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Clinical research in adolescents: challenges and opportunities using obesity as a model

Abstract

Adolescent medicine is relatively young, compared to paediatric or adult medicine. Descriptive and observational studies have dominated the adolescent literature, including those studies published in the International Journal of Obesity. In addition, many studies have combined child and adolescent age groups, making it difficult to determine adolescent-specific outcomes. It is important that high quality intervention studies in adolescents occur. Adolescence is a time of extraordinary plasticity. Habits, attitudes and physical morbidity that develop during adolescence set up trajectories that have a profound influence on health and wellbeing for the long term. Overweight and obesity are an excellent example of the need for high quality intervention studies and yet in the last two decades there have been very few randomized, controlled trials of overweight and obesity management in adolescents. There are a number of complexities in adolescent research that create additional challenges to those that accompany any clinical research. These include recruitment and retention, issues around consent and confidentiality and the central role that parents play in supporting the research protocol. Pubertal stage is a potential confounder and needs to be accurately measured. This is certainly true for studies in overweight and obesity where excess adiposity influences pubertal and other hormones. The opportunities to undertake quality research in adolescents are likely to be enhanced by the use of novel approaches which acknowledge the unique features of adolescents and their world.

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References

  1. http://www.adolescenthealth.org (accessed 12 September 2008).

  2. http://www.iaah.org (accessed 15 September 2008).

  3. Belfer ML . Child and adolescent mental disorders: the magnitude of the problem across the globe. J Child Psychol Psych 2008; 49: 226–236.

    Article  Google Scholar 

  4. Morad M, Kandel I, Hyam E, Merrick J . Adolescence, chronic illness and disability. Int J Adol Med Health 2004; 16: 21–27.

    Google Scholar 

  5. Delva J, Johnston LD, O’Malley PM . The epidemiology of overweight and related lifestyle behaviors: racial/ethnic and socioeconomic status differences among American youth. Am J Prev Med 2007; 33 (4 Suppl): S178–S886.

    Article  PubMed  Google Scholar 

  6. Giedd JN . Structural magnetic resonance imaging of the adolescent brain. Ann NY Acad Sciences 2004; 1021: 77–85.

    Article  Google Scholar 

  7. www.obesityguidelines.gov.au (accessed 12 September 2008).

  8. Srinivasan SR, Frontini MG, Berenson GS . Bogalusa Heart Study. Longitudinal changes in risk variables of insulin resistance syndrome from childhood to young adulthood in offspring of parents with type 2 diabetes: the Bogalusa Heart Study. Metab Clin Exp 2003; 52: 443–450.

    Article  CAS  PubMed  Google Scholar 

  9. Rosina R, Crisp J, Steinbeck KS . Treatment adherence of youth and young adults with and without chronic illness. Nursing Health Sci 2003; 5: 139–147.

    Article  Google Scholar 

  10. Burke ME, Albritton K, Marina N . Challenges in the recruitment of adolescents and young adults to cancer clinical trials. Cancer 2007; 110: 2385–2393.

    Article  PubMed  Google Scholar 

  11. Ojeda SR, Lomniczi A, Mastronardi C, Heger S, Roth C, Parent A-S et al. Minireview: the neuroendocrine regulation of puberty. Endocrinol 2006; 147: 1166–1174.

    Article  CAS  Google Scholar 

  12. Bass SL, Saxon L, Corral AM, Rodda CP, Strauss BJ, Reidpath D et al. Near normalisation of lumbar spine bone density in young women with osteopenia recovered from adolescent onset anorexia nervosa: a longitudinal study. J Pediatr Endocrinol Metab 2005; 18: 897–907.

    Article  PubMed  Google Scholar 

  13. Patton GC, Viner R . Pubertal transitions in health. Adolescent Health Monograph. Lancet 2007; 7–16.

  14. Tanner JM . Growth at Adolescence. 2nd edn. Blackwell: Oxford, 1962.

    Google Scholar 

  15. Havelock JC, Auchus RJ, Rainey WE . The rise in adrenal androgen biosynthesis: adrenarche. Sem Repro Med 2004; 22: 337–347.

    Article  CAS  Google Scholar 

  16. Shalitin S, Phillip M . Role of obesity and leptin in the pubertal process and pubertal growth—a review. Int J Obesity 2003; 27: 869–874.

    Article  CAS  Google Scholar 

  17. Whatmore AJ, Whatmore J, Hall CM, Jones J, Westwood M, Clayton PE . Ghrelin concentrations in healthy children and adolescents. Clin Endo 2003; 59: 649–654.

    Article  CAS  Google Scholar 

  18. Culbertson JL, Newman JE, Willis DJ . Childhood and adolescent psychologic development. Pediatric Clin N Am 2003; 50: 741–764.

    Article  Google Scholar 

  19. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH . Establishing a standard definition for child overweight and obesity: international survey. BMJ 2000; 320: 1240–1243.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Sopher A, Shen W, Pietrobelli A . Pediatric body composition. In: Heymsfield SH, Lohman TG, Wang ZM, Going SB (eds). Human Body Composition. Human Kinetics: Champaign, IL, 2005, pp 129–140.

    Google Scholar 

  21. Li H, Stein AD, Barnhart HX, Ramakrishnan U, Martorell R . Association between prenatal and postnatal growth and adult size and composition. Am J Clin Nutr 2003; 77: 1498–1505.

    Article  CAS  PubMed  Google Scholar 

  22. Cole TJ, Faith MS, Pietrobelli A, Heo M . What is the best measure of adiposity change in growing children:BMI, BMI%, BMI z-score or BMI centile? Eur J Clin Nutr 2005; 59: 419–425.

    Article  CAS  PubMed  Google Scholar 

  23. Pietrobelli A, Boner AL, Tatò L . Adipose tissue and metabolic effects: new insight into measurements. Int J Obes 2005; 29 (S2): S97–S100.

    Article  Google Scholar 

  24. Dorn LD, Dahl RE, Woodward HR, Biro F . Defining the boundaries of early adolescence: a user's guide to assessing pubertal status and pubertal timing in research with adolescents. Appl Dev Sci 2006; 10: 30–56.

    Article  Google Scholar 

  25. Wang Y . Is obesity associated with early sexual maturation? A comparison of the association in American boys versus girls. Pediatrics 2002; 110: 903–910.

    Article  PubMed  Google Scholar 

  26. Pasquali R, Gambineri A . Polycystic ovary syndrome: a multifaceted disease from adolescence to adult age. Ann NY Acad Sci 2006; 1092: 158–174.

    Article  PubMed  Google Scholar 

  27. Gordon-Larsen P, Adair LS, Nelson MC, Popkin BM . Five-year incidence in the transition period between adolescence and adulthood: the National Longitudinal Study of adolescent health. Am J Clin Nutr 2004; 80: 569–575.

    CAS  PubMed  Google Scholar 

  28. Coates TJ, Jeffery RW, Slinkard LA, Killen JD, Danaher BG . Frequency of contact and monetary reward in weight loss, lipid change and blood pressure reduction in adolescents. Behav Ther 1982; 13: 175–185.

    Article  Google Scholar 

  29. Brownell KD, Kelman JH, Stunkard AJ . Treatment of obese children with and without their mothers. Pediatr 1983; 71: 515–523.

    CAS  Google Scholar 

  30. Mellin LM, Slinkard LA, Irwin CE . Adolescent obesity intervention: validation of the SHAPEDOWN program. JADA 1987; 87: 333–338.

    CAS  Google Scholar 

  31. Saelens BE, Sallis JF, Wilfley DE, Patrick K, Cella JA, Buchta R . Behavioral weight control for overweight adolescents initiated in primary care. Obes Res 2002; 10: 22–32.

    Article  PubMed  Google Scholar 

  32. Berkowitz RI, Wadden TA, Tershakovec AM, Cronquist JL . Behaviour therapy and sibutramine for the treatment of adolescent obesity: a randomized controlled trial. JAMA 2003; 289: 1805–1812.

    Article  CAS  PubMed  Google Scholar 

  33. Ebbeling CB, Leidig MM, Sinclair KB, Hangen JP, Ludwig DS . A reduced-glycemic load diet in the treatment of adolescent obesity. Arch Ped Adol Med 2003; 157: 773–779.

    Article  Google Scholar 

  34. Deforche B, De Bourdeaudhuij I, Debode P, Vinaimont F, Hills AP, Verstraete S et al. Changes in fat mass, fat-free mass and aerobic fitness in severely obese children and adolescents following a residential treatment programme. Eur J Pediatr 2003; 162: 616–622.

    Article  PubMed  Google Scholar 

  35. Rolland-Cachera MF, Thibault H, Souberbielle JC, Soulie D, Carbonel P, Deheeger M et al. Massive obesity in adolescents; dietary interventions and behaviours associated with weight regain at 2y follow-up. Int J Obesity 2004; 28: 514–519.

    Article  CAS  Google Scholar 

  36. White MA, Martin PD, Newton RL, Walden HM, York-Crowe EE, Gordon ST et al. Mediators of weight loss in a family-based intervention presented over the internet. Obes Res 2004; 12: 1050–1059.

    Article  PubMed  Google Scholar 

  37. Godoy-Matos A, Carraro L, Vieira A, Oliveira J, Guedes EP, Mattos L et al. Treatment of obese adolescents with sibutramine: a randomized double-blind, controlled study. J Clin Endocrinol Metab 2005; 90: 1460–1465.

    Article  CAS  PubMed  Google Scholar 

  38. Chanonine JP, Hampl S, Jensen C, Boldrin M, Hauptman J . Effect of orlistat on weight and body composition in obese adolescents; a randomized controlled trial. JAMA 2005; 293: 2873–2883.

    Article  Google Scholar 

  39. Balagopal P, George D, Patton N, Yarandi H, Roberts WL, Bayne E et al. Lifestyle-only intervention attenuates the inflammatory state associated with obesity: a randomized controlled study in adolescents. J Pediatr 2005; 146: 342–348.

    Article  PubMed  Google Scholar 

  40. Berkowitz RI, Fujioka K, Daniels SR, Hoppin AG, Owen S, Perry AC et al. Effects of sibutramine treatment in obese adolescents, a randomised controlled trial. Ann Intern Med 2006; 145: 81–90.

    Article  CAS  PubMed  Google Scholar 

  41. Shah M, Simha V, Garg A . Review: long-term impact of bariatric surgery on body weight, comorbidities, and nutritional status. J Clin Endocrinol Metab 2006; 91: 4223–4231.

    Article  CAS  PubMed  Google Scholar 

  42. Inge TH, Xanthakos SA, Zeller MH . Bariatric surgery for pediatric extreme obesity: now or later? Int J Obesity 2007; 31: 1–14.

    Article  CAS  Google Scholar 

  43. Crosnoe R, McNeely C . Peer relations, adolescent behavior, and public health research and practice. Fam Community Health 2008; 31 (Suppl 1): S71–S80.

    Article  PubMed  Google Scholar 

  44. Breland-Noble AM, Bell C, Nicolas G . Family first: the development of an evidence based family intervention for increasing participation in psychiatric clinical care and research in depressed African American adolescents. Fam Process 2006; 45: 153–169.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Spigarelli M . Adolescent participation in research. J Adol Health 2008; 43: 1–2.

    Article  Google Scholar 

  46. Summerbell CD, Ashton V, Campbell KJ, Edmunds L, Kelly S, Waters E . Interventions for treating obesity in children. Cochrane Database Syst Revi 2003; 3: CD001872.

    Google Scholar 

  47. McGovern L, Johnson JN, Paulo R, Hettinger A, Singhal V, Kamath C et al. Treatment of pediatric obesity: a systematic review and meta-analysis of randomized trials. J Clin Endocrin Metab 2008; 9 September 2008 [E-pub ahead of print].

  48. Middlekoop K, Myer L, Mark D, Mthimunye SP, Smit JS, Wood R et al. Adolescent and adult participation in an HIV vaccine preparedness cohort in South Africa. J Adol Health 2008; 43: 8–14.

    Article  Google Scholar 

  49. Lemmens KP, Abraham C, Hoekstra T, Ruiter RA, De Kort WL, Brug J et al. Why don’t young people volunteer to give blood? An investigation of the correlates of donation intentions among young nondonors. Transfusion 2005; 45: 945–955.

    Article  CAS  PubMed  Google Scholar 

  50. Rojas NL, Sherrit L, Harris S, Knight JR . The role of parental consent in adolescent substance use research. J Adol Health 2008; 42: 192–197.

    Article  Google Scholar 

  51. Hunter CM, Peterson AL, Alvarez LM, Poston WC, Brundige AR, Haddock CK et al. Weight management using the internet a randomized controlled trial. Am J Prev Med 2008; 34: 119–126.

    Article  PubMed  Google Scholar 

  52. Williamson DA, Walden HM, White MA, York-Crowe E, Newton Jr RL, Alfonso A et al. Two-year internet-based randomized controlled trial for weight loss in African-American girls. Obesity 2006; 14: 1231–1243.

    Article  PubMed  Google Scholar 

  53. Rami B, Popow C, Horn W, Waldhoer T, Schober E . Telemedical support to improve glycemic control in adolescents with type 1 diabetes mellitus. Eur J Pediatr 2006; 165: 701–705.

    Article  PubMed  Google Scholar 

  54. Wilkins A, Mak DB . Sending out an SMS: an impact and outcome evaluation of the Western Australian Department of Health's 2005 chlamydia campaign. Health Promot J Austr 2007; 18: 113–120.

    Article  PubMed  Google Scholar 

  55. Lawson ML, Cohen N, Richardson C, Orbine E, Pham B . A randomized trial of regular standardized telephone contact by a diabetes nurse educator in adolescents with poor diabetes control. Pediatr Diabetes 2005; 6: 32–40.

    Article  PubMed  Google Scholar 

  56. Franklin V, Waller A, Pagliari C, Greene S . ‘Sweet Talk’: text messaging support for intensive insulin therapy for young people with diabetes. Diabetes Technol Ther 2003; 5: 991–996.

    Article  PubMed  Google Scholar 

  57. Ferrari A, Montello M, Budd T, Bleyer A . The challenges of clinical trials for adolescents and young adults with cancer. Pediatr Blood Cancer 2008; 50 (5 Suppl): 1101–1104.

    Article  PubMed  Google Scholar 

  58. Mattila VM, Parkkari J, Rimpela A . Adolescent survey non-response and later risk of death. A prospective cohort study of 78609 persons with 11-year follow up. BMC Public Health 2007; 7: 87.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Booth ML, Bernard D, Quine S, Kang MS, Usherwood T, Alperstein G et al. Access to health care among Australian adolescents: Young people's perspectives and their socio-demographic distribution. J Adolesc Health 2004; 34: 97–103.

    Article  PubMed  Google Scholar 

  60. Janssen I, Craig WM, Boyce WF, Pickett W . Associations between overweight and obesity with bullying behaviors in school-aged children. Pediatrics 2004; 113: 1187–1194.

    Article  PubMed  Google Scholar 

  61. Dalle Grave R, Calugi S, Molinari E, Petroni ML, Bondi M, Compare A et al. QUOVADIS Study Group. Weight loss expectations in obese patients and treatment attrition: an observational multicenter study. Obes Res 2005; 13: 1961–1969.

    Article  PubMed  Google Scholar 

  62. O’Connor J, Steinbeck KS, Hill AJ, Booth ML, Kohn MR, Shah S et al. Evaluation of a community-based weight management program for overweight and obese adolescents: the Loozit study. Nutr Diet 2008; 65: 121–127.

    Article  Google Scholar 

  63. Boys A, Marsden J, Stillwell G, Hatchings K, Griffiths P, Farrell M . Minimizing respondent attrition in longitudinal research: practical implications from a cohort study of adolescent drinking. J Adolesc 2003; 26: 363–373.

    Article  PubMed  Google Scholar 

  64. Day C . Children's and young people's involvement and participation in mental health care. Child Adol Ment Health 2007; 13: 2–8.

    Article  Google Scholar 

  65. Steinbeck K, Baur LA, Morris A, Ghersi D . A proposed protocol for the development of a register of trials of weight management of childhood overweight and obesity. Int J Obesity 2006; 30: 2–5.

    Article  CAS  Google Scholar 

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Steinbeck, K., Baur, L., Cowell, C. et al. Clinical research in adolescents: challenges and opportunities using obesity as a model. Int J Obes 33, 2–7 (2009). https://doi.org/10.1038/ijo.2008.263

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