Specialist Children's Obesity Management Services: What Makes a Difference in Outcomes?

Abstract

Background and Objective: Evidence supports multi-component behavioural interventions of greater than 26 h to improve weight status in children and adolescents who are obese. It can be challenging for health systems to provide services at this intensity. This study aimed to determine the effectiveness of a pilot multidisciplinary specialist service provided to children and adolescents who were overweight or obese and living in Brisbane, Australia. Materials and Methods: All children referred over a one year period were eligible to participate. A retrospective analysis of electronic medical records and appointment records was conducted to collect demographic details, anthropometric measures and appointment details. Semi-structured interviews were used to gather information regarding service perceptions and experiences. Results: 25 children and adolescents (52% male) ranging in age from 4.8-15.3 years participated. There was a statistically significant improvement in BMI z-score for all participants (z = -2.814, p = 0.005) and males showed greater improvements compared to females (z = -2.432, p = 0.015 vs. z = -1.560, p = 0.119, respectively). Discharged participants showed better outcomes compared to those who withdrew. Measures of success were achieved on average in 3-5 h over 12 months, less than evidence-based recommendations. Results should be carefully considered at the systems level and questions regarding service length, setting, participant characteristics, attrition rates and measures of success require further consideration. Conclusion: The results generate important considerations regarding specialist obesity management services from a service delivery and systems perspective. Additional large scale pragmatic, implementation studies are required to help progress this agenda.