Evaluating 12 Years of Implementing a Multidisciplinary Specialist Child and Adolescent Obesity Treatment Service: Patient-Level Outcomes

Abstract

IntroductionChildhood obesity is a chronic disease that requires multidisciplinary and specialist intervention to address its complex pathophysiology, though access to treatment is limited globally. Evaluating the impact of evidence-based interventions implemented in real-world clinical settings is essential, in order to increase the translation of research into practice and enhance child health outcomes. In Ireland, the National Model of Care for Obesity highlighted the need to develop and improve healthcare services for children and adolescents with obesity.AimsThis study aims to evaluate the impact of a family-based, Tier 3 multi-disciplinary child and adolescent obesity outpatient service (www.w82go.ie) on standardized body mass index (BMI-SDS).MethodsFollowing referral by pediatricians, patients were assessed by a pediatric multidisciplinary team (physiotherapist, dietician, and psychologist) and personalized obesity treatment plans were developed. Anthropometric and demographic information were recorded at baseline and final visit. Descriptive statistics were used to explore distribution, central tendency and variation in the demographic data, change in BMI-SDS over time was assessed using a t-test, and multiple linear regression analysis was used to investigate the association of demographic factors on the change in BMI-SDS.ResultsThe overall mean BMI-SDS reduction across the whole cohort (n = 692) was −0.17 (95% CI = −0.20, −0.13; P < 0.001). Younger age at admission and longer duration of treatment were associated with greater BMI-SDS reduction but there was no significant association between change in BMI-SDS and any of the other parameters (deprivation score, treatment type, sex, obesity category at admission or presence of comorbid condition).ConclusionEngagement in a specialist Tier 3 pediatric obesity service was associated with reductions in BMI-SDS in children and adolescents with obesity.

Special considerations for the child with obesity: An Obesity Medicine Association (OMA) clinical practice statement (CPS) 2024

“…In a 12-year evaluation of an obesity multidisciplinary specialist treatment service, Wyse et al. (2022) found a −0.17 BMI SDS change across the whole cohort and that younger age at intervention initiation and longer duration of the intervention resulted in a greater BMI-SDS; there was no significant association with this change and any other parameter studied [ 83 ]. The CPG states “Although providing patient-centered and non-stigmatizing nutrition and activity counseling is important for children of all weight classifications, there is no evidence to support either watchful waiting or unnecessary delay of appropriate treatment of children who have already developed obesity.…”

Body Composition in Fussy-Eating Children, with and without Neurodevelopmental Disorders, and Their Parents, Following a Taste Education Intervention

“…The causes of obesity are multifaceted and complex and include environmental, physiological, genetic, and behavioral factors [ 8 , 9 , 10 ]. There is also evidence of parental feeding practices and obesity being tied to children’s eating psychopathology and weight trajectories [ 11 ].…”

“…In recent decades, the prevalence of overweight and obesity in children and adults has increased considerably worldwide [1][2][3][4]. Obesity is considered a chronic, relapsing, and progressive disease, affecting individuals in all environments and demographics, particularly those in the lower socioeconomic brackets [5][6][7][8].…”

Addressing child and adolescent obesity management in Ireland: identifying facilitators and barriers in clinical practice

“…For example, the revised RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework (22) describes the need to assess organisational and patient characteristics and perspectives to understand specific contexts. Limited data suggest that there is no consistent approach to assessment, diagnosis, management, or signposting for obesity in paediatric services in practice locally, but rather standalone interventions or partial interventions may be delivered in routine practice by individuals and services regionally (23)(24)(25)(26)(27). In Ireland, to realise the implementation of the HSE model of care for treating obesity, a fundamental understanding is required around (a) what HPs can currently deliver in terms of treatment and (b) what is needed to build capacity throughout the health system to improve identification, clinical assessment, treatment access, and treatment delivery and outcomes related to obesity in CYP.…”