APOLO-Teens, a web-based intervention for treatment-seeking adolescents with overweight or obesity: study protocol and baseline characterization of a Portuguese sample

  • Sofia RamalhoEmail author
  • Pedro F. Saint-Maurice
  • Diana Silva
  • Helena Ferreira Mansilha
  • Cátia Silva
  • Sónia Gonçalves
  • Paulo Machado
  • Eva Conceição
Original Article



APOLO-Teens is an ongoing web-based program combining a manualized intervention delivered by Facebook®, a self-monitoring web application and monthly chat sessions to optimize treatment as usual for adolescents with overweight and obesity. The aims of this paper are twofold: (1) to describe the study protocol of the APOLO-Teens randomized controlled effectiveness trial and (2) to present baseline descriptive information of the Portuguese sample.


APOLO-Teens includes adolescents aged between 13 and 18 years with BMI percentile ≥ 85 (N = 210; 60.00% girls, BMI z-score 2.40 ± 0.75) undergoing hospital ambulatory treatment for overweight/obesity. Participants completed a set of self-report measures regarding eating behaviors and habits, psychological functioning (depression, anxiety, stress, and impulsivity), physical activity, and quality of life.


Depression, anxiety, stress, impulsivity, and percentage body fat were inversely associated with health-related quality of life (rs = − 0.39 to − 0.62), while physical activity out-of-school was positively correlated with health-related quality of life (rs = 0.22). When compared to boys, girls demonstrated statistically significant higher scores on psychological distress, disturbed eating behaviors, impulsivity, were less active at school and had lower scores on the health-related quality of life (p < 0.05).


The results showed that there were gender differences in key psychological constructs that are likely to determine success with the treatment and that, therefore, need to be considered in future interventions. The results of APOLO-Teens randomized controlled trial will determine the impact of these constructs on the efficacy and adherence to a web-based intervention for weight loss in the Portuguese population.

Level of evidence:

Level V, cross-sectional descriptive study.


Web-based intervention Pediatric obesity Adolescents Weight loss treatments Eating behaviors 



This research was partially supported by Fundação para a Ciência e a Tecnologia/Foundation for Science and Technology through a European Union COMPETE program Grants to Eva Conceição (POCI-01-0145-FEDER-028209 and IF/01219/2014) and doctoral scholarship (SFRH/BD/104182/2014) to Sofia Ramalho. This work was conducted at Psychology Research Centre (UID/PSI/01662/2013), University of Minho and supported by the Portuguese Foundation for Science and Technology and the Portuguese Ministry of Science, Technology, and Higher Education through national funds and co-financed by FEDER through COMPETE2020 under the PT2020 Partnership Agreement (POCI-01-0145-FEDER-007653).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the university ethics review board and by the ethical committees from the hospital centers involved [São João Hospital Center (CHSJ), Oporto Hospital Center—Northern Maternal and Child Center (CMIN)].

Informed consent

Written informed consent was obtained from the participants’ parents/caregivers.

Supplementary material

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Supplementary material 1 (TIFF 7970 KB)
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  1. 1.
    Adams KF, Leitzmann MF, Ballard-Barbash R et al (2014) Body mass and weight change in adults in relation to mortality risk. Am J Epidemiol 179:135–144. CrossRefPubMedGoogle Scholar
  2. 2.
    Engeland A, Bjørge T, Tverdal A, Søgaard AJ (2004) Obesity in adolescence and adulthood and the risk of adult mortality. Epidemiology 15:79–85. CrossRefPubMedGoogle Scholar
  3. 3.
    Kelsey MM, Zaepfel A, Bjornstad P, Nadeau KJ (2014) Age-related consequences of childhood obesity. Gerontology 60:222–228. CrossRefGoogle Scholar
  4. 4.
    Ng M, Fleming T, Robinson M et al (2014) Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 384:766–781. CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Bibiloni MDM, Pons A, Tur JA (2013) Prevalence of overweight and obesity in adolescents: a systematic review. ISRN Obes. CrossRefPubMedCentralGoogle Scholar
  6. 6.
    Finkelstein EA, Graham WCK, Malhotra R (2014) Lifetime direct medical costs of childhood obesity. Pediatrics 133:1–9. CrossRefGoogle Scholar
  7. 7.
    Tsiros MD, Sinn N, Brennan L et al (2008) Cognitive behavioral therapy improves diet and body composition in overweight and obese adolescents. Am J Clin Nutr 87:1134–1340CrossRefPubMedGoogle Scholar
  8. 8.
    Lloyd-Richardson EE, Jelalian E, Sato AF et al (2012) Two-year follow-up of an adolescent behavioral weight control intervention. Pediatrics 130:281–288. CrossRefGoogle Scholar
  9. 9.
    Cooper Z, Fairburn C, Hawker D (2004) Cognitive-behavioral treatment of obesity: a clinician’s guide, 1st edn. The Guilford Press, New YorkGoogle Scholar
  10. 10.
    Vignolo M, Rossi F, Bardazza G et al (2008) Five-year follow-up of a cognitive-behavioural lifestyle multidisciplinary programme for childhood obesity outpatient treatment. Eur J Clin Nutr 62:1047–1057. CrossRefPubMedGoogle Scholar
  11. 11.
    Al-Khudairy L, Loveman E, Colquitt JL et al (2017) Diet, physical activity and behavioural interventions for the treatment of overweight or obese adolescents aged 12 to 17 years. Cochrane Database Syst Rev. CrossRefPubMedGoogle Scholar
  12. 12.
    Whitlock EP, O’Connor EA, Williams SB et al (2010) Effectiveness of primary care interventions for weight management in children and adolescents: an updated, targeted systematic review for the USPSTF. Evid Synth. CrossRefGoogle Scholar
  13. 13.
    Whitlock EP, O’Connor EA, Williams SB et al (2008) Effectiveness of weight management programs in children and adolescents. Evid Rep Technol Assess 170:1–308Google Scholar
  14. 14.
    Rajmil L, Bel J, Clofent R et al (2017) Clinical interventions in overweight and obesity: a systematic literature review 2009–2014. Anales de Pediatría 86:197–212. CrossRefPubMedGoogle Scholar
  15. 15.
    Ramalho SM, Silva CB, Pinto-Bastos A, Conceição E (2016) New technology in the assessment and treatment of obesity. In: Ahmad S, Imam S (eds) Obesity, Springer, Cham, pp 257–266.
  16. 16.
    Barak A, Hen L, Boniel-Nissim M, Shapira N (2008) A comprehensive review and a meta-analysis of the effectiveness of Internet-based psychotherapeutic interventions. J Technol Hum Serv 26:109–160. CrossRefGoogle Scholar
  17. 17.
    Park BK, Nahm ES, Rogers VE (2016) Development of a Teen-friendly health education program on Facebook: lessons learned. J Pediatr Health Care 30:197–207. CrossRefPubMedGoogle Scholar
  18. 18.
    Ruotsalainen H, Kyngas H, Tammelin T et al (2015) Effectiveness of Facebook-delivered lifestyle counselling and physical activity self-monitoring on physical activity and body mass index in overweight and obese adolescents: a randomized controlled trial. Nurs Res Pract. CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Napolitano M, Hayes S, Bennett GG et al (2013) Using Facebook and text messaging to deliver a weight loss program to college students. Obesity 21:25–31. CrossRefPubMedGoogle Scholar
  20. 20.
    Merchant G, Weibel N, Patrick K et al (2014) Click like to change your behavior: a mixed methods study of college students’ exposure to and engagement with Facebook content designed for weight loss. J Med Internet Res 16:e158. CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Lenhart A, Purcell K, Smith A, Zickuhr K (2010) Social media and mobile internet use among teens and young adults. PEW Res Cent. CrossRefGoogle Scholar
  22. 22.
    Neve M, Morgan PJ, Jones PR, Collins CE (2010) Effectiveness of web-based interventions in achieving weight loss and weight loss maintenance in overweight and obese adults: a systematic review with meta-analysis. Obes Rev 11:306–321. CrossRefPubMedGoogle Scholar
  23. 23.
    Kaisari P, Yannakoulia M, Panagiotakos DB (2013) Eating frequency and overweight and obesity in children and adolescents: a meta-analysis. Pediatrics 131:958–967. CrossRefPubMedGoogle Scholar
  24. 24.
    Neumark-Sztainer D, Wall M, Perry C, Story M (2003) Correlates of fruit and vegetable intake among adolescents: findings from Project EAT. Prev Med (Baltim) 37:198–208. CrossRefGoogle Scholar
  25. 25.
    Loth KA, MacLehose RF, Larson N et al (2016) Food availability, modeling and restriction: how are these different aspects of the family eating environment related to adolescent dietary intake? Appetite 96:80–86. CrossRefPubMedGoogle Scholar
  26. 26.
    Eriksson I, Unden AL, Elofsson S (2001) Self-rated health. Comparisons between three different measures. Results from a population study. Int J Epidemiol 30:326–333. CrossRefPubMedGoogle Scholar
  27. 27.
    Maloney MJ, McGuire JB, Daniels SR (1988) Reliability testing of a children’s version of the eating attitude test. J Am Acad Child Adolesc Psychiatry 27:541–543. CrossRefPubMedGoogle Scholar
  28. 28.
    Teixeira M, Pereira A, Saraiva J et al (2012) Portuguese validation of the children’s eating attitudes test. Revista de Psiquiatria Clínica 39:189–193. CrossRefGoogle Scholar
  29. 29.
    Tylka TL, Kroon Van Diest AM (2013) The Intuitive Eating Scale-2: item refinement and psychometric evaluation with college women and men. J Couns Psychol 60:137–153. CrossRefPubMedGoogle Scholar
  30. 30.
    Duarte C, Pinto-Gouveia J, Mendes A (2016) Psychometric properties of the Intuitive Eating Scale-2 and association with binge eating symptoms in a Portuguese community sample. Int J Psychol Psychol Ther 16:329–341Google Scholar
  31. 31.
    Lemoine JE, Konradsen H, Lunde Jensen A et al (2018) Factor structure and psychometric properties of the Body Appreciation Scale-2 among adolescents and young adults in Danish, Portuguese, and Swedish. Body Image 26:1–9. CrossRefPubMedGoogle Scholar
  32. 32.
    Conceição E, Mitchell JE, Machado PP et al (2017) Repetitive eating questionnaire [Rep (eat)-Q]: enlightening the concept of grazing and psychometric properties in a Portuguese sample. Appetite 117:351–358. CrossRefPubMedGoogle Scholar
  33. 33.
    Saint-Maurice PF, Welk GJ (2014) Web-based assessments of physical activity in youth: considerations for design and scale calibration. J Med Internet Res 16:e269. CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Whiteside SP, Lynam D, Miller J, Reynolds S (2005) Validation of the UPPS Impulsive Behavior Scale: a four factor model of impulsivity. Eur J Personal 19:559–574. CrossRefGoogle Scholar
  35. 35.
    Gloster AT, Rhoades HM, Novy D et al (2008) Psychometric properties of the Depression Anxiety and Stress Scale-21 in older primary care patients. J Affect Disord 110:248–259. CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Leal I, Antunes R, Passos T et al (2009) Estudo da Escala de Depressão Ansiedade e Stresse para Crianças (EADS-C). Psicol saúde doenças 10:277.284Google Scholar
  37. 37.
    Lima L, Guerra MP, Lemos M (2009) Adaptação da escala genérica do Inventário Pediátrico de Qualidade de Vida—Pediatric Quality of Life Inventory 4. 0—PedsQL, a uma população portuguesa. Rev Port Saude Publica 8:83–96.
  38. 38.
    Tabachnick BG, Fidell LS (2007) Using multivariate statistics, 5th edn. Allyn and Bacon, New YorkGoogle Scholar
  39. 39.
    Goldschmidt AB, Aspen VP, Sinton MM et al (2008) Disordered eating attitudes and behaviors in overweight youth. Obesity 16:257–264. CrossRefPubMedGoogle Scholar
  40. 40.
    Hayes JF, Fitzsimmons-Craft EE, Karam AM et al (2018) Disordered eating attitudes and behaviors in youth with overweight and obesity: implications for treatment. Curr Obes Rep 7:235–246. CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Neumark-Sztainer DR, Wall MM, Haines JI et al (2007) Shared risk and protective factors for overweight and disordered eating in adolescents. Am J Prev Med 33:359–369. CrossRefPubMedGoogle Scholar
  42. 42.
    Rancourt D, McCullough MB (2015) Overlap in eating disorders and obesity in adolescence. Curr Diabetes Rep 15:e78. CrossRefGoogle Scholar
  43. 43.
    Rankin J, Matthews L, Cobley S et al (2016) Psychological consequences of childhood obesity: psychiatric comorbidity and prevention. Adolesc Health Med Ther 7:125–146. CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.School of PsychologyUniversity of MinhoBragaPortugal
  2. 2.National Institutes of Health, National Cancer InstituteRockvilleUSA
  3. 3.Centro Hospitalar de São JoãoPortoPortugal
  4. 4.Centro Hospitalar e Universitário do Porto, Centro Materno Infantil do Norte (CMIN)PortoPortugal

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