Introduction: Lack of impulse control and impaired stress regulation may explain the development of obesity and its challenging therapy, already in youth. To improve self-regulation of overweight adolescents and subsequently their weight status, we tested, whether a biofeedback relaxation exercise decreases stress and whether relaxation services implemented in a novel Smartphone App supported intervention have effects on stress and weight outcomes.
Methods: First 6 months data in 31 adolescents with BMI >P.90 of an ongoing 12-month randomized controlled study are being reported. Patients try to relax over two minutes through a breathing exercise while observing in real time their arousal level measured as skin conductance with NeXus-10. Cortisol in blood as stress marker is measured before and after this exercise, at start, 3, 6 and 12 months. During the intensive phase of 6 months, 18 patients of the intervention group (IG) are equipped with a smartphone and a specially designed chat App with game character, which encourages them through a virtual coach to achieve daily activity or relaxation challenges and earn virtual rewards. While 13 patients of the treatment as-usual group (CG) have monthly visits on site during the intensive phase, IG has only four visits. Beside BMI and BMI Standard Deviation Score (SDS), adjusted for age and sex, clinical parameters and stress questionnaires (TICS) are being assessed at start, 6 and 12 months.
Results: Age (13.7 years, 1117), mean BMI (30±3.8 kg/m2), mean BMI SDS (2.5±0.5 SD) and cortisol levels (median 217, 48511 mmol/L) were similar in both groups at start. In the IG, cortisol levels decreased after the biofeedback session by 31% (P=0.04) at start, by 24% (P=0.01) after 3 and 32% after 6 months (P=0.002). The CG exhibited a significant cortisol decrease by 34% (P=0.005) at start and by 42% after 3 months (P=0.002), but not after 6 months. No long-term changes of cortisol were observed. BMI SDS was stabilized in the IG (Δ BMI SDS 0.04) while decreased significantly in the CG (Δ BMI SDS −0.4, P=0.01) after 6 months. So far, no consistent correlations between changes in BMI SDS and cortisol during therapy were found.
Conclusion: Electrodermal biofeedback regulates acute stress in obese adolescents, an age group with difficulties managing emotions and can be a valuable tool in obesity therapy. The long-term effects of biofeedback therapy on chronic stress and BMI are currently under investigation.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology