Background: Treatment of pediatric obesity is challenging and especially the long-term outcome has been modest in many previous studies.
Objective and hypotheses: We wanted to evaluate the efficacy of obesity treatment in specialist care and to find out factors, which have a major impact on the outcome.
Methods: A total of 654 children (302 girls) aged 218 years treated for obesity between 2005 and 2012 in three specialist clinics covering whole Eastern Finland were included. BMI-SDS based on the national growth references before the treatment, at baseline, and up to 3 years after baseline were recorded. The change in BMI-SDS and potential factors influencing the outcome (age and BMI-SDS at baseline, sex, presence of acanthosis nigricans (AN), psychiatric disturbances, parental obesity, motivation for treatment, and adherence to the protocol) were explored with mixed model analyses.
Results: BMI-SDS increased during the year before the baseline (mean difference 0.13 (S.D. 0.14); P<0.001), and decreased from the baseline (at 0.5 year −0.07 (0.01); at 1 year −0.10 (0.01); at 2 years −0.09 (0.02), all P<0.001, and at 3 years −0.06 (0.02) P=0.005). The presence of AN or age >10 years at baseline attenuated the treatment outcome and the long-term outcome was negligible. Children aged <10 years and those without AN had a significant and long-lasting decrease in BMI-SDS (at 3 years −0.27 (0.04), P<0.001 and −0.14 (0.04), P<0.001, respectively). In addition, motivation for treatment, adherence to the protocol, and BMI-SDS at baseline affected the outcome, whereas sex, psychiatric disturbances, or parental obesity had no impact on it.
Conclusions: Treatment of pediatric obesity is most effective when started at a younger age. The association of AN with a poor treatment outcome is a novel finding and suggests a link to insulin resistance. This warrants further studies.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology