Predicting Weight Loss and Maintenance in Overweight/Obese Pediatric Patients

Abstract

Background: Pediatric lifestyle interventions have positive short-term effects on obese patients. Studies on long-term effects are still scarce in Europe. We investigated long-term weight patterns and sociodemographic predictors of a weight change in a large Central European (Germany, Austria and Switzerland) overweight pediatric cohort. Methods: The APV (Adiposity Patients Verlaufsbeobachtung) database was retrospectively analyzed; 157 specialized childhood obesity centers contributed standardized data of 29,181 patients [body mass index (BMI) ≥90th percentile; 5-25 years old] presenting between 2000 and 2012. BMI standard deviation scores (BMI-SDS) were analyzed in a 2-year follow-up and grouped according to BMI-SDS changes. Multiple logistic regression analyses were conducted to assess associations between sociodemographic factors and weight patterns. Results: 2-year follow-up data were available in 3,135 patients (54.6% female). Five distinct weight trajectories ‘rapid weight loss' (n = 735, 23.4%), ‘delayed success' (n = 697, 22.2%), ‘cycling weight' (n = 43, 1.4%), ‘initial weight loss' and ‘weight rebound' (n = 383, 12.2%) and ‘no weight loss throughout' (n = 1,277, 40.7%) best characterized long-term BMI-SDS changes. Younger and male patients were more likely to reduce weight and maintain weight loss. Conclusions: Our results suggest that an intervention before the onset of puberty seems promising for long-term weight maintenance in overweight children. Thus, new concepts are needed to improve long-term treatment success in patients with lower success rates.

Changing Characteristics of Obese Children and Adolescents Entering Pediatric Lifestyle Intervention Programs in Germany over the Last 11 Years: An Adiposity Patients Registry Multicenter Analysis of 65,453 Children and Adolescents

“…The authors also stated a higher success rate in younger children [10]. Similar results were indicated by another study with 2-year follow-up [11]. This emphasizes the importance of an early and effective intervention in childhood obesity.…”

“…2a-c). Previous studies indicated that a lower BMI at the beginning of a LI is one predictor of success as measured by BMI SDS [10,11]. However, the indication to participate in an outpatient or inpatient LI depends on obesity degree and existing risk factors or comorbidities (table 4) [21,22].…”

Paediatric obesity treatment had better outcomes when children were younger, well motivated and did not have acanthosis nigricans

“…Furthermore, at 36 months, 33% had a decrease of at least 5% in BMI SDS and 27% had a decrease of ≥0.25 BMI SDS. This was a very acceptable long‐term outcome when it was compared with many other contemporary studies and even more acceptable when we took into account that only a few studies were able to present long‐term follow‐up data . Our encouraging results on long‐term outcome could be, at least partly, due to good motivation for treatment and adherence to the protocol.…”

Comparative Effectiveness of Clinical-Community Childhood Obesity Interventions

“…28 An expert panel has suggested that a BMI z-score reduction of 0.20 units is associated with clinically significant improvement. 29 Other studies suggest that changes of 0.15 BMI z-score units led to more healthful cardio-metabolic profiles. 28 As suggested by a recent evidence review of childhood obesity management, regardless of what the threshold of clinical significance will be determined to be, simply arresting gain in excess BMI likely constitutes a clinically important benefit for many children.…”