Getting the best help for overweight young people

Obesity among children and teenagers is on the increase worldwide. More and more people use food as a reward or a source of comfort, or as a way of escaping from the world around them -- with the result that they often become overweight.

This can lead to physical and psychological health problems, and is also very expensive for society as a whole.

According to figures from the Norwegian Directorate of Health, industrialised countries such as Norway spend between 1 and 2 per cent of their GDP on the treatment of health problems linked to people's lifestyles and life habits. In 2015 spending was equivalent to between NOK 31.8 and 64.1 billion. (Figures from Statistics Norway)

A physical and psychological problem

"Of course, we're finding that overweight is often the result of bad eating habits," says Nina Vanvik Hansen, who is a research engineer and Project Manager at SINTEF. "As are rule these habits are inherited. There are also issues of shame, often accompanied by bullying. For those affected, being overweight is both a physical and a psychological problem," she says.

Vanvik Hansen has nursing experience, and is now heading a pilot project called "Overweight among the young" (Ungdom og overvekt). She conducts interviews and workshops with overweight young people and their parents with the aim of finding out how we can best communicate with and follow up young people with eating and weight-related problems.

The researchers have also carried out a thorough needs assessment to obtain a picture of what they call the "user's journey" that young people suffering from obesity experience across both the specialist and primary health care services.

"Our aim is to use the results to progress to a stage where we can better define the issue and take our findings from this study forward" explains Anne Karen Aanonli, who is an industrial designer and a colleague of Vanvik Hansen at SINTEF.

"Our aim is develop one or more digital tools that can help young people to control their food intake and activity levels. What is special about this project is its high level of user participation which in turn influences the result. So firstly we examine the needs of all those involved in service provision, and then attempt to develop concepts that meet these needs in the best way possible," she says.

A welcome development

Physiotherapist Marte Volden works in a cross-disciplinary team at the obesity clinic at St. Olav's Hospital in Trondheim, and welcomes such a tool.

"Young people are the group with which we have the least success. For them I see a clear need for innovative thinking when it comes to motivation and supervision," she says.

Volden has extensive experience in treating young people with weight problems, and their families. She believes that a digital support tool is a good idea, not least because young people often struggle to maintain their motivation over time.

"Young people lead busy lives. Things are happening all the time and food is often readily available," she says. "In many ways we're living in a society that promotes obesity. Making sure that young people's motivation to maintain control over their food intake is a time-consuming and resource-demanding business. For this reason I believe that a digital tool may be of great help because it will create opportunities for much closer levels of supervision than we are achieving today. It may also contribute towards a feeling of autonomy, so I'm looking forward to trying it out," says Volden.

Linked to shame

In her role as Project Manager, Nina Vanvik Hansen has participated in the interviews and workshops conducted with the young people. She tells Gemini that many of those who took part in the project were already receiving treatment for overweight at their local hospitals, and so were very familiar with current treatment regimes.

"What we found was that many young people thought there was a lot of hassle associated with the regime when their parents were assigned with supervising treatment between visits to the doctor," she says.

Many responded that they preferred it when supervision was carried out by someone with whom they had no personal relationship. They most preferred supervision to be carried out by health service personnel.

The researchers also found that it was important that the young people were not regarded as ill as a result of being overweight.

"Being overweight is not considered to be an illness. In medical terms a patient is not ill until overweight is diagnosed as obesity," explains Vanvik Hansen.

"For this reason it is important that health services targeting overweight young people focus on providing knowledge about food and nutrition, while at the same time not contributing to increased body dissatisfaction or pathologizing overweight. Being overweight can also create problems with social relationships. Many of those interviewed were ashamed of their own bodies and felt embarrassed eating in public. One of the girls said that she never ate at school because she was overweight. As a result, she binged when she came home after school," she says.

More knowledge

Most of the young people who took part in the study enjoyed preparing food, and often cooked food themselves. However, they also said that they knew too little about food and nutrition and wanted some practical tips.

"Another said that she would like to see a system similar to AA (Alcoholics Anonymous)," says Vanvik Hansen. "A network where people could share their experiences and get support and encouragement to be themselves and talk openly about the problem. It is, after all, a problem that many share," she says.

"The project has also revealed that general practitioners and health visitors both wanted better and simpler ways of communicating with young people so that supervision before, during and after consultations could be made easier. Moreover, we recognise a need to detect and get a handle on young people's weight problems at an even earlier stage. This is where health visitors can play a vital role when it comes to prevention, not least because this is always easier than treatment," she says.

"It is often the health visitor that first identifies overweight in children. Furthermore, a closer working relationship with doctors will make the health visitor's job easier. Obesity in children is a sensitive issue that isn't always easy to bring up with the parents. We've all read stories in the media about health visitors exposed after labelling children as overweight. It may give them some sense of security to know that a doctor is 'covering their back'," says Vanvik Hansen.

Game or app?

The research team also made many other findings that reveal details about the day-to-day lives, thoughts and problems of overweight young people.

"We found that the key lies in identifying effective platforms for communication and information," says Anne Karen Aanonli. "It's important that this develops into something that the young people feel they own -- in the sense that 'this is me and my life'. Self-motivation is essential," she says.

Aanonli is now well underway with expanding the project across the whole country.

The researchers are now looking for opportunities to develop a digital system based on elements from games technologies, among others. The completed system will motivate, instruct, communicate with, and boost the self-esteem of the young people who use it. But no decision has yet been made as to whether this will be in the form of a website, an app, or perhaps a separate computer program.

"Our aim is to develop a tool that can be introduced to obesity patients at St. Olav's, but which also has transfer value to other hospitals and patient groups" says Aanonli.

The project owners are St. Olav's Hospital and Overhalla municipality, with funding provided by the Norwegian Directorate of Health and Innovation Norway.