Abstract
BackgroundA 6-month pediatric weight loss program showed modest success, but the sustainability of this success after 12 months was unclear. The present study aims tomeasure the medium-term effectiveness of family-based weight management in pediatric primary care to reduce body weight in children living with obesity.MethodsIn a retrospective cohort study, children ages 3 to 17 years with obesity in Kaiser Permanente Orange County, California, who enrolled in a weight management program between April 2014 and December 2018 (FB-WMG, n = 341) were compared to children referred but not enrolled (Ref-CG, n = 317) and controls matched by sex, age, zip code and BMI (Area-CG, n = 801). The relative distance from the median BMI-for-age at months 0, 6, and 12 were expressed as difference-in-differences (DID) using multivariable linear regressions with robust standard error.ResultsThe baseline BMI-for-age was 98.6 (SD 1.08) percentile in FB-WMG, 98.2 (SD 1.22) percentile in Ref-CG, and 98.6 (1.13 in Area-CG). FB-WMG had a median of 3 visits (P25 1 visit, P75 5 visits) in the first 6 months. Despite a more considerable decrease in the relative distance to the median BMI-for-age in FB-WMG children with 3+ visits after 6 months, the success obtained was not sustained at 12 months (DID FB-WMG vs Area-CG -0.34, 95% CI − 3.00 to 2.33%, FB-WMG vs Ref-CG -0.39, 95% CI − 3.14 to 2.35%). At 12 months, there was no statistical significant difference between the three groups (FB-WWG, Ref-CG, Area-CG).ConclusionsThe initial success in weight management was not sustained in the absence of continued support for healthy lifestyle changes. Based on current evidence, continued support is necessary to maintain and promote success beyond a brief 6 month intervention. Long-term pediatric weight management programs are needed to promote continuing progress.
Highlights
In the United States during 2015-2018, 19% of 6 to year old children and 21% of adolescents between and 19 years of age were living with obesity [1]
We identified youth who were enrolled in a family-based weight management program using International Classification of Diseases, 9th and 10th Revision, Clinical Modification (ICD-9 and ICD-10) Z71.3 and V65.3 and a KPSC-specific code for weight management
We identified youth with obesity who were referred to the family-based weight management program but did not participate in any sessions (Ref-CG, n = 317), as well as area-matched youth who were never referred and were not enrolled in a K.P. weight management program (Area-CG, n = 801)
Summary
In the United States during 2015-2018, 19% of 6 to year old children and 21% of adolescents between and 19 years of age were living with obesity [1]. The U.S Preventive Services Task Force (USPSTF) concluded that comprehensive, intensive behavioral interventions with a total of 26 contact hours or more are required to achieve sustained weight loss [14]. This approach is hampered by limited available resources, high attrition of participants, and weight gain relapses [15,16,17,18]. A 6-month pediatric weight loss program showed modest success, but the sustainability of this success after 12 months was unclear. The present study aims tomeasure the medium-term effectiveness of family-based weight management in pediatric primary care to reduce body weight in children living with obesity
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