Modest treatment effects and high program attrition: The impact of interdisciplinary, individualized care for managing paediatric obesity

Avis, Jillian L. S.; Ambler, Kathryn A.; Jetha, Mary; Boateng, Henrietta; Ball, Geoff D.C.

doi:10.1093/pch/18.10.e59

Cited by 14 publications

(17 citation statements)

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“…Four Canadian weight management programs have published evaluations, which demonstrated statistically significant, clinically moderate weight loss effects but high rates of attrition ( Watson-Jarvis, Johnston & Clark, 2011 ; Panagiotopoulos et al, 2011 ; Ball et al, 2011 ; Avis et al, 2013 ). The Centre for Healthy Weights Shapedown BC obesity management program reports a significant change from weight gain to weight loss at the end of the program.…”

Section: Resultsmentioning

confidence: 99%

“…Participant BMI z-scores on average decreased from 2.14 to 2.08 ( Watson-Jarvis, Johnston & Clark, 2011 ). Program attrition in an interdisciplinary, individualized care weight management program in Edmonton, Alberta, was 49 and 73% at 7 and 11 months, with 8 and 5% of children showing BMI decreases at these time-points ( Avis et al, 2013 ). Given the considerable heterogeneity between studies with regard to sample characteristics, settings, interventions, and outcome measures, we estimated the probability of weight loss after completion of a lifestyle intervention at 30% with 10% and 50% as worst and best case estimates.…”

Section: Resultsmentioning

confidence: 99%

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Successful childhood obesity management in primary care in Canada: what are the odds?

Kuhle

Doucette

Piccinini‐Vallis

et al. 2015

PeerJ

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Background. The management of a child presenting with obesity in a primary care setting can be viewed as a multi-step behavioral process with many perceived and actual barriers for families and primary care providers. In order to achieve the goal of behavior change and, ultimately, clinically meaningful weight management outcomes in a child who is considered obese, all steps in this process should ideally be completed. We sought to review the evidence for completing each step, and to estimate the population effect of secondary prevention of childhood obesity in Canada.Methods. Data from the 2009/2010 Canadian Community Health Survey and from a review of the literature were used to estimate the probabilities for completion of each step. A flow chart based on these probabilities was used to determine the proportion of children with obesity that would undergo and achieve clinically meaningful weight management outcomes each year in Canada.Results. We estimated that the probability of a child in Canada who presents with obesity achieving clinically meaningful weight management outcomes through secondary prevention in primary care is around 0.6% per year, with a range from 0.01% to 7.2% per year. The lack of accessible and effective weight management programs appeared to be the most important bottleneck in the process.Conclusions. In order to make progress towards supporting effective pediatric obesity management, efforts should focus on population-based primary prevention and a systems approach to change our obesogenic society, alongside the allocation of resources toward weight management approaches that are comprehensively offered, equitably distributed and robustly evaluated.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Successful childhood obesity management in primary care in Canada: what are the odds?

Kuhle

Doucette

Piccinini‐Vallis

et al. 2015

PeerJ

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“…This population was younger (mean age 11.8 years) and less obese (mean BMI 37 kg m −2 ) than teens enrolled in STOMP but had a similar profile of baseline comorbidities . A recent study from Edmonton, Canada, reported very similar outcomes in 165 children age 5–18 years with no mean BMI z‐score change and a 73% attrition rate over 11 months .…”

Section: Discussionmentioning

confidence: 98%

Adolescents with severe obesity: outcomes of participation in an intensive obesity management programme

et al. 2014

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“…the impact of negative personality traits in care delivery (35,69), and preferences or demands expressed on subjects unrelated to health, but related to certain aspects of daily life, when encountering a health issue (e.g. lifestyle changes to prevent childhood obesity) (61). They suggest that the usual characteristics of age, sex, clinical condition and education, may not predict how patients tolerate the adaptation of particular interventions (68), and call for opening up of patient characteristics used during segmentation analysis, and the type of data collected (67,83).…”

Section: Discussionmentioning

confidence: 99%

“…Research could also help structure the content of a customized intervention. Several articles underlined the importance of coordination and communication efforts in customizing interventions, in particular by emphasizing the role of structural integration or developing multidisciplinary teams (61,62,63). Other articles have stressed the importance of personalizing professional-patient relationships (85) while some others have stressed the key-role of modular packages (26).…”

Section: Discussionmentioning

confidence: 99%

Current Developments in Delivering Customized Care: A Scoping Review

Minvielle

Fourcade

Ricketts

et al. 2020

Preprint

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Background In recent years, there has been a growing interest in healthcare personalization and customization (e.g. personalized medicine and patient-centered care). While some positive impacts of these approaches have been reported, there has been a dearth of research on how these approaches are implemented and combined for healthcare delivery systems. Objective The present study undertakes a scoping review of current developments for delivering customized care, according to theoretical and practical guidelines for customization delivery approaches. Methods Article searches were initially conducted in November 2018, and updated in January 2019 and March 2019, according to Prisma guidelines. Two investigators independently searched MEDLINE, PubMed, PyscINFO, Web of Science, Science Direct and JSTOR, The search was focused on articles that included “care customization”, “personalized service and healthcare”, individualized care” and “targeting population” in the title or abstract. Inclusion and exclusion criteria were defined. Disagreements on study selection and data extraction were resolved by consensus and discussion between two reviewers. Results We identified 70 articles published between 2008 and 2019. Most of the articles (n = 43) were published from 2016 to 2019. Four categories of patient characteristics used for segmentation analysis emerged: clinical, psychosocial, service and costs. We observed they often coexisted with the most commonly described combinations, namely clinical, psychosocial and service. A minority of articles (n = 18) reported assessments on quality of care, experiences and costs. Finally, few articles (n= 6) formally defined a conceptual basis related to mass customization, whereas only half of articles used existing theories to guide their analysis or interpretation. Conclusions There is no common theory based strategy for providing customized care. In response, we have highlighted three areas for researchers and managers to advance the customized development concept in healthcare delivery systems: better define the content of the segmentation analysis and the intervention steps, demonstrate its added value, in particular its economic viability, and align the logics of action that underpin current efforts of customization. It would allow them to use customization to reduce costs and improve quality of care.

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Modest treatment effects and high program attrition: The impact of interdisciplinary, individualized care for managing paediatric obesity

Abstract: An individualized, interdisciplinary weight management intervention led to weight stabilization and a modest weight reduction in children with obesity. Strategies to minimize program attrition are needed to optimize family engagement in care and success in managing paediatric obesity.

Cited by 14 publications

References 0 publications

Successful childhood obesity management in primary care in Canada: what are the odds?

Successful childhood obesity management in primary care in Canada: what are the odds?

Adolescents with severe obesity: outcomes of participation in an intensive obesity management programme

Current Developments in Delivering Customized Care: A Scoping Review

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