/id/eprint/1546430 |
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