Psychosocial Interventions in the Treatment of Severe Adolescent Obesity: The SHINE Program



      Psychosocial interventions (PSIs) are characterized by three phases: (1) an initial in-depth assessment, (2) an intensive multifaceted intervention to stem a condition, and (3) an extensive maintenance program. PSIs are often used for treatment of mental health conditions; however, applicability in the treatment of adolescent obesity is unknown. This article sought to evaluate the service-level outcomes of a PSI for young people (aged 10–17) with severe obesity.


      A retrospective evaluation of participants attending the Self Help, Independence, Nutrition and Exercise program between 2011 and 2016 (n = 435; age: 13.1 ± 2.1 years, male: 51%, white: 87.4%, body mass index [BMI]: 33.5 ± 7.5 kg/m2, standardized BMI [BMI SDS]: 3.1 ± .5 units). Anthropometric measurements (BMI and waist circumference) were collected at baseline, 3, 6, 9, and 12 months. Psychosocial measures (anxiety, depression, and self-esteem) were collected at baseline and 3 months. Participant retention was also assessed.


      After 3 months, 95% of participants remained with a mean BMI SDS reduction of .19 units (95% confidence interval: .17, .21). Anxiety, depression, and self-esteem improved by 50%, 54%, and 38%, respectively. BMI SDS reductions of .29, .35, and .41 units were found at 6, 9, and 12 months. Fifty-four percent of participants chose to attend the final intervention phase. A higher baseline BMI SDS and a greater reduction in BMI SDS predicted final intervention phase attendance.


      The Self Help, Independence, Nutrition and Exercise PSI demonstrated positive mean reductions in all measurements across all time points. In contrast to other community-based weight management services, these results suggest the utility of, and further exploration of, PSIs in the treatment of severe adolescent obesity.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Adolescent Health
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Public Health England
        Child weight data factsheet.
        Public Health England, London2014
        • Singh A.S.
        • Mulder C.
        • Twisk J.W.
        • et al.
        Tracking of childhood overweight into adulthood: A systematic review of the literature.
        Obes Rev. 2008; 9: 474-488
        • Nieman P.
        • LeBlanc C.
        Psychosocial aspects of child and adolescent obesity.
        Pediatr Child Health. 2012; 17: 205-206
        • Department of Health
        Developing a specification for lifestyle weight management services: Best practice guidance for tier 2 services.
        Department of Health, London, UK2013
        • Public Health England
        National mapping of weight management services.
        Public Health England, London, UK2015
        • National Institute for Health and Care Excllence
        Managing overweight and obesity among children and young people: Lifestyle weight management services.
        National Institute for Health and Care Excellence, London2013
        • Upton P.
        • Taylor C.E.
        • Peters D.M.
        • et al.
        The effectiveness of local child weight management programmes: An audit study.
        Child Care Health Dev. 2013; 39: 125-133
        • Dalen J.
        • Brody J.L.
        • Staples J.K.
        • Sedillo D.
        A conceptual framework for the expansion of behavioral interventions for youth obesity: A family-based mindful eating approach.
        Child Obes. 2015; 11: 577-584
        • Forsman A.K.
        • Nordmyr J.
        • Wahlbeck K.
        Psychosocial interventions for the promotion of mental health and the prevention of depression among older adults.
        Health Promot Int. 2011; 26: 85-107
        • Gamble C.
        • Hart C.
        The use of psychosocial interventions.
        Nurs Times. 2003; 99: 46-47
        • Lonigan C.J.
        • Elbert J.C.
        • Johnson S.B.
        Empirically supported psychosocial interventions for children: An overview.
        J Clin Child Psychol. 1998; 27: 138-145
        • Yach D.
        • McKee M.
        • Lopez A.D.
        • et al.
        Improving diet and physical activity: 12 lessons from controlling tobacco smoking.
        BMJ. 2005; 330: 898-900
        • Bray G.A.
        Obesity is a chronic, relapsing neurochemical disease.
        Int J Obes Relat Metab Disord. 2003; 28: 34-38
        • Sharman K.
        • Nobles J.
        SHINE: A stepped care approach to the management of severe obesity in young people.
        Prim Health Care. 2016; (in press)
        • Cole T.J.
        • Freeman J.V.
        • Preece M.A.
        Body mass index reference curves for the UK, 1990.
        Arch Dis Child. 1995; 73: 25-29
        • Hoffmann T.C.
        • Glasziou P.P.
        • Boutron I.
        • et al.
        Better reporting of interventions: Template for intervention description and replication (TIDieR) checklist and guide.
        BMJ. 2014; 348: 1-12
        • McCarthy H.D.
        • Jarrett K.V.
        • Crawley H.F.
        The development of waist circumference percentiles in British children aged 5.0-16.9 years.
        Eur J Clin Nutr. 2001; 55: 902-907
        • Ells L.J.
        • Hancock C.
        • Copley V.R.
        • et al.
        Prevalence of severe childhood obesity in England: 2006–2013.
        Arch Dis Child. 2015; 100: 1-6
        • Rosenberg M.
        Society and the adolescent self-image.
        Princeton University Press, Princeton, New Jersey1965
        • Zigmond A.S.
        • Snaith R.P.
        The hospital anxiety and depression scale.
        Acta Psychiatr Scand. 1983; 67: 361-370
        • White D.
        • Leach C.
        • Sims R.
        • et al.
        Validation of the hospital anxiety and depression scale for use with adolescents.
        Br J Psychiatry. 1999; 175: 452-454
        • White I.R.
        • Horton N.J.
        • Carpenter J.
        • et al.
        Strategy for intention to treat analysis in randomised trials with missing outcome data.
        BMJ. 2011; 342: 1-4
        • Upton P.
        • Taylor C.E.
        • Erol R.
        • Upton D.
        Family-based childhood obesity interventions in the UK: A systematic review of published studies.
        Community Pract. 2014; 87: 25-29
        • Rudolf M.
        • Christie D.
        • McElhone S.
        • et al.
        Watch it: A community based programme for obese children and adolescents.
        Arch Dis Child. 2006; 91: 736-739
        • Robertson W.
        • Friede T.
        • Blissett J.
        • et al.
        Pilot of “Families for Health”: Community-based family intervention for obesity.
        Arch Dis Child. 2008; 93: 921-926
        • Oude Luttikhuis H.
        • Baur L.
        • Jansen H.
        • et al.
        Interventions for treating obesity in children.
        Cochrane Database Syst Rev. 2009; 1: CD001872
        • Ford A.L.
        • Hunt L.P.
        • Cooper A.
        • Shield J.P.
        What reduction in BMI SDS is required in obese adolescents to improve body composition and cardiometabolic health?.
        Arch Dis Child. 2010; 95: 256-261
        • Reinehr T.
        • Andler W.
        Changes in the atherogenic risk factor profile according to degree of weight loss.
        Arch Dis Child. 2004; 89: 419-422
        • Kolotourou M.
        • Radley D.
        • Chadwick P.
        • et al.
        Is BMI alone a sufficient outcome to evaluate interventions for child obesity?.
        Child Obes. 2013; 9: 350-356
        • Jensen C.D.
        • Duraccio K.M.
        • Hunsaker S.L.
        • et al.
        A qualitative study of successful adolescent and young adult weight losers: Implications for weight control intervention.
        Child Obes. 2014; 10: 482-490
        • Skelton J.A.
        • Beech B.M.
        Attrition in paediatric weight management: A review of the literature and new directions.
        Obes Rev. 2010; 12: 273-281
        • Watson P.M.
        • Dugdill L.
        • Pickering K.
        • et al.
        Service evaluation of the GOALS family-based childhood obesity treatment intervention during the first 3 years of implementation.
        BMJ Open. 2015; 5: e006519
        • Fagg J.
        • Cole T.J.
        • Cummins S.
        • et al.
        After the RCT: Who comes to a family-based intervention for childhood overweight or obesity when it is implemented at scale in the community?.
        J Epidemiol Community Health. 2015; 69: 142-180
        • Banks J.
        • Cramer H.
        • Sharp D.J.
        • et al.
        Identifying families' reasons for engaging or not engaging with childhood obesity services: A qualitative study.
        J Child Health Care. 2014; 18: 101-110
        • Sacher P.M.
        • Kolotourou M.
        • Chadwick P.M.
        • et al.
        Randomized controlled trial of the MEND program: A family-based community intervention for childhood obesity.
        Obesity. 2010; 18: S62-S68
        • van den Akker E.L.
        • Puiman P.J.
        • Groen M.
        • et al.
        A cognitive behavioral therapy program for overweight children.
        J Pediatr. 2007; 151: 280-283
        • de Niet J.
        • Timman R.
        • Jongejan M.
        • et al.
        Predictors of participant dropout at various stages of a pediatric lifestyle program.
        Pediatrics. 2011; 127: 164-170
        • Miller W.C.
        • Jacob A.V.
        The health at any size paradigm for obesity treatment: The scientific evidence.
        Obes Rev. 2001; 2: 37-45
        • Bombak A.
        Obesity, health at every size, and public health policy.
        Am J Pub Health. 2014; 104: 60-67
        • Bacon L.
        • Aphramor L.
        Weight science: Evaluating the evidence for a paradigm shift.
        J Nutr. 2011; 10: 1-13