Global study examines consequences of uncontrolled hunger in adolescents living with obesity

Teenagers living with obesity who say hunger is preventing them from losing weight (hunger-barrier ALwO) perceive their weight more negatively and worry about it more than youngsters who don’t see hunger as an obstacle, new research being presented at the European Congress on Obesity (ECO) in Dublin, Ireland (17-20 May) shows.

The international study also found that hunger-barrier ALwO are more likely to be female and more likely to say their weight makes them unhappy and leads to them being bullied. They are also more likely to be actively trying to lose weight.

Dr Bassam Bin-Abbas, of the Department of Paediatrics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia, and colleagues carried out a sub-analysis of data from ACTION Teens, a global study of the experiences, care and treatment of adolescents living with obesity (ALwO), their caregivers and their healthcare providers.

The survey-based study, which is being conducted in ten countries (Australia, Colombia, Italy, Korea, Mexico, Saudi Arabia, Spain, Taiwan, Turkey and the UK) aims to improve awareness of management, treatment and support for ALwO. It has previously found uncontrolled hunger to be the biggest barrier to weight loss.

Data on 5,275 ALwO (aged 12-17 years), 5,389 caregivers of ALwO and 2,323 healthcare professionals (HCPs) was included in the sub-analysis.

ALwO were grouped based on their responses to survey questions about barriers to weight loss: those in the “hunger-barrier ALwO” group (1,980, 38%) indicated not being able to control hunger is a barrier to them losing weight, the “non-hunger barrier ALwO” group (3,295, 62%) did not indicate this.

Hunger-barrier ALwO were more likely to be female (47% vs. 42%), to be in the oldest age group (16–17 years; 49% vs. 41%), have obesity class II (27% vs.18%) and have a direct relative with overweight (mother with overweight: 31% vs. 24%; father with overweight: 29% vs. 21%) than the non-hunger barrier ALwO group. However, hunger-barrier ALwO were less likely to have obesity class I (60% vs. 68%) and class III (12% vs. 14%).

The hunger-barrier ALwO perceived their weight more negatively. More hunger-barrier ALwO believed their weight to be above normal than non-hunger barrier ALwO (90% vs. 68%) and fewer were satisfied with their weight (14% vs. 38%). Hunger-barrier ALwO were more likely to say their weight make them unhappy (56% vs. 36%), less likely to be proud of their body (15% vs. 38%) and more likely to say they are bullied because of their weight (28% vs 22%).

ALwO who saw hunger as a barrier to weight loss were also more likely to be worried about their weight and its effect on their health. A greater proportion of hunger-barrier ALwO were somewhat, very or extremely worried about their weight (85% vs. 64%) or worried “a lot” about their weight affecting their future health (44% vs. 32%) than non-hunger barrier ALwO.

The survey responses also revealed that the hunger-barrier ALwO were more likely to be actively trying to lose weight. A greater proportion of hunger-barrier ALwO had attempted to lose weight in the past year (70% vs. 51%), improved their eating habits (51% vs. 35%), become more physically active (37% vs. 32%), recorded the foods they ate (23% vs. 14%), seen a nutritionist/dietitian (21% vs. 13%) or an obesity/weight management doctor (20% vs. 9%) than non-hunger-barrier ALwO.

More hunger-barrier ALwO indicated they were very likely to attempt to lose weight in the next 6 months (42% vs. 36%). Although only 6% of the adolescents in both groups had taken prescription weight-management medication in the past year, those in the hunger-barrier ALwO group were more likely to say they would feel comfortable taking weight-management medication after an HCP recommendation (44% vs. 35%).

The survey also looked at the types of food available at home and the household’s habits. A significantly greater proportion of hunger-barrier ALwO than non-hunger-barrier ALwO indicated there are typically fruit and vegetables (61% vs. 47%), sugary snacks such as sweets and biscuits (55% vs. 36%) and sugary drinks, including soft drinks, fruit juice and energy drinks (53% vs. 35%), available in their house.

Compared with non-hunger barrier ALwO, significantly more hunger-barrier ALwO indicated that they/their family frequently order takeaways (37% vs. 24%), while fewer said that their family likes to exercise together (18% vs. 21%).

The hunger-barrier ALwO were more likely to say that their family is open and supportive in helping them lose weight (38% vs. 25%).

The researchers conclude that there is an association between the perception that an inability to control hunger is a barrier to weight loss and adolescents’ awareness of their obesity status, dissatisfaction with their body and engagement in weight-management behaviors.

Many people living with obesity have weaker appetite regulation, with food having less impact on the systems that inhibit eating behavior.”

Dr Bassam Bin-Abbas, Department of Paediatrics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia

“Consequently hunger is not dampened. This leads to the feeling food is controlling you and this makes it very difficult to resist cues to eat. This may mean that hunger is associated with more unsuccessful weight loss attempts and weight regains and so greater feelings of failure and lack of self-worth.”

Professor Jason Halford, president of the European Association for the Study of Obesity, head of the School of Psychology at the University of Leeds and one of the study’s authors, adds: “Healthcare providers must be aware that uncontrolled hunger caused by the biology of obesity is a real barrier to weight loss and they must take steps to help young people overcome it.

“They must also be alert to lack of self-worth, worry and other negative feelings that can be associated with it.

“Meanwhile, young people who struggle to lose weight because of hunger should not take it as a personal failure but seek healthcare advice.”