Walking the teenage tightrope: tools for managing obesity in teenagers

Maryam Kebbe, PhD Graduand, University of Alberta.kebbe@ualberta.ca

Keywords: Adolescent; Health Services; Life Style; Obesity; Multilingualism

Figure 1: Example cards per category and suit in Conversation Cards for Adolescents©

Figure 1: Example cards per category and suit in Conversation Cards for Adolescents©

Imagine a time when you tried to change your lifestyle for the better. Now, imagine being a teenager with obesity going through emotional, physical, and social changes and trying to make those lifestyle changes in a fat-shaming environment with very few resources and support. For teenagers with obesity, lifestyle changes are key to improving their health and well-being [1]. However, teenagers are walking a tightrope act; most have suboptimal lifestyle habits [2] and may benefit from communicating better with health professionals to adopt healthy changes.

My research aimed to develop a clinical, bilingual (English and French) tool called Conversation Cards for Adolescents© (CCAs) (Figure 1) to help improve conversations between teenagers and health professionals and collaboratively set lifestyle-related goals. CCAs are based on behavioral change theories and principles of patient-centered care, which is a partnership approach to healthcare decision making between a patient and health professional [3]. Health professionals may not always possess knowledge of the real difficulties a teenager is likely to experience. Consequently, they may set a lifestyle goal inappropriate for the teenager, reducing his or her commitment to making a change. This highlights the importance of considering teenagers’ needs, priorities, and preferences both in practice and at earlier stages through bottom-up research designs.

From 2016 to 2018, I worked with Anglophone and Francophone teenagers with obesity as well as health professionals as partners and participants in my research to identify (through literature searches, panels, interviews, and focus groups) and prioritize (through surveys) factors that help or hinder teenagers’ success in making healthy lifestyle changes [please see 4-6 for more details]. Using data from 571 teenagers and 31 health professionals, we developed CCAs in collaboration with Obesity Canada, Canada’s leading obesity charity and authoritative voice on obesity prevention, treatment, and policy. CCAs are a deck of cards organized by seven lifestyle ‘suits’ (nutrition, physical activity, sedentariness, sleep, mental well-being, relationships, and clinical factors) and distributed over three categories (barrier, enabler, recommendation), with 15 cards per category. For example: “I feel like I am being watched or judged when doing physical activity in public” or “It’s helpful to start small and gradually work up when making lifestyle changes”. Teenagers and health professionals are encouraged to use the cards to collaboratively agree on main goals for change. As of January 2019, 500 English and 200 French decks were printed and are available for purchasing through Obesity Canada [7].

Data included in CCAs highlight the importance of tailored, multi-component, multi-level interventions for lifestyle management in teenagers with obesity. In ongoing research, we are examining the feasibility, user experiences, and preliminary impact of CCAs in a clinical setting to improve communication and lifestyle habits among teenagers with obesity. In being responsive of their needs, we hope that CCAs can facilitate and simplify walking the teenage tightrope.


[1] Ho M, Garnett SP, Baur L, Burrows T, Stewart L, Neve M, et al. Effectiveness of lifestyle interventions in child obesity: systematic review with meta-analysis. Pediatrics. 2012;130(6):e1647-71. DOI: 10.1542/peds.2012-1176

[2] Ball GDC, Lenk JM, Barbarich BN, Plotnikoff RC, Fishburne GJ, Mackenzie KA, et al. Overweight children and adolescents referred for weight management: are they meeting lifestyle behaviour recommendations? Appl Physiol Nutr Metab. 2008;33(5):936-45. DOI: 10.1139/H08088

[3] Hudon C, Fortin M, Haggerty J, Loignon C, Lambert M, Poitras ME. Patient-centered care in chronic disease management: a thematic analysis of the literature in family medicine. Patient Educ Couns. 2012;88(2):170-6. DOI: 10.1016/j.pec.2012.01.009

[4] Kebbe M, Damanhoury S, Browne N, Dyson MP, McHugh TLF, Ball GDC. Barriers to and enablers of healthy lifestyle behaviours in adolescents with obesity: a scoping review and stakeholder consultation. Obes Rev. 2017;18(12):1439-53. DOI: 10.1111/obr.12602

[5] Kebbe M, Perez A, Buchholz A, McHugh TLF, Scott SD, Richard C, et al. Barriers and enablers for adopting lifestyle behavior changes among adolescents with obesity: a multi-centre, qualitative study. PLoS ONE 2018;13(12):e0209219. DOI: 10.1371/journal.pone.0209219

[6] Kebbe M, Perez A, Buchholz A, Scott SD, McHugh TLF, Richard C, et al. Adolescents’ involvement in decision-making for pediatric weight management: a multi-centre qualitative study on perspectives of adolescents and health care providers. Patient Educ Couns 2019;102(6):1194-202. DOI: 10.1016/j.pec.2019.01.017

[7] Store/Boutique [Internet]. Obesity Canada, c2019 [cited 2019 Jun 24]. Available from https://obesitycanada.ca/store/