An Individual, Community-Based Treatment for Obese Children and Their Families: The Solution-Focused Approach

Abstract

Background: This study evaluates an individual, community-based treatment for obese children and their families. In this program, a treatment team applied solution-focused techniques to develop a custom-made treatment plan in collaboration with the participants. The treatment plan consisted of community-based lifestyle activities. Methods: 559 obese children with an average BMI z-score of 2.76 ± 0.54 took part in the 12-month study, and 372 children with an average BMI z-score of 2.75 ± 0.52 took part in the 24-month study. At the start of the study, ethnicity and special school needs were recorded. Before, after 12 months, and after 24 months of the treatment, body weight and height were measured. The effect of the treatment on body weight was evaluated using BMI z-scores. Results: 291 children (52%) completed 12 months of treatment, whereas 22 children (4%) were dismissed earlier due to a good response. After 12 months, the children showed a significant decrease in BMI z-score by 0.16 (95% confidence interval (CI) 0.11-0.20; p < 0.005). After 24 months, 103 children (28%) were participating in the program, with a significant decrease in BMI z-score of 0.15 (95% CI 0.07-0.22; p < 0.005). 50 children (13%) were dismissed before the end of the second year due to significant weight loss (standard deviation z-score reduction -0.38; 95% CI 0.30-0.46; p < 0.005; with an average treatment duration of 12.9 ± 6.4 months). There was a negative correlation of age and reduction in BMI z-score: children younger than 6 years showed a decrease in BMI z-score of 0.45 (95% CI 0.26-0.65) and 0.31 (95% CI 0.11-0.53) after 12 and after 24 months, respectively. Conclusions: Children showed a significant decrease in BMI z-score after the treatment. We found a negative correlation of age and weight loss. Special attention to patients with a high risk of drop-out might further improve these results. We advise a referral to obesity treatment as early as possible since a ‘wait and see' policy might have adverse results in obese children.

The Limitations of Transforming Very High Body Mass Indexes into z -Scores among 8.7 Million 2- to 4-Year-Old Children

“…About 6% of all 2- to 19-year-olds in the United States have severe obesity (25). Although the CDC (1) cautioned about extrapolating beyond the range of the data used to estimate the LMS measures (3 rd through 97 th percentiles, corresponding to z-scores of ±1.88), BMIz continues to be widely used for children who have extreme BMI values (8,26–31). Our results emphasize that BMIz is a poor BMI metric among these children, as the conversion of very high BMIs to z-scores is strongly influenced by the L and S measures in the CDC growth charts.…”

“…The attenuation and confounding of very high BMIz values could be particularly problematic in longitudinal studies that focus on children with obesity (8,26–28,32). As these children age during follow-up, the extent of the compression of very high BMIz values will vary based on the values of L and S in the growth charts.…”

“…Investigators have continued to use LMS-extrapolated z-scores in analyses that include a high proportion of children who have a BMI ≥ 97 th percentile in the CDC growth charts (8,26,32), and some have recommended (34) that ΔBMIz be used for children who have a BMI ≥ 99 th percentile. However, BMIz values calculated from the CDC growth charts for children who have a BMI ≥ 97 th percentile (z ~ 1.88) can differ substantially from the empirical estimates (6), and the magnitude of these differences increases as the BMI level becomes more extreme.…”

Longitudinal changes in BMIz-scores among 45 414 2–4-year olds with severe obesity

“…Although the report for the CDC growth charts (Kuczmarski et al, 2002) cautioned about extrapolating outside the 3rd and 97th percentiles of BMI, BMI z remains widely used in studies that include large numbers of children with very high BMIs (Hampl et al, 2016; Kreier et al, 2013; McCormick et al, 2014; Smego et al, 2017; Wang et al, 2015). We have shown that, among children with severe obesity, BMI z levels are only weakly associated with other measures of body size (Freedman et al, 2017a) and the current results highlight the drawbacks of attempting to assess longitudinal BMI z changes.…”

“…Extrapolated z -scores based on the CDC growth charts are widely used among children who have very high BMIs (Baughcum et al, 2015; Hampl et al, 2016; Kreier et al, 2013; Smego et al, 2017; Wang et al, 2015). However, BMI z values for extremely high BMIs can differ substantially from the empirical estimates (Flegal et al, 2009), have an effective upper limit (Woo, 2009) and are strongly influenced by sex and age.…”