Evolution throughout the program Why parents need to be involved in the treatment of their obese teenagers ? Results of a qualitative study C. Chamay Weber1,2, N. Camparini,1L. Lanza2, C. Torriani, F. Narring1 1Adolescent Medicine Unit, Adolescent and Young Adult Program, 2 Exercise Medicine, Paediatric Cardiology Unit, Department of Child and Adolescent & Department of Community Medicine and Primary Care, University Hospital of Geneva and University of Geneva, Switzerland Purpose: Family dynamics are strongly associated with teenage obesity. Our aim was to assess parents' and adolescents’ perceptions before and at the end of a six month Family-Based Behavioral Treatment (FBBT) program for obese teenagers. Contrepoids© Program for adolescents Adolescents Psycho educational’ sessions sports' sessions Parents Adolescents and Parents Methods: We conducted 4 focus group sessions with obese adolescents aged 12-18 and their parents participating in a FBBT program (2 before and 4 after the program, 13 parents and 18 adolescents in separate groups). Open ended questions were used to explore their perceptions at the beginning and at the end of the program : - How are family interactions ? What can they say about their/their child’s well-being ? What do they think about their participation in the program ? Sessions were recorded, transcribed and content analysis was performed. Some of the topics discussed in the groups: Motivation, diet, family dynamics, family values, adolescence and development, emotion and eating, conflicts management, self-esteem. Results: Parents' perceptions before the program Adolescents' perceptions before the program Responsibility: “ I want him to grow up and to learn how to eat and how to face life ” “ I would like him to have self-control about food. What I am doing for him now, he has to be able to do it by himself  ” Responsability: “ My mom is always watching me, she checks up on everything I eat. She doesn’t understand that I can cope by myself. She has gotten used to doing this for a long time ” Discouragement: “ Sometimes, my parents tell me not to eat this or that. I’m fed up. I feel discouraged ” Conflicts: “ there is many conflicts. Always behind her saying : don’t eat that, you have enough, don’t open the fridge ! ” “ So many conflicts that we can’t speak together anymore ” “ For six month I have put the food under key, because she was eating all the food we have ” “ We have tried everything: to hide food, to be nasty, blackmail ” “ Sometimes, I ‘m walking through the kitchen and my mom says: stop, don’t do that ! even if I haven’t planned to eat anything . That irritates me ” To take control: “I hope to control myself not to eat ” To take care of oneself : “  It’s also about learning how to take care of oneself : my daughter doesn’t take any interest in her appearance, whether for brushing her hair or her teeth. She would go out any which way ” To break isolation: “ I hope to make friends ” Evolution throughout the program Parents 'perceptions at the end of the program Adolescents 'perceptions at the end of the program Feeling co responsable : “ I though that it was a matter of will and that he had to make the first step. I then realized, through these discussions, that I also have a role to play in order trying to make things better ”   Being more responsible/growing up: “ It helps us to make a step forward, to see things in a different way, to grow up”   “ I don’t know if I can say I’m more mature, but I feel I’m more responsable ” Restoring trust and communication : “A kind of trust has been established: the trust she expected of us and the one we were expected of her ” Having parents trust /less conflicts : “ My mother gives me more freedom, she doesn’t say anymore «you already took a second helping, so be careful ». We now have nice meals with no conflicts and that has really changed ” “ We communicate better ” Avoiding food conflicts: “ I have understand that my role was not about enter ing systematically into conflict about food… our relationship has changed ” “ Things are better now. Mealtimes used to be very conflictual. As I was upset, I didn’t appreciate what I was eating or would take my revenge on food and eat twice as much because I was angry! ” Stepping back from the situation: “Since the beginning of the program, it’s been less of an issue, because we’ve been able to delegate it to the group. We speak about it less at home, so it’s less stressful ” Restoring self-esteem/breaking isolation : ”I felt alone in life. I felt fat and ugly. Since I have started coming here, I don’t think that anymore. I’m just like everyone else… I have friends. Even if I haven’t lost weight, it doesn’t matter. It doesn’t have the same importance now. What’s important is that I feel good about myself ” Group support: “It is a bit of a paradox: on one hand I’ve realized that obesity is a serious illness, but on the other hand, we (the family) stress about it less because we have support” Conclusions : Obesity has substantial repercussions on family dynamics which may have a negative impact on weight loss in adolescents. Weight loss programs for teenagers up to 18 years of age must include parents in order to relieve their distress of having an obese child, modify family’s interactions and allow teenager’s autonomy and self-efficacy.