ESPE Abstracts (2019) 92 P3-104

Treating Paediatric Morbid Obesity using the Multidisciplinary Intensive Inpatient Approach

Ruma Deshpande1, Shelley Easter1, Claire Semple1, Melanie Wenn1, Sarah Luther1, Rhian Augustus1, Julian Hamilton - Shield2,1, Dinesh Giri1


1Department of Pediatric Endocrinology, Bristol Royal Hospital for Children, Bristol, United Kingdom. 2Bristol NIHR Biomedical Research Unit (Nutition theme), University of Bristol, Bristol, United Kingdom


Background: Interplay of various factors contribute to development of morbid childhood obesity and to its recalcitrant nature making it a treatment challenge. A tertiary level, structured multidisciplinary outpatient approach may not always be sufficient in identifying morbid obesity causation. In the absence of other effective treatment modalities, a hospital stay approach can be a suitable option in selected resistant cases.

Methods: We retrospectively reviewed the records of four patients admitted for inpatient obesity management over a 12-month period from March 2018 to February 2019, this being approximately 5% of patients seen. During their stay, they received an individualised multi-modality support, involving inputs from paediatric endocrinologist, obesity nurse specialist, paediatric dietitian, social worker and clinical psychologist. Eating patterns, sleep, behavioural and psychosocial issues were considered. The children were given a guided menu choice from the hospital menu and access to outside food was limited. Regular supervised exercise in the form of hospital walks was encouraged and access to electronic medium was kept to a minimum. Family re-education about obesity and lifestyle modification were reinforced.

Results: Four patients (A, B, C, D) with morbid obesity (average BMI SDS:4.1) were admitted during this period. (Table 1).Mean length of hospital stay was 10.5 days. The prolonged stay of patient C was complicated by life threatening airway obstruction requiring CPAP stabilisation. The average documented weight loss at discharge was 4.9%. Post discharge follow-up at 1 month, BMI SDS losses from admission were sustained in all children.

Table 1: Inpatient stay-Weight,BMI SDS at admission, discharge and follow-up
PatientSex Age (yrs) Stay (days) Adm Wt (Kg)Adm BMI SDSDisch Wt (Kg)Disch Wt loss%Disch BMI SDSF/u BMI SDS
AM1151424.18139.81.554.164.15
BM1361103.71106.63.093.643.64
CM92286.54.1177.410.54.013.87
DF4935.54.433.94.54.144.13

Discussion: Supervised intensive multidisciplinary inpatient setting led to demonstration of successful and convincing weight loss. It offers a crucial contact period between the family and multidisciplinary team for re-education and can serve as a guide towards further weight loss. It may identify an at risk home environment if the child regains weight once back home which may warrant care in an alternative environment.Long-term sustainability and feasibility of the inpatient approach is questionable and might add burden on a health system working near maximum capacity already.

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