title: Can early weight loss, eating behaviors and socioeconomic factors predict successful weight loss at 12- and 24-months in adolescents with obesity and insulin resistance participating in a randomised controlled trial?
abstract: BACKGROUND
  Lifestyle interventions in adolescents with obesity can result in weight loss following active intervention but individual responses vary widely. This study aimed to identify predictors of weight loss at 12- and 24-months in adolescents with obesity and clinical features of insulin resistance.
  
  
  METHODS
  Adolescents (n = 111, 66 girls, aged 10-17 years) were participants in a randomised controlled trial, the RESIST study, examining the effects of two diets differing in macronutrient content on insulin sensitivity. Eighty-five completed the 12-month program and 24-month follow-up data were available for 42 adolescents. Change in weight was determined by BMI expressed as a percentage of the 95th percentile (BMI95). The study physician collected socioeconomic data at baseline. Physical activity and screen time, and psychological dimensions of eating behavior were self-reported using the validated CLASS and EPI-C questionnaires, respectively. Stepwise multiple regressions were conducted to identify models that best predicted change in BMI95 at 12- and 24-months.
  
  
  RESULTS
  Mean BMI95 was reduced at 12-months compared with baseline (mean difference [MD] ± SE: -6.9 ± 1.0, P < 0.001) but adolescents had significant re-gain from 12- to 24-months (MD ± SE: 3.7 ± 1.5, P = 0.017). Participants who achieved greater 12-month weight loss had: greater 3-month weight loss, a father with a higher education, lower baseline external eating and parental pressure to eat scores and two parents living at home. Participants who achieved greater 24-month weight loss had: greater 12-month weight loss and a lower baseline emotional eating score.
  
  
  CONCLUSIONS
  Early weight loss is consistently identified as a strong predictor of long-term weight loss. This could be because early weight loss identifies those more motivated and engaged individuals. Patients who have baseline factors predictive of long-term weight loss failure may benefit from additional support during the intervention. Additionally, if a patient does not achieve early weight loss, further support or transition to an alternate intervention where they may have increased success may be considered.
  
  
  BACKGROUND
  Australian New Zealand Clinical Trial Registration Number (ACTRN) 12608000416392 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=83071.
authors.affiliation: Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia. megan.gow@health.nsw.gov.au.|The Children's Hospital at Westmead Clinical School, University of Sydney, Locked Bag 4001, Westmead, NSW, 2145, Australia. megan.gow@health.nsw.gov.au.
authors.forename: Megan L
authors.initials: ML
authors.lastname: Gow
authors.affiliation: The Children's Hospital at Westmead Clinical School, University of Sydney, Locked Bag 4001, Westmead, NSW, 2145, Australia.|Kids Research Institute, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia.
authors.forename: Louise A
authors.initials: LA
authors.lastname: Baur
authors.affiliation: The Children's Hospital at Westmead Clinical School, University of Sydney, Locked Bag 4001, Westmead, NSW, 2145, Australia.
authors.forename: Mandy
authors.initials: M
authors.lastname: Ho
authors.affiliation: Nutrition and Dietetics and Weight Management Services, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia.
authors.forename: Kerryn
authors.initials: K
authors.lastname: Chisholm
authors.affiliation: CSIRO Food and Nutritional Sciences, PO Box 10041, Adelaide BC, SA, 5000, Australia.
authors.forename: Manny
authors.initials: M
authors.lastname: Noakes
authors.affiliation: Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia.|The Children's Hospital at Westmead Clinical School, University of Sydney, Locked Bag 4001, Westmead, NSW, 2145, Australia.|Kids Research Institute, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia.
authors.forename: Chris T
authors.initials: CT
authors.lastname: Cowell
authors.affiliation: Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia.|The Children's Hospital at Westmead Clinical School, University of Sydney, Locked Bag 4001, Westmead, NSW, 2145, Australia.|Kids Research Institute, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia.
authors.forename: Sarah P
authors.initials: SP
authors.lastname: Garnett
mesh_terms: D000293:Adolescent; D001315:Australia; D015992:Body Mass Index; D000068959:Body Weight Maintenance; D002648:Child; D004032:Diet; D004435:Eating; D004644:Emotions; D005247:Feeding Behavior / Q000523:psychology; D005260:Female; D006801:Humans; D007333:Insulin Resistance; D008019:Life Style; D008297:Male; D009042:Motivation; D009520:New Zealand; D009765:Obesity / Q000523:psychology / Q000628:therapy; D010290:Parents; D012931:Social Environment; D012959:Socioeconomic Factors; D013997:Time Factors; D015431:Weight Loss
keywords: Eating behaviors; Insulin resistance; Obesity; Pediatric; Predictors; RESIST; Socioeconomic; Weight loss