This study describes the first reality-based television series focusing on obesity prevention in Kuwaiti adolescents. The Right Diet television series provided direct easy access to highly personalized feedback on the weight, diet, physical activity, and health of participating adolescents. This encouraged and enabled participants to monitor themselves, and make rational judgments regarding the competing claims of fad diets. The findings show that the 13 episodes resulted in a 10% reduction in body weight in most participants during the 6-month study period.
On average, participants lost 10.6 kg and reduced their body mass index by 4.8 kg/m.2
However, it is worth mentioning that gain in height was a confounding factor for reduction of body mass index in the participants. The weight loss achieved was largely due to the fact that the program used several strategies for weight reduction, such as family and peer influence, a physical activity program, counseling on dietary habits, and continuous follow-up for 6 months. Although the participants in this study were obese, by the end of the television program, 12 of them had lost enough weight to move from the obese category to the overweight category. Only two participants did not lose weight, and this was because they had previously followed fad diets which led to failure. Although adolescence is a critical time for intervention to control obesity and its associated health problems, the findings of this study suggest that a television weight loss program concept could be effective and important in guiding parents and adolescents to set appropriate achievable and sustainable weight loss goals.
In general, we can assume that this television series provided a safe, enjoyable, and social environment which may have contributed to weight reduction in the participants. In addition, the program was flexible and did not require participants to stay in a camp, as with other reality television shows focusing on weight loss. These shows have been criticized for motivating participants to win prizes rather than to achieve a healthy weight. Accordingly, the results achieved in these weight loss reality television shows are arguably not representative of reality at all. Another criticism is that short-term weight loss will inevitably result in slowing of metabolism, leading to rapid uncontrollable weight gain in coming years.24
Weight loss by each participant in the current television series was achieved by a change in lifestyle (ie, dietary habits and physical activity) and included selection of activities and a dietary regimen. This television series used a number of techniques to achieve the desired outcomes, including modification of dietary habits, increasing physical activity, counseling, family involvement, as well as peer and other psychosocial support services. Because this study was a multicomponent television series, it was not possible to identify the most effective interventions. The success of the participants in achieving and maintaining a negative energy balance may be highly dependent on nonspecific factors, such as the social environment of the television program, including the counselor, family support, and peer group. Such factors may assist in weight loss.
Counseling and follow-up were used to advise participants and educate them on safe and effective weight loss strategies and to guide them away from fad diets.25
In this study, the participants confirmed the importance of counseling as the most important factor in successful weight loss (85.7%). As in another study,26
all participants at the beginning of the television series wanted intensive weight loss treatment as soon as possible. In fact, some participants reported disappointment at the beginning and others lost weight but later experienced no more weight reduction; however, the follow-up counseling helped the participants to control their weight successfully.
Many factors can influence the decision to counsel on weight loss. One common factor is the clinician’s perception of the patient’s receptiveness to suggestions.27
Lack of patient motivation is often cited by health care providers as a barrier to change.28
However, a health care provider’s perception of motivation is not necessarily equivalent to the patient’s self-reported motivation level.29
This discrepancy can negatively affect communication. Nevertheless, counseling by weight loss professionals and physicians provides insufficient guidance on weight management strategies, possibly because of inadequate skills and confidence on the part of the counsellor. 30
Therefore, weight loss counseling by dieticians and physicians should have a significant effect on the patient’s understanding and motivation for weight loss. In addition, the results of the current study suggests that it is important for weight loss professionals to spend a few minutes evaluating a teenager’s readiness to change, setting appropriate weight loss goals, and providing information about how to modify dietary patterns. The teenager’s current and past levels of physical activity should also be assessed, as well as any barriers to physical activity.
Parents play a fundamental role in the development of their teenager’s food preferences and energy intake, and this includes their own eating behavior and motivation.31
Therefore, parents can create an environment for children and adolescents that may foster development of healthy eating behavior and maintenance of an appropriate weight, or may promote overweight and disordered eating. In this study, the role of parents, especially mothers, was viewed by the participants as the second most important determinant of weight loss after the counselor. Mothers in particular influence teenage eating behavior because they spend considerably more time than fathers in direct interaction with their teenagers in familial situations. The findings of our study and those of previous researchers31
suggest that effective prevention programs must focus on providing anticipatory guidance for parenting to foster patterns of preference and food selection in adolescents more consistent with healthy diets and also promote the ability of teenagers to self-regulate their intake of food. Guidance for parents should include information on how teenagers form their eating behaviors in the family context. Practical advice for parents should include how to foster teenager’s preferences for healthy foods and how to promote acceptance of new healthy foods by adolescents. Parents need to understand the consequences of coercive feeding practices and be given alternatives to restricting food and pressuring teenagers to eat. Providing parents with easy-to-use information regarding appropriate portion sizes for adolescents is also essential.
On the other hand, individual lifestyle choices may also be directly influenced by peer behavior. This study confirms that peer support to modify eating behavior is also important in weight reduction strategies. A number of observational studies have investigated adolescent social networks and documented a positive correlation between an adolescent’s weight and the average weight of their peers.33
This is particularly true in Kuwait, where friends meet at restaurants two or three times a week. Further, when regular exercise and sport become more popular in an individual’s social network, the chances that the individual will engage in these activities increases, perhaps because of interest stimulated by peer involvement in this activity or social pressure to conform to group norms.
The main limitations of this study are its small number of participants and the lack of a control group or a randomly selected group of participants from a population-based sample as a comparator. However, a control group was difficult to include in this study for a number of social and cultural reasons. A long intervention program of this nature is unusual in Arab countries. Another important factor is that we did not include information on changes in energy intake, physical activity, and lifestyle. The adolescents who volunteered to participate in this television series may be different from those normally seen in public and private health clinics. Thus, selection bias remains a problem that must be resolved before one can generalize these results to the broader population. Despite these limitations, the benefits of this television series represent a valuable practical educational option for obese adolescents. In this study, encouraging progress was made in several areas, including diet, physical activity, behavior, and increased awareness of the problem of adolescent obesity.
In conclusion, using media tools such as a television series can be an effective strategy to promote healthy weight. The findings of this study are consistent with other studies utilizing various media as components of weight loss programs for children and adolescents.36
Other mediabased studies have focused on promoting healthy eating choices and increasing physical activity.17
Therefore, the government should encourage the media to promote healthy eating and physical activity. This study also indicates that parental involvement is key to the success of obesity prevention programs and may be a better method for improving a teenager’s diet than attempts at dietary control. In addition, personalization of the diet and exercise regime was important in this television series. With the dramatically increasing prevalence of obesity among adolescents and its associated impact on health and longevity, there is an urgent need for specific media programs at the nationwide level to combat obesity among adolescents.