Date Published: July 13, 2017
Publisher: Public Library of Science
Author(s): Chiara Mameli, Jesse C. Krakauer, Nir Y. Krakauer, Alessandra Bosetti, Chiara Matilde Ferrari, Laura Schneider, Barbara Borsani, Sara Arrigoni, Erica Pendezza, Gian Vincenzo Zuccotti, David Meyre.
To evaluate the effects of an outpatient multidisciplinary weight loss intervention in reducing body mass index (BMI) in children and adolescents suffering overweight and obesity, changes in A Body Shape Index (ABSI, waist circumference normalized to height and weight) and Hip Index (HI, normalized hip circumference) during treatment and correlation between the ABSI and HI with change in BMI z score.
We analyze anthropometric data from pediatric patients affected by overweight and obesity aged 2 to 18 years old who entered our multidisciplinary weight loss intervention, which included medical, psychological and nutritional sessions, from January 1st 2006 to December 31st 2016. Lifestyle modification counselling was delivered. Follow-up visits were planned every month for 3 months and subsequently every 2–4 months. BMI, ABSI, and HI were converted to z scores using age and sex specific population normals.
864 patients entered our intervention. 453 patients (208 males), mean age 11.2 ±3.1 years, 392 with obesity (86%, z-BMI 2.90 ±0.80 SD) and 61 patients with overweight (z-BMI 1.73±0.21 SD) attended at least 1 follow-up visit. The mean number of visits was 3.5 (± 1.8 SD) in overweight subjects and 3.9 (±2.2 SD) in ones with obesity. At the last attended follow-up visit (at 16 ± 12 months SD) we observed a reduction in mean z-BMI in patients with obesity (to 2.52 ±0.71 SD) and patients with overweight (to 1.46 ±0.5 SD). Most patients (80.8%) reduced their BMI z scores. Mean ABSI and HI z scores showed no significant change. 78/392 patients (19.8%) recovered from obese to overweight, 5/392 (1.2%) from obese to normal weight. The recovery rate from overweight to normal weight was 13.1%. In a multivariate model, initial BMI z score and number of follow-up visits were significant predictors of weight change, while age, sex, ABSI, and HI were not significant predictors.
Patients affected by overweight and obesity involved in a multidisciplinary weight loss intervention reduced their mean BMI z score, while ABSI and HI were stable. Weight loss was not predicted by initial ABSI or HI. More visits predict more weight loss, but dropout rates are high. The great majority of patients leave the weight management program before having normalized their BMI.
Obesity is one of the most serious international health concerns. It affects physical health, as well as social and emotional well being . Over the past 30 years, a substantial increase in the prevalence of overweight and obesity in children and adolescents throughout the world has been reported . Childhood obesity rates in Italy are among the highest (36% for boys and 34% for girls) . Obesity results from an imbalance between energy intake and expenditure, with an increase in positive energy balance being associated with lifestyle (activity level) and dietary intake . However, more holistically, obesity is due to the interaction between many genetic, social and environmental factors .
Since the year 2006, the Endocrinology and Diabetes Clinic of V. Buzzi Children’s Hospital in Milan (Italy) has evaluated and treated overweight and obese children and adolescents. The multidisciplinary team is composed of a paediatric endocrinologist, a dietician and a clinical psychologist (same trained staff since 2006). In particular the clinical psychologist was involved in the organization and integration of experts in this project. From January 1st 2006 to December 31th 2016, patients with overweight and obesity aged between 2 and 18 years old were invited by their family paediatrician to be evaluated in the Clinic. Every subject was screened (T0 or baseline visit) by the medical team by means of a medical exam and measures of height and weight to identify the condition of overweight (BMI z score between 1 and 2 for age and sex according to WHO charts) or obesity (BMI z score ≥ 2). Weight was measured using a medical-certified scale (SECA, Hamburg, Deutschland). Height was measured using a medical-certified stadiometer for children (SECA, Hamburg, Deutschland). Waist and hip circumferences (WC, HC) were measured in centimeters to the nearest 0.1 cm twice using inextensible anthropometric tape positioned parallel to the floor. WC was measured midway between the lowest border of rib cage and the upper border of iliac crest, at the end of normal expiration. HC was measured at the widest part of the hip at the level of the greater trochanter .
From January 1 2006 to December 31 2016, 864 patients were screened at T0 medical visit. 325/864 (37%) refused to be included in the program. Reasons given by parents included lack of interest in the program (102 patients, 31%), too much time required for follow-up visits (87 patients, 27%) and absence of agreement of both parents for program participation (80 patients, 24%). 56 patients (17%) preferred to not give any explanation.
This report summarizes the results of over 10 years of experience in multidisciplinary weight loss intervention delivered in an outpatient setting for reducing body mass index in a large cohort of children and adolescents with overweight and obesity. These results reflect real-life issues and concerns in the management of overweight children and adolescents in a clinical setting.
We observed a reduction in mean BMI z score in both children and adolescents with overweight and obesity attending a multispecialty lifestyle-based treatment program. However, the patients’ dropout rate is high, with most leaving the program by the second year of treatment. While most patients (80.8%) showed reduction in BMI z score at the last follow-up visit compared to baseline, only 1.2% of patients with obesity and 13.1% of overweight ones recovered to normal weight before leaving the weight management program. In a multivariate model, at-diagnosis BMI z score and the number of follow-up visits are significant predictors of weight change. Weight change was similar across the range of values of the complementary anthropometric measures ABSI and HI.