ESPE2015 Poster Category 2 Fat (64 abstracts)
Network Coordinated Primary Care Intervention in Obese Children and Adolescents: Almost a Decade of Experience
Sophie Guilmin-Crépon a, , Amine Arsan b , Priscilla Boizeau a , Corinne Alberti a , Laurent Fidalgo b , Bertrand Chevallier b, , Patricia Lubelski b , Jacques Cheymol b , Alain Zaluski b , Patrick Tounian b, , Jean-Claude Carel b, & on behalf of REPOP Ile-de-France b
aClinical Epidemiology Unit, Robert Debre Hospital, APHP, Paris, France; bREPOP Ile-de-France, Paris, France; cPediatric Endocrinology and Diabetology, Robert Debre Hospital, APHP, Paris, France; dPediatrics, Ambroise Pare, APHP, Boulogne, France; ePediatric Gastroenterology and Nutrition, Armand Trousseau Hospital, APHP, Paris, France
Background: French health authorities have developed a national program to organize outpatient care networks for the prevention and management of obesity in children and adolescents (Réseau de Prise en Charge de l’Obésité Pédiatrique (REPOP)). To date, REPOP Ile-de-France has more than 250 primary care physicians with dietitians, nurses, educators, and psychologists trained in the management of childhood obesity as part of a standard care pathway, working in close collaboration with expert hospital staff.
Objective and hypotheses: To describe the evolution of BMI in children and adolescents followed by REPOP Ile-de-France and to determine factors associated with the evolution of body size.
Method: All children and adolescents prospectively included in the REPOP cohort from 09/2003 to 02/2012. Results are expressed as median (q1;q3). The primary endpoint was the evolution of BMI Z-score and improvement was defined as a decrease >10% at the last follow-up visit. Cox models were used to analyze the influence of clinical and familial characteristics.
Results: Among 4174 patients, 59% were available for analysis beyond 3 months. Subjects lost to follow-up were more likely female (62.6% vs 58.8%, P=0.01), older (10.5 years (8.5; 12.7) vs 10.3 (8.2; 12.4), P=0.02) and more obese (BMI Z-score 3.4 (2.8; 4.2) vs 3.3 (2.7; 4.0), P=0.00001). The other 2468 subjects were used for analysis, with a median duration of follow-up of 11 months (5.7; 19.5). The median change in BMI Z-score was −0.26 (−0.56; −0.02). The primary endpoint was met in 1047 patients (42.4%) with significant associations with age (OR 0.93 (0.88; 0.99), P=0.02), BMI Z-score at baseline (OR 0.95 (0.92; 0.99), P=0.02), maternal BMI (OR 0.98 (0.97; 0.99), P=0.01), and time between consultations (OR 0.88 (0.84; 0.91), P<0.0001). The proportion of subjects with waist-to-height ratio ≥0.5 decreased from 89 to 80%, P<0.0001).
Conclusion: Network coordinated primary care intervention is associated with clinical improvement in obese children and adolescents. These results suggest that early identification and referral is associated with improved outcome. They could help to improve the program by highlighting population at risk of loss of follow-up.
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