Background: Adherence to follow-up visits in children and adolescents with obesity is a key factor for successful therapeutic outcomes in these patients.
Objective: To analyze the adherence to scheduled visits and drop-out rate and the anthropometric, metabolic and behavioral outcomes as a result of an intervention program in a large cohort of children and adolescents with obesity.
Patients and Methods: A retrospective, observational study of 1300 patients with obesity (47.2% females; 53.3% prepubertal; 75.8% Caucasians; mean age:10.46±3.28 years, BMI: +4.01±1.49 SDS) undergoing an intervention program based on nutritional counseling, physical activity and behavioral therapy was performed. Drop-out rate and time of follow-up, as well as changes in eating patterns and physical activity were recorded. Paired comparisons of BMI-SDS, blood glucose, uric acid, lipoprotein, triglyceride levels and HOMA index from baseline (B) to the end of follow-up (E) were made, with ethnicity, sex and pubertal status included as variables.
Results: Mean follow-up time was 1.59±1.60 years with a 59.9% drop-out rate [11.2% after first evaluation and 32.5% after getting the results of complementary examinations (second visit)]. Drop-out rate was higher in males (X2:14.70;P<0.05), prepubertal children (X2:6.39; P<0.05) and Latino patients (X2:28.94;P<0.001) and highest in the first 6 months. Among those who abandoned follow-up, 84.1% showed no fulfillment of clinical recommendations in their previous visit, whereas 10.5% showed clinical improvement. BMI-SDS at E was +3.59±1.87 SDS decreasing 0.37±1.25 SDS from B (P<0.001), mainly in the first year, with partial recovery in the second year and later stabilization. The BMI-SDS decrease was greater in males (P<0.01) and prepubertal children (P<0.001).
Unscheduled eating, quick eating pace and lack of physical activity significantly decreased (all P<0.001) from B (prevalence 81.9%, 74.0% and 74.7%, respectively) to E (57.2%, 47.3% and 49.8%).
The metabolic profile at both B and E was available in 451 patients. Impaired glucose tolerance (IGT) prevalence decreased from 9.3% at B to 3.5% at E (P<0.001). HDL level increased whereas HOMA index, LDL, uric acid and triglyceride levels decreased from B to E (all P<0.01), with a significant correlation between the intensity of the decrease in BMI-SDS and that of each metabolic change (P<0.01).
Conclusions: Therapeutic outcomes in childhood and adolescent obesity is determined by follow-up adherence. Unfortunately, there is a high drop-out rate, particularly in the first 6 months.
19 - 21 Sep 2019
European Society for Paediatric Endocrinology