Importance of Age for 3-Year Continuous Behavioral Obesity Treatment Success and Dropout Rate

Division of Pediatrics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
Obesity Facts (Impact Factor: 2.25). 03/2012; 5(1):34-44. DOI: 10.1159/000336060
Source: PubMed


To assess whether first year weight loss, age, and socioeconomic background correlate with the success rate of continuous long-term behavioral obesity treatment.
In a 3-year longitudinal study, obese children (n = 684) were divided into three groups based on age at the start of treatment, age 6-9 years, 10-13 years, and 14-16 years. RESULTs: The mean BMI standard deviation score (BMI-SDS) decline was age-dependent (p = 0.001), independently of adjustment for missing data: -1.8 BMI-SDS units in the youngest, -1.3 in the middle age group, and -0.5 in the oldest age group. SES and parental BMI status did not affect the results. 30% of the adolescents remained in treatment at year 3. There was only a weak correlation between BMI-SDS change after 1 and 3 years: r = 0.51 (p < 0.001). Among children with no BMI-SDS reduction during year 1 (n = 46), 40% had a clinically significantly reduced BMI-SDS after year 3.
Behavioral treatment should be initiated at an early age to increase the chance for good results. Childhood obesity treatment should be continued for at least 3 years, regardless of the initial change in BMI-SDS.

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    • "From a clinical perspective, our results suggest that family-centered interventions such as the FCU can have a positive impact on family processes, which may in turn impact adolescent health in a manner that is carried forward into adulthood, even if the program does not include components related to nutrition or physical activity. This is especially promising as targeting obesity in adolescents through traditional means (focusing on obesity-related behaviors) continues to produce very modest results (Danielsson et al., 2012). As noted by Gerards and colleagues (2011), few obesity prevention and intervention programs address broader aspects of parenting, and our findings can spur the development of new programs by suggesting specific mechanisms by which the family can influence adolescent and early-adult health. "
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    ABSTRACT: OBJECTIVES To investigate whether the degree of obesity predicts the efficacy of long-term behavioral treatment and to explore any interaction with age. DESIGN A 3-year longitudinal observational study. Obese children were divided into 3 age groups (6-9, 10-13, and 14-16 years) and also into 2 groups (moderately obese, with a body mass index [BMI]-standard deviation [SD] score [or z score] of 1.6 to <3.5, and severely obese, with a BMI-SD score of ≥3.5). SETTING National Childhood Obesity Center, Stockholm, Sweden. PARTICIPANTS Children 6 to 16 years of age who started treatment between 1998 and 2006. INTERVENTION Behavioral treatment of obesity. MAIN OUTCOME MEASURE Change in BMI-SD score during 3 years of treatment; a reduction in BMI-SD score of 0.5 units or more was defined as clinically significant. RESULTS A total of 643 children (49% female children) met the inclusion criteria. Among the youngest moderately obese children, 44% had a clinically significant reduction in BMI-SD score (mean reduction, -0.4 [95% CI, -0.55 to -0.32]). Treatment was less effective for the older moderately obese children. Twenty percent of children who were 10 to 13 years of age and 8% of children who were 14 to 16 years of age had a reduction in BMI-SD score of 0.5 units or more; 58% of the severely obese young children showed a clinically significant reduction in BMI-SD score (mean reduction, -0.7 [95% CI, -0.80 to -0.54]). The severely obese adolescents showed no change in mean BMI-SD score after 3 years, and 2% experienced clinically significant weight loss. Age was found to be a predictor of a reduction in BMI-SD score (odds ratio, 0.68 units per year [95% CI, 0.60-0.77 units per year]). CONCLUSIONS Behavioral treatment was successful for severely obese children but had almost no effect on severely obese adolescents.
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