PHILADELPHIA — An “ah-ha!” moment can be the key to teen weight loss.

Adolescents who experience a “transformative event”—an experience that changes their self-concept with regard to weight or exercise—are apparently more likely to lose weight than are those who never undergo such a moment, Dr. Alexis Lieberman said at the annual meeting of the Eastern Society for Pediatric Research.

For some teens, the experience comes during a serious talk with a physician; for others, athletics is the motivating factor. But whatever the force behind the transformative event, she said, it appears to be a vital part of the weight loss experience.

Dr. Lieberman presented the results of a qualitative study of 22 teens. All of the participants were black, inner city residents with a mean age of 16 years. Additionally, all of the teens in the study had either gained or lost at least 2 kg/m

They participated in a series of structured interviews and focus group meetings, during which Dr. Lieberman and her colleagues explored important contributors to their weight change, including dietary habits, knowledge of healthy eating, finances and the impact of poverty, psychology, exercise, and home-school environment.

The group included 10 weight increasers (six males and four females) with an average body mass index (BMI) of 38 kg/m

Both of the groups had similarly poor dietary habits, she said. “Both tended to skip breakfast, eat junk food between and often instead of meals, and buy snacks at local convenience stores and fast food restaurants. Nobody ate very well.”

Interestingly, Dr. Lieberman said, the teens did have a good basic knowledge of what constitutes a healthy diet, and they could accurately describe a balanced meal.

Poverty did not play as large a role as the researchers anticipated. While a lack of money did increase a teen's tendency to buy cheap, low-quality foods, it also forced many into the subsidized food programs at their schools.

“Not having money meant they couldn't buy french fries in the cafeteria, and instead had to go to the free lunch line, where the food was supposedly healthier,” said Dr. Lieberman, a pediatrician at Albert Einstein Medical Center, Philadelphia.

Several important thematic differences emerged between the groups, including the transformative experience, family support, and exercise.

A transformative experience occurred in six of the weight decreasers and only two of the weight increasers.

For several of the decreasers, the moment was a meeting with a physician, especially being told they were at risk of developing diabetes. Some related that prognosis to the same illness in a relative, and made a decision to change their own future.

For others, Dr. Lieberman said, the moment had to do with athletics. One teen was recruited from his recreation center basketball team to a traveling city team, and had to lose weight to stay on the team. Another girl joined the track team. Her coach advised her to improve her eating habits and lose weight because she had the potential to be a fast runner.

“These moments were related to an increase in self-esteem,” Dr. Lieberman said.

One decreaser was sentenced to boot camp for stealing cars. The rigorously active schedule and opportunity for self-evaluation were his triggers for weight loss.

“Three years later, he has maintained the loss and continues to lift weights,” she added.

A violent experience changed the life of the final weight decreaser. He was almost “jumped,” Dr. Lieberman said. His grandfather then signed him up for a martial arts program at the local gym.

“A supportive family member helped make this a transformative moment, instead of a damaging one,” she said.

Transformative experiences also occurred in two teens who gained weight. One said his religious conversion allowed him to accept himself “as a big person.” Another teen learned she was a prediabetic, but wasn't able to make the changes necessary to lose weight.

Exercise was another big difference between the groups, Dr. Lieberman said. Eight of the decreasers consistently engaged in intense physical activity (at least 2 hours each day of team sports or weight lifting), compared with only one of the increasers. “The one increaser who exercised was on a dance team that served doughnuts after practice.”

The final difference between the groups was family influence. The decreasing group reported that family members tried to positively influence their diet, and encouraged their weight loss.

The teens who increased their weight, however, reported that they received support to accept their weight, with their family using euphemisms (“You're thick, not fat”) and telling them they “looked fine just as they were.”

“Parents do find the term 'overweight' or 'fat' offensive,” Dr. Lieberman said. “They prefer terms like 'gaining weight too quickly' or 'big for his age.'”

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Family members who encouraged weight loss and healthy diet played a crucial role in teens' weight loss. DR. LIEBERMAN

Transformative Event Helps Teens Lose Weight