Effects of Dietary Counseling and Physical Activities on Overweight and Obesity among Adolescents Visiting a Tertiary Care Hospital, Dhaka

Abstract

Background: Adolescent overweight and obesity are rapidly increasing in low- and middle-income countries, including Bangladesh, due to urbanization, lifestyle transitions, and changing dietary patterns. Increased consumption of energy-dense, processed foods, reduced physical activity, and growing screen dependency have significantly contributed to this trend. These conditions are associated with an early onset of noncommunicable diseases (NCDs), such as diabetes, cardiovascular diseases, and psychological disorders. Despite the recognized importance of lifestyle modification, limited evidence exists in Bangladesh regarding the effectiveness of combined dietary counseling and physical activity interventions among adolescents. Therefore, this study aimed to assess the impact of integrated lifestyle interventions on nutritional status, dietary behavior, physical activity, and psychological well-being among adolescents attending a tertiary care hospital in Dhaka. Methodology: A mixed-methods study design was employed, incorporating both quantitative and qualitative approaches. The study was conducted at the adolescent outpatient department of Bangladesh Shishu Hospital and Institute, Dhaka. The quantitative component followed a pre-post nonrandomized experimental design involving adolescents with overweight or obesity (BMI ≥25 kg/m², Asian cut-off). Data were collected at baseline and after intervention through face-to-face interviews using a pretested semi-structured questionnaire, along with anthropometric measurements and laboratory assessments. Dietary intake was assessed using a 24-hour recall and food frequency questionnaire (FFQ), while physical activity was measured using a modified Global Physical Activity Questionnaire (GPAQ). Psychological status was evaluated using the Strengths and viii Difficulties Questionnaire (SDQ). The intervention included individualized dietary counseling, structured diet plans, promotion of regular physical activity and psychological support. Participants were followed for up to 15 months with periodic monitoring. The qualitative component included case studies and focus group discussions (FGDs) with adolescents and parents to explore behavioral, environmental, and psychosocial factors influencing obesity. Quantitative data were analyzed using SPSS (version 26), applying descriptive statistics and inferential tests such as paired t-tests and chi-square tests. Qualitative data were analyzed using thematic analysis. Results: A total of 226 adolescents participated in the study, of whom 57.5% were male and 42.5% were female, with a mean age of 13.25 years. The majority (75.2%) were aged 10–14 years, and most participants belonged to urban (92.9%), nuclear family settings (88.9%) with good socioeconomic status (76.1%). Baseline dietary assessment revealed high consumption of carbohydrates and fats, with frequent intake of rice, fast foods, and low consumption of fruits, vegetables, and dairy products. Average daily intake included high carbohydrate (18.72 servings) and fat (11.68 servings) consumption, while fruit (0.51 servings) and milk intake (0.32 servings) were inadequate. Mean caloric intake before intervention was 2461.57 kcal, indicating excess energy consumption. Physical activity levels were low at baseline, with 71.7% of participants categorized as having low activity and none engaging in vigorous activity. Following intervention, there was a significant improvement in activity levels, with 46.5% achieving high physical activity. Mean MET scores increased significantly from 2.47 to 6.32 (p < 0.001). ix Psychological outcomes also improved significantly. The mean SDQ score decreased from 26.19 at baseline to 16.25 at follow-up (p < 0.001), indicating reduced emotional and behavioral difficulties. Anthropometric outcomes showed a progressive and statistically significant reduction in BMI across follow-up visits (p < 0.001). At baseline, 64.2% of participants were overweight and 35.8% were obese. After intervention, 70.8% achieved normal BMI, while only 9.7% remained overweight and 19.5% remained obese. Qualitative findings supported these results. Adolescents reported unhealthy dietary habits, high screen time, and experiences of bullying prior to intervention. Parents demonstrated limited awareness and often encouraged unhealthy eating behaviors. Post-intervention, both adolescents and parents reported improved dietary practices, increased physical activity, reduced screen dependency, and enhanced psychological well-being. Case studies further illustrated substantial individual improvements in weight, mental health, and social functioning. Conclusion: The study demonstrates that integrated interventions combining dietary counseling, physical activity, and psychological support are highly effective in improving both physical and mental health outcomes among adolescents with obesity. Adolescent obesity is a multifactorial condition requiring a holistic, family-centered approach. Early intervention and increased parental awareness are essential for sustainable lifestyle modification and long-term prevention of obesity-related complications.