S66 Poster Abstracts / 60 (2017) S39eS82
support and education (Ferrer-Roca 2012) to tackle the
increasing prevalence of obesity in young people (WHO 2013).
The mHealth based PEGASO project utilizes a user-centred
design (UCD) approach integrating teenage and scientific re-
quirements with a framework of behavior change (Michie et al.
2011) for real-time behavior detection and evaluation using an
innovative technology platform to target obesity-related be-
haviors in teenagers (Pate et al. 2013). An evaluation of the
multi-technology system (mobile applications, wearable sensors
and serious game) is being undertaken to understand; - the
impact on teenage lifestyle awareness and motivation for
healthier behaviors - teenage experience of longitudinal system
interaction and perspectives on health information
technologies.
Methods: Following three UCD stages of technology develop-
ment, across four European sites (England, Scotland, Italy,
Catalonia), 525 teenagers aged 13-16 are taking part in a 6-
month quasi experimental two-arm pilot trial. Participants are
recruited from schools at each pilot site. The intervention
group is testing the PEGASO system whereas the comparison
group continues their usual educational routine. The primary
outcomes are between and within group changes in physical
activity, sedentary behaviour, diet and sleeping behaviour, and
knowledge about a healthy lifestyle. Secondary outcomes
include; anthropometric measures, motivation, habit formation,
self-awareness, user experience of the mHealth intervention
and engagement.
Results: Preliminary findings demonstrate that teenagers are
keen to engage with mobile and wireless health technologies
providing individualised feedback. Teenagers positively report
on the system in relation to understanding more about their
personal health and the opportunities of ‘quantified self’. Initial
responses about sharing data are mixed, with preferences to be
limited to parents but at the teenager’s discretion. Connectivity
to healthcare services and clinical experts was positively viewed
but again with individual needs underpinning those features.
Further data collection and statistical analysis of the behavioral,
physical and psychological parameters will provide insight into
any behavior changes exhibited by the teenage participants and
whether engagement in the system relates to an increase in
personal health awareness. Lessons learnt regard the challenges
and opportunities associated with implementation of mHealth
for teenagers, social connectivity, health inequalities, teens
as lead users of technology and their expectations, state of the
art mHealth vs main stream technologies and ethical
considerations.
Conclusions: Early indications from the study present PEGASO
as an enabling technology for proactive engagement of teen-
agers in obesity prevention. It provides insight into the oper-
alisation of behaviour change techniques (BCTs) within a novel
system which aims to sustainably reduce teenage obesity-
related behaviour. Findings of teenagers’ perspectives of tech-
nological functions that operationalised BCTs (aesthetics, us-
ability, motivation for use, and engagement throughout the
trial) provide a valuable use specification for clinicians looking
to procure or utilise mHealth interventions with teenagers. This
submission provides a novel, holistic view of the multidisci-
plinary collaborative approach taken to understand teenage user
requirements, development and testing of an mHealth tech-
nology system for health promotion.
Sources of Support: This research was part of the PEGASO project
[http://pegasof4f.eu/]. Funded by the European Commission FP7
Grant Funding Stream (Grant Ref: 610727).
122.
CARDIOMETABOLIC RISKS AND BODY WEIGHT
STATUS IN OVERWEIGHT AND OBESE
ADOLESCENTS
Mujgan Alikasifoglu, MD, Asli Okbay Gunes, MD, Selmin Kose, BScN,
Suphi Vehid, MD, PhD, Oya Ercan, MD.
Istanbul University Cerrahpasa Medical Faculty.
Purpose: The prevalence of obesity among adolescents has
increased over the past decade. Although the prevalence of car-
diometabolic risk factors is relatively low among adolescents
who are overweight or obese, those with more severe forms of
obesity may be at greater risk. Thus to study the relationship
between degree of obesity and cardiometabolic risk factors
during adolescence is crucial. The aim of this study was to
improve the understanding of the distribution of cardiometabolic
risk factors according to the degree of obesity in adolescents by
gender.
Methods: We performed a retrospective cross-sectional analysis
of the data from overweight or obese adolescents 11 to 18
years of age who were evaluated in Istanbul University Cer-
rahpasa Medical Faculty Department of Pediatrics Adolescent
outpatient clinic from January 2012 to December 2014 to assess
the prevalence of multiple cardiometabolic risk factors accord-
ing to the severity of obesity. Weight status was classified on
the basis of measured height and weight. Body mass index SDS
value was calculated by using age and gender specific Turkish
body mass index values to standardize the degree of obesity.
We used standard definitions of abnormal values for total
cholesterol, high-density lipoprotein cholesterol, low-density
lipoprotein cholesterol, triglycerides, blood pressure, fasting
insulin (hyperinsulinemia >30mU/mL) and fasting glucose,
HOMA IR (>3,16 was accepted as insulin resistance) and report
the prevalence of abnormal values in adolescents according to
body mass index SDS values by gender. For statistical analyses
chi-square test, Student T test, Aspin Welch test and Kendall’s
tau_b test were used as appropriate and a p<0,05 was accepted
as significant.
Results: Among 363 adolescents with a body-mass index at the
85th percentile or higher; 27.5% were overweight, and 72,5%
were obese. Mean values for Body mass index-SDS (Female¼
2,550,65, Male¼ 2,140,52) and HDL- kolesterol (Female¼
51,2911,30, Male¼ 47,4014,02) variables were higher in fe-
male participants than in male participants (p¼ 0,0001, p¼
0,005 respectively). When we analysed data based on Body
mass index SDS value for each gender, we found that hyper-
tension, hyperinsulinism and high HOMA-IR value were related
to Body mass index SDS in the female and hypertension and
hyperinsulinism were related to body mass index SDS in the
male.
Conclusions: Degree of obesity in adolescents was associated
with an increased prevalence of cardiometabolic risk factors,
particularly among females. Thus determination of the degree of
obesity in daily practice, can help identify adolescents who are at
 Poster Abstracts / 60 (2017) S39eS82
the greatest risk for the negative health effects associated with
obesity.
Sources of Support: No source of support. This is aretrospective
study which use data from patients’ files.
123.
RELATIONSHIP BETWEEN DISORDERED EATING
ATTITUDES AND BONE HEALTH IN OBESE
ADOLESCENTS
Asli Okbay Gunes, MD, Mujgan Alikasifoglu, MD, Ethem Erginoz, MD,
PhD, Oya Ercan, MD.
Istanbul University Cerrahpasa Medical Faculty.
Purpose: Disordered eating attitudes are common among ado-
lescents. Adolescence is a critical period for bone development.
Some studies showed that bone health could be affected by
disordered eating attitudes. So it is worth to study the effect of
stress that is caused by disordered eating attitudes on bone health
of obese adolescents. To examine the effect of stress that is caused
by disordered eating attitudes on markers of bone turnover and
bone mineral density in obese adolescents.
Methods: Eighty obese adolescents, between 11- 18 years old, who
were evaluated in Istanbul University Cerrahpasa Medical Faculty
Department of Pediatrics Adolescent outpatient clinic between
November 2013-September 2014 were enrolled in this study.
Twenty four hours urine free cortisol level was measured as a
marker of biological stress. Bone turnover was evaluated with the
measurement of serum bone spesific alkaline phosphatase, serum
osteocalcin and urine N telopeptide level. Bone mineral density
(BMD) was measured by dual energy x ray absorptiometry.
Disordered eating attitudes were evaluated with “Eating Disorder
Examination Questionnaire”, “Dutch Eating Behaviour Question-
naire”; depression was evaluated with “The Children’s Depression
Inventory”, anxiety was evaluated with “State- Trait Anxiety In-
ventory for Children” and clinical psychiatric evaluation was done
for binge eating disorder. Chi- square test, Fisher exact test, Mann-
Whitney U test, Student T test, Pearson correlation test, Spearman
correlation test were used for univariate analyses. Series of lineer
regression model were used for multivariate analysis.
Results: At univariate analyses, “Dutch Eating Behaviour Ques-
tionnaire” total score and restrictive eating subscale score were
positively correlated with 24 hours urine free cortisol level
(p¼0,045, p¼0,043 respectively), while, there were no relation-
ships between these scores and bone turnover marker and bone
mineral dansity. There were no significant correlation between
“Eating Disorder Examination Questionnaire” scores and 24 hours
urine free cortisol level, bone turnover markers and bone mineral
dansity. There was no significant relationship between binge
eating disorder and 24 hours urine free cortisol level, however,
there was a significant relationship between binge eating disorder
and areal femur neck bone mineral dansity level (p¼ 0,049). At
lineer regression analysis, after controling for age, gender, weight,
height, puberty, depression and anxiety scores only “Dutch Eating
Behaviour Questionnaire” total score and restrictive eating sub-
scale score were found to be significantly associated with 24 hours
urine cortisol level (p¼ 0,035, p¼0,014 respectively).
Conclusions: The results of this cross sectional study showed that
disordered eating attitudes, especially restrictive eating, act as a
stressor for obese adolescents. For this reason, all obese adoles-
cents should be evaluated for disordered eating attitudes at heath
S67
visits. Although in this study, no relationships between disordered
eating attitudes and bone health was shown; one can speculate
that in adolescence, the negative effects of disordered eating atti-
tudes on bone health cannot be apparent until later years. Thus, we
think that prospective longitudinal studies are required to under-
stand these relationships properly.
Sources of Support: Istanbul University Scientific Research Project.
124.
THE MISSED DIAGNOSIS AND MIS-DIAGNOSIS OF
PEDIATRIC OBESITY
Janet Lydecker, PhD, Carlos Grilo, PhD.
Yale University School of Medicine.
Purpose: Targeted prevention and early intervention efforts to
address pediatric obesity must, as a prerequisite, identify children
with overweight or obesity. The American Academy for Pediatrics
recommends that screening all children and adolescents for
overweight/obesity (US Preventive Services Task Force, 2010).
Their recommendations specify overweight (85th-95th) and
obesity (>95th) using sex-specific BMI-for-age percentiles. Patel
and colleagues (2010), in evaluating obesity assessment and
diagnosis from a nationally representative 2005-2007 sample of
youth, found that pediatric obesity was underdiagnosed with only
18% of children receiving appropriate obesity diagnosis. The cur-
rent study aimed (1) to examine whether, at all visits when height
and weight were available to the healthcare provider, obesity is
diagnosed; and (2) to examine characteristics of children receiving
and not receiving an appropriate obesity diagnosis.
Methods: Medical records from a leading hospital/medical school
comprised the study sample. All health appointments for children
(age 9-18 years) between November 2011 and May 2015 in which
height, weight, sex, and age were recorded during the same visit
were evaluated for appropriate diagnosis of obesity (N¼136,274
visits). Sex-specific BMI-for-age percentiles were calculated and
categorized as no overweight/obesity (95th percentile). This study
was reviewed and approved by the Yale Institutional Review Board.
Chi-square tests compared diagnoses with children’s weight
category (no overweight/obesity, overweight, obesity). Binary
2logistic regression examined the following demographic charac-
teristics of children >95th percentile receiving and not receiving
an appropriate obesity diagnosis: Sex, Race (White[reference],
Black, Asian, American-Indian, Hawaiian, Other, Missing), Ethnicity
(Hispanic, Not Hispanic), and Age (9-12, 13-18 years).
Results: Among all visits (N¼136,274), 5.93% of visits (n¼8,077)
received an overweight/obesity diagnosis, and yet, 39.89% of visits
(n¼54,365) warranted a diagnosis of overweight/obesity. Only
3.07% of encounters that should (n¼23,149) have had an over-
weight diagnosis received (n¼710) an overweight diagnosis. Only
21.01% of encounters that should (n¼31,216) have had an obesity
diagnosis received (n¼6,558) an obesity diagnosis. Healthcare
providers were more likely to miss a diagnosis of overweight than
obesity (Z¼59.78, p<.001), and were more likely to misdiagnose
obesity as overweight (n¼528; 1.69%), than to misdiagnose over-
weight as obesity (n¼248; 1.07%; Z¼-6.03, p<.001). Boys (Odds
Ratio: 0.77 [95% CI 0.72-0.81]) and adolescents (0.86 [0.82-0.91])
were significantly less likely to be diagnosed with obesity. Black
race (1.77 [1.65-1.91]), Asian race (1.07 [0.83-1.39]), American-In-
dian race (2.38 [1.15-4.92]), Hawaiian race (3.06 [1.54-6.08]), and