Background

Lifestyle changes, such as diet and exercise, are the widely accepted first-line treatments for adolescents with obesity. However, successful lifestyle change is heavily dependent on recognizing the importance of societal and cultural factors.

Methods

Patients 12-19 years of age with a BMI ≥ 95th percentile are eligible for our local multidisciplinary adolescent weight loss clinic. Patients were seen every 4-6 weeks. A behavioral questionnaire was collected at the initial visit and clinical data was collected at every visit. The questionnaire was given to patients and caretakers, and focused on goal setting, support structures, socioeconomic data, and lifestyle habits.

Results

A total of 189 adolescents had an initial visit. Overall, receiving reduced cost meals was associated with a significantly lower likelihood of losing weight (p<0.01). When stratified by race, White adolescents were more likely to have lost weight if caretakers reported having enough money to buy healthy food (p<0.05); in contrast, Black adolescents were less likely to have lost weight (p<0.05). However, Black participants were more likely to lose weight if they reported eating fruits and vegetables (p<0.05). Hispanic adolescents were less likely to lose weight if they had been tested for sleep apnea (p<0.05); similarly, Black adolescents were less likely to lose weight if caretakers reported that they were too tired to lose weight (p<0.05). Female adolescents were more likely to lose weight if they felt unhappy about their appearance (p<0.05). Interestingly, male adolescents were less likely to lose weight if they felt unhappy about their appearance (p<0.05).

Conclusions

Social and cultural norms influence weight loss in adolescents in unique and differing ways. Tailoring weight loss interventions to be culturally competent could increase successful and sustainable lifestyle changes in diverse groups of adolescents with obesity.