Improving weight loss in young people living with obesity

Overweight and obesity affects one in three children in England. It is linked to other illnesses such as type 2 diabetes and having trouble breathing while asleep. Bristol’s care of childhood obesity (CoCO) clinic is a major pilot site for future childhood obesity services in NHS England’s Complications Related to Excess Weight (CEW) clinics.

Researchers from the CoCO clinic look at how changing eating behaviours and improving patient experience can affect weight loss. We investigate how behaviour (including eating speed and mindful eating), hormones and our brains affect relationships with food.

Our main aim during this research was to investigate how weight loss in young people living with obesity can be improved. We did this by co-developing a novel therapeutic intervention based on acceptance and commitment therapy (ACT) and informed by self-determination theory (SDT).

Self-determination theory

SDT is a theory dealing with the motivation behind peoples’ actions. Health and weight can be influenced by our habits and lifestyle choices. This means that motivation—the energy we use to achieve something like weight loss—plays a role in these choices and in our ability to make long-term changes for the benefit our health.

Our previous research used SDT to explain that intrinsic or internal motivation may be particularly important for weight change in young people – that is, changing behaviour because you want to, rather than because someone else has told you to.

Acceptance and commitment therapy

ACT helps participants accept feelings they might find difficult to deal with. They are encouraged to see these feelings as responses to certain situations and accept them, rather than seeing them as something that stands in the way of achieving their goals.

Project aims

This project focuses on developing an intervention that is acceptable to young people. It established how ACT could be used to encourage changes in behaviour and eating habits. Our aim was to develop an intervention that ultimately leads to improved weight management in young people living with obesity.

What we did

Reviewing ACT

We wanted to understand whether young people would find ACT acceptable for helping them to manage their weight and whether it would be feasible and beneficial to offer them this type of therapy. To do this, we explored current research into the topic. We identified six ACT-based interventions aimed at weight management and reviewed a total of 13 studies looking at these interventions.

We found that there is currently little evidence for recommending ACT in the treatment of adolescents with overweight or obesity. However, young people were very accepting of ACT-based therapy which they demonstrated through high programme attendance and retention rates.

Developing the intervention

We developed AIM2Change, a weight-management intervention for young people who hadn’t been able to make lifestyle changes while attending specialist weight-management services in the past.

AIM2Change is an ACT-based intervention that will be delivered during one-to-one online sessions over a seven-week period.

To develop this intervention, we:

• interviewed 12 families attending the CoCO clinic
• consulted with patient and public involvement groups (PPI)
• conducted a COM-B (capability, opportunity, motivation, behaviour) analysis

The approach provided us with a broad range of perspectives and helped us created a tailored intervention to meet the needs of our patient group whilst being pragmatic and deliverable.

What next?

The next steps for this intervention will be to co-develop the therapy sessions further with service users, before implementing a feasibility trial.

How we involved people

Young people and adults living with obesity attended six PPI sessions held online:

• at the design stage to discuss overall approach and preferred language
• pre and post ethical approval to improve information for participants
• at the design stage of the next feasibility trial to discuss ideas of what to measure
• at the final stage to provide us with overall feedback

PPI group members provided an evaluation of their experiences after each session.

This project involves work from Dr Aidan Searle, Dr Jennifer Cox, Dr Ella Hinton and Professor Julian Hamilton-Shield.