Background: A meta-analysis of 39 studies using multicomponent lifestyle interventions, in comparison to standard, minimal, or no treatment identified a mean difference in BMI z-score of -0.12 (95% CI -0.17 to -0.06) at six months. However, a minimum BMI-SDS reduction of 0.25 or greater has been shown to improve metabolic health in overweight children. We describe our experience in a multidisciplinary (MDT) clinic at a tertiary children's hospital with tier 3 level of care for obesity.
Methods: We retrospectively reviewed records of new patients seen on two or more occasions in our obesity clinic from October 2017 to September 2018. Our tier 3 set-up was radically changed two years ago to incorporate a specialist nurse, paediatric psychologist and social worker in addition to medical staff and paediatric dietitians. The first visit includes a detailed medical, dietary, behavioral and physical activity history, physical examination and blood tests. Henceforth, the emphasis is on family education with respect to diet, physical activity and lifestyle choices. Biopsychosocial factors are assessed and addressed directly by the extended team. Simple, achievable and sustainable lifestyle changes and targets are suggested at each visit (2-monthly) which are gradually revised as necessary until they became a part of daily lifestyle. No one member of the team leads, all contribute equally, but with each family one or two members may become predominant in leading change.
Results: 26 (16 males) out of 44 children were seen at least twice and were included in the analysis. The presentation age ranged from 4 to 16 years (mean 10.6). The first visit BMI SDS ranged from 2.03 to 5.28 (mean 3.41). Their follow up period ranged from 2 months to 9 months (mean 6 months). The mean BMI SDS during this follow-up period was 3.14, showing a 0.27 reduction (95% CI -0.478 to -0.064). Follow up BMI SDS dropped in 20 children (77%), remained the same in one (4%) and increased in five children (19%).
Discussion: Extra personnel enabling a whole-systems approach to weight management with realistic goal setting achieved a mean BMI SDS improvement of -0.27 at six months, improving on a recent meta-analysis of trials (-0.12). However, even with the best support, it may be a challenge to achieve or sustain BMI reductions due to lack of motivation, frustration and social issues. Continuing efforts and further innovative strategies need to be identified to improve and maintain the outcomes.
19 Sep 2019 - 21 Sep 2019