Multidisciplinary Weight Management Program Research Articles

Association Between Physician Recommendation for Adolescents to Join a Weight Loss Program and BMI Change

To explore whether reasons for enrollment in a pediatric multidisciplinary weight management program (PMWMP) are associated with subsequent weight loss. A retrospective analysis of obese adolescents (12-18 years old, body mass index [BMI] > 95th percentile) who enrolled in a PMWMP from April 2007 to March 2009, and had BMI measurements at weeks 1 and 12. Reasons for enrollment were obtained from parents' responses to an enrollment questionnaire (which allowed selection of more than one reason). The most common reasons for enrollment were computed. Linear regression was used to explore associations between mean change in BMI and reasons for enrollment, controlling for demographic and anthropometric factors. Most of the 90 adolescents who met the inclusion criteria were female (70%) and white (57%). Mean age was 14.5 years and mean initial BMI was 42 kg/m(2). The most common reasons for enrolling in the PMWMP were due to concerns about adolescents' physical health (96%), concerns about adolescents' mental health (76%), and because of a physician recommendation (73%). The mean 12-week change in BMI showed a greater decrease for those who enrolled due to a physicians' recommendation versus those who did not (-1.5 vs -0.5 kg/m(2): P < .05). This finding remained significant even when controlling for the covariates of interest. A physician's recommendation to join a PMWMP appears to be associated with greater weight loss among obese adolescents than other reasons for enrollment. Further research should explore how physician involvement affects long-term weight loss.

Six-Month Dietary Changes in Ethnically Diverse, Obese Adolescents Participating in a Multidisciplinary Weight Management Program

This study's objective was to examine dietary and metabolic changes in obese adolescents who completed 6 months of participation in an outpatient multidisciplinary weight management program (N = 67). Participants (75% African American, 66% female, mean age = 13.7 years) completed 24-hour dietary recalls and underwent measurement of anthropometrics and fasting blood lipid parameters at baseline and after 6 months of participation. General linear models suggested that participants significantly reduced total energy, total fat, saturated fat, carbohydrate, sodium, and sugar intakes, and increased fiber and fruit and vegetable intake (P < .05). Gender-stratified models showed differences in fruit/vegetable intake, percentage calories from fat, sodium, and dietary cholesterol intakes by gender. Significant improvements in body mass index percentile and lipid profiles were also found, lending objective support to the dietary changes participants made. Findings suggest that participation in this multidisciplinary treatment helped participants make behaviorally based dietary changes, which were associated with improved dietary intakes and health status.

Results from a clinical multidisciplinary weight management program.

Published data regarding outcomes of pediatric behavioral weight management are mainly from research interventions. The authors wished to explore outcomes from a clinical program. A retrospective analysis of data from obese adolescents enrolled in the Michigan Pediatric Outpatient Weight Evaluation and Reduction program (April 2007 to June 2008). The multidisciplinary program included group sessions, individual visits, and exercise classes. Linear regression was used to explore associations between change in body mass index (BMI) and age, sex, race, and insurance. N = 67. Mean age was 14.5 years; 71% female, 50% Medicaid enrollees, and 30% African American. Mean initial BMI was 40. Mean change in BMI was -2.3 for those completing the 24-week program (n = 48; P < .01). Reduction in BMI was not associated with participants' demographic characteristics. A clinical multidisciplinary weight loss program for adolescents can lead to decreases in BMI after 24 weeks. Further work is needed to assess long-term outcomes.

Physicians’ Perspectives on Referring Obese Adolescents to Pediatric Multidisciplinary Weight Management Programs

To identify factors that might influence physicians' referrals of obese adolescents to pediatric multidisciplinary weight management (PMWM) programs. Survey of a national sample of 375 pediatricians (PDs) and 375 family physicians (FPs) explored program availability, referral history, desired services, and when in the course of treatment physicians would refer. Differences were examined via chi(2) tests. Response rate was 67%. More PDs than FPs reported having a PMWM program available (46% vs 10%, P < .01). More PDs (PD 83% vs FP 53%, P < .01) and female physicians (88% vs 65%, P < .01) reported having made a referral. Most physicians wanted coordinated diet, activity, and behavioral therapy (79%). Almost all physicians indicated they would refer when unsure of what else to do, or if requested by the patient/parent. PMWM program referrals appear limited by availability. These data also suggest physicians may be reticent to refer. Further work should examine whether this affects patient outcomes.

Psychosocial Factors and Perspectives on Weight Gain and Barriers to Weight Loss Among Adolescents Enrolled in Obesity Treatment

The aim of the current descriptive study was to explore factors related to psychosocial wellbeing, weight gain and perceived barriers to exercise and nutrition in 135 obese adolescents enrolled in a multidisciplinary weight management program. Participants completed initial intake interviews, which included information about psychosocial well-being, factors associated with weight gain, and barriers to exercise and nutrition. We examined the associations among psychosocial factors and participants' attendance compliance for the nutrition, exercise, and behavioral support and modification components of the program. Results indicated that familial factors were associated with weight gain, and family, peer, and individual factors were associated with barriers to healthy eating and exercise. Among the psychosocial factors, history of trauma was negatively associated with compliance. Findings emphasize the importance of addressing psychosocial well-being and using a systems approach to weight management for obese adolescents.

Factors Contributing to Weight Misperception in Obese Children Presenting for Intervention

To assess weight stigma, self-perception of weight status, and factors contributing to accurate self-perception of weight status in obese youth presenting for treatment at a hospital-based multidisciplinary weight management program. Participants (N = 97; mean age = 8.56 +/- 1.66 years) used a figural rating scale to assess weight stigma and their current and ideal body type, and Sizing Me Up, a measure of obesity-specific health-related quality of life (HRQOL). The majority endorsed negative/stereotypical attributes toward an obese body type, chose an average or underweight figure as their ideal, and 39% misperceived their weight status. Older child age and greater HRQOL impairment were significant predictors (P < .01) of correct self-perception. Pediatricians may find that talking with the elementary school-aged patient and family about whether weight/size affects their day-to-day life will prove to be a salient and neutral opening to discussing the child's obesity and need for intervention.

How young for bariatric surgery in children?

Obesity affects 50% of adults and 18% of children in the USA. It has wide-ranging comorbidities with clinical, psychosocial, and economic ramifications. Obesity refers to a condition of excess body fat. The basis for weight gain is a fundamental imbalance between caloric intake and output, but individual variation based on genetics, metabolism, and diverse environmental triggers is seen. Although modifications to our obesogenic society and education about the risks in our environment may lead to a decrease in the incidence of obesity through prevention, treatment for those already obese is critically important. In adults, the most successful treatment programs for obesity include a surgical procedure. This article discusses the problems obesity presents to children and their families, highlights the unique aspects of treating obesity in children, reviews the currently utilized bariatric surgical procedures, and introduces those bariatric procedures that are under development. When considering whether to use bariatric surgical procedures in a multidisciplinary weight management program for children, the special needs and characteristics of children with a severe weight problem must be considered. Development of bariatric surgical techniques and devices and implementation of these tools in multidisciplinary weight management programs need greater attention. This will require the combined efforts of the pediatric health care providers from many specialties and partnerships with industry to facilitate discovery and implementation.

Prevalence of the Metabolic Syndrome Among Obese Adolescents Enrolled in a Multidisciplinary Weight Management Program: Clinical Correlates and Response to Treatment

The aim of this study was to determine the prevalence of the metabolic syndrome at baseline and after 6 months of lifestyle modification among obese adolescents referred to a multidisciplinary weight management program. A total of 165 obese adolescents were evaluated at baseline, and measurements were repeated in 57 subjects who completed 6 months of the program. Metabolic syndrome was defined as having three or more of the following: a body mass index (BMI) >97(th) percentile, hypertension, low high-density lipoprotein cholesterol (HDL-C), hypertriglyceridemia, and impaired fasting glucose (IFG). The prevalence of a BMI >97(th) percentile, hypertension, hypertriglyceridemia, low HDL-C, and IFG was 92.7, 54.5, 29.1, 26.7, and 2.4%, respectively. The prevalence of the metabolic syndrome at baseline was 30.3%. After 6 months of lifestyle modification, BMI z scores, percent body fat, total cholesterol, and low-density lipoprotein cholesterol (LDL-C) decreased significantly from baseline; however, there was no significant change in the number of subjects demonstrating >or=three criteria of the metabolic syndrome. Approximately one third of the study subjects met the criteria of the metabolic syndrome, emphasizing the growing concern for the future development of premature cardiovascular disease in this high-risk population. Our data suggest that new strategies for lifestyle modification may be needed to improve cardiovascular risk factors significantly among adolescents with obesity.

Community‐based multidisciplinary weight management program in Mexico: Metabolic profile of patients at baseline

BackgroundMultidisciplinary interventions for the management of obesity have become the most accepted model of treatment.ObjectiveTo determine the metabolic profile of patients attending a 6 month multidisciplinary weight management program at the National Institute of Medical Sciences and Nutrition in Mexico City.Subjects and methods1216 obese patients who voluntarily entered a 6 month multidisciplinary weight management program (Feb. 2003 to Sept. 2007) were evaluated. Assessment at baseline included anthropometrical (BMI), clinical (blood pressure), and metabolic (glucose, lipid profile) measurements. Cardiometabolic abnormalities (diabetes mellitus, glucose =100mg/dL, triglycerides (TG) =150 mg/dL, cholesterol =200mg/dL, HDL &lt;40/50mg/dL in males and females, LDL =100mg/dL, HOMA =5.13 and blood pressure (BP) =130/85mmHg) were assessed at baseline, and patients were considered "metabolically normal" with 0‐1 abnormalities.ResultsPatients were 38.8±11.7 years old with a BMI of 43.8±8.4; 896 (74%) were female; 62.9% of participants had BMI=40. Prevalence of diabetes was 27.6%. Abnormal values in glucose, TG, cholesterol, HDL, LDL, HOMA and BP were 41.3%, 52.7%, 33.2%, 87.5%, 71.1%, 45.9% and 62.3%, respectively. Only 91 patients (7.5%) were "metabolically normal".ConclusionsA high prevalence of metabolic abnormalities was found in the obese population attending the program. "Metabolically normal" subjects should be studied further.

Community‐based multidisciplinary weight management program in Mexico: Determinants of success

BackgroundStrategies to improve success rates in weight managements programs are needed.ObjectiveTo identify the determinants of success (weight loss =5%) of patients attending a 6 month (7 appointments) multidisciplinary weight management program at the National Institute of Medical Sciences and Nutrition in Mexico City.Subjects and methods1216 obese patients who voluntarily entered the program were evaluated. Assessment at baseline included general and socioeconomic (age, gender, schooling, civil status, appointments, previous treatment), anthropometrical (BMI, waist circumference, previous weight loss), clinical (blood pressure), metabolic (glucose, lipid profile) psychological (emotional eating, conscience of disease, anxiety and depression scores, family support, motivation stage, and diagnosis of food disorders) measurements. A stepwise logistic regression model for success was developed, with socioeconomic, anthropometrical, metabolic, clinical and psychological characteristics as independent variables.ResultsPatients were 38.8±11.7 years old with a BMI of 43.8±8.4; 74% were female; 62.9% of participants had BMI=40. Success rate was 43%. Determinants of success were socioeconomic class (OR=1.51, 95%CI 1.11‐2.07), number of visits (OR=2.09, 95%CI 1.44‐3.04), previous treatment (OR=0.49, 95%CI 0.25‐0.97) and anxiety score (OR 0.94, 95%CI 0.88‐0.99).ConclusionsStrategies to help patients deal with stress should be implemented and efforts to ensure compliance should be made to ensure the expected weight loss.

Tailored Mobile Phone Text Messages as an Adjunct to Obesity Treatment for Adolescents

Background: The American Academy of Pediatrics recommends multidisciplinary treatment when primary care efforts to treat obesity in adolescents have failed. However, multidisciplinary weight management programs often suffer from poor treatment adherence, high attrition rates, and low reach. Identifying ways to address these issues is important to improving outcomes.

Development of Bariatric Surgery: The Effectiveness of a Multi-disciplinary Weight Management Programme in Hong Kong

In Hong Kong, obesity and its associated co-morbidities are increasingly becoming a health and societal burden. Conservative weight management therapy is ineffective in maintaining substantial weight loss in severely obese patients and more invasive interventions are required to achieve sustainable weight loss. Invasive bariatric procedures were introduced to Hong Kong in 2002. Severely obese patients will be seen in a combined obesity clinic where multi-disciplinary assessment was carried out before interventional therapy. Patients will be allocated to various bariatric surgeries such as laparoscopic adjustable gastric banding (LAGB), laparoscopic sleeve gastrectomy (LSG) or laparoscopic gastric bypass (LGB) when operative criteria were met. For selected patients who were not suitable or refused surgical treatment, endoscopic placement of intragastric balloon (IGB) will be used as an alternative weight control option. Multi-disciplinary approach was also applied during perioperative period to accomplish different clinical needs for the individual patient. Over 500 patients were seen in our unit seeking advice on severe obesity. Two hundred and twenty-five patients received interventional therapy which included LAGB (n = 57), LSG (n = 71), LGB (n = 7) and IGB programme (n = 120). Thirty patients (25%) received second bariatric surgery after IGB removal. Adverse events occurred in 20 patients (7.8%) and there was no operative mortality. At 2 years, the mean percentage of excessive weight loss (%EWL) for LAGB, LSG and LGB are 34%, 51% and 61%, respectively. In those patients who received IGB alone, the mean %EWL at removal and 6 months after removal were 44% and 34%, respectively. Through a multi-disciplinary weight management programme with different specialties and various bariatric procedures, favourable results can be achieved in patients with severe obesity.

Evaluation of a 6-month multi-disciplinary healthy weight management program targeting urban, overweight adolescents: Effects on physical fitness, physical activity, and blood lipid profiles

This study evaluated preliminary physical fitness, physical activity, and blood lipid profile data obtained from overweight adolescents upon enrolling in a healthy weight management program and following 6 months of program participation. One hundred and sixty-eight participants (13.4+/-1.8 years, 37.9+/-8.3 kg/m(2), 59.5% female and 76.2% African-American) enrolled in the program. The intervention addressed factors related to nutrition, physical activity, and other behaviors related to weight management. Sixty-four participants (38.1%) completed 6 months of program participation. While there was no significant reduction in body mass or body mass index (BMI), BMI z-score was reduced by 1.2% (p < 0.05), cardiorespiratory fitness was increased by 10.8% (p = 0.001), body fat percentage was reduced by 2.6% (p = 0.001), total cholesterol was reduced by 7.2% (p < 0.001), and low density lipoprotein (LDL-C) was reduced by 8.4% (p < 0.001) at 6 months. Continued development and evaluation of programs designed to prevent and treat child and adolescent overweight is warranted to address this major public health issue.

A case of asymptomatic fungal and bacterial colonization ofan intragastric balloon

Intragastric balloon therapy, as a part of a multidisciplinary weight management program, is an effective short-term intervention for weight loss. Although the insertion procedure is easy and generally well tolerated by patients, a few complications can occur. We report here a heavy smoker with intragastric balloon insertion complicated by colonization with opportunistic organisms. The 27-year-old female, body mass index 35.5 kg/m(2), had a BioEnterics Intragastric Balloon inserted under conscious sedation without any perioperative complications. Six months later, when the standard removal time arrived, the balloon was seen to be covered with a necrotic white-gray material. Microbiological examination revealed Enterobacter cloacae and Candida species yeast colonies. We recommend that asymptomatic fungal and/or bacterial colonization should be considered among the complications of the intragastric balloon procedure, despite its rarity.

Pilot Study of a 10-Week Multidisciplinary Tai Chi Intervention in Sedentary Obese Women

Alternative approaches to weight control and physical activity are increasingly needed. Numerous factors influence weight management, including the choice of physical exercise. No study has previously examined the therapeutic effect of a multidisciplinary weight management program incorporating Tai Chi (TC) exercises among sedentary obese women. Randomized intervention trial with blinded medical provider. In day hospital consultations. Twenty-one obese women. All subjects participated in a 10-week weight management program that was part of usual care and included a hypocaloric balanced diet, a weekly physician/psychologist/dietician group session, and an exercise program. For the exercise component, subjects were randomized to either a 2-hour weekly session of TC or a conventional structured exercise program. Changes in weight, body composition, heart rate, blood pressure, mobility scores, mood, Three Factor Eating Questionnaire scores, and General Self-Efficacy. The TC arm improved in resting systolic blood pressure, chair rise test, mood, and reduced percent of fat at week 10 and at 6 months follow-up. General self-efficacy was enhanced in both groups and maintained at 30 weeks. The observed benefits over a 30-week period of a multidisciplinary weight management program incorporating TC exercises on physical functioning mood and dietary restraint need further understanding of how sedentary obese women adhere to physical activity like TC or other alternative exercises.

P87. Improvements in Low Back Pain Following Enrollment in a Multidisciplinary Weight Management Program

BACKGROUND CONTEXT: Weight loss is commonly recommended to patients with low back pain. However, there is little literature to support this approach as a therapeutic intervention, and a recent systematic review identified no studies that addressed whether non-operative weight loss can improve low back pain.

Effectiveness of a Parent and Child Multidisciplinary Weight Reduction Program: Survey of Fit' N Fun Program Participants

Participants will be able to identify food related behaviors associated with childhood obesity and the effect of a multidisciplinary weight management program on improving food related behaviors.

A Pediatric Weight Management Program for High‐risk Populations: A Preliminary Analysis

To determine whether a multidisciplinary pediatric weight management program effectively improves BMI, BMI z-score, and cardiovascular risk factors (CVRFs) in high-risk populations. A retrospective chart review was performed on children seen in the NEW Kids Program at the Children's Hospital of Wisconsin, a family-based clinic that treats pediatric obesity using medical management, nutrition education, behavioral intervention, and physical activity. Inclusion criteria were program participation for >or=9 months and >4 visits. Analyses were performed to identify factors associated with pre- to postintervention changes in BMI, BMI z-score, and CVRF laboratory values. A total of 66 patients met inclusion criteria; the mean age was 11 years (s.d.+/-3.4), 56% were racial/ethnic minorities, 45% were Medicaid recipients, 48% resided in impoverished communities, and 38% had a BMI >or=40 kg/m(2). Of the 66 patients, 91% had more than one weight-related comorbidity, 88% had CVRFs, and the preintervention mean BMI was 37 kg/m(2). After the intervention, there was an overall increase in absolute BMI, but a small, yet significant decrease in BMI z-score (mean -0.03+/-0.16; P<0.05). There were significant pregroup to postgroup improvements in total cholesterol, low-density lipoprotein, and triglycerides levels (P<0.05). Insurance coverage, race/ethnicity, gender, age, and initial BMI were not significantly associated with changes in BMI or BMI z-score. A multidisciplinary pediatric weight management program can improve the weight status of high-risk populations, including minorities, Medicaid recipients, patients with multiple comorbidities and CVRFs, and the severely obese.

Safety and Effectiveness of the Intragastric Balloon for Obesity. A Meta-Analysis

Intragastric balloons have been used since 1985 to treat obesity, but an evidence-based systematic review had not been previously performed. The objective of this study is to determine the safety, efficacy, and effectiveness of the most widely used balloon, BioEnterics Intragastric Balloon (BIB), to treat obesity. Systematic literature review of Medline, Embase, and other information sources from inception to March 2006. The quality of selected studies was assessed. Meta-analysis of weighted mean difference was made using the inverse variance method. We pooled 15 articles (3,608 patients) to estimate BIBs effectiveness. The estimates for weight lost at balloon removal for BIB were the following: 14.7 kg, 12.2% of initial weight, 5.7 kg/m(2), and 32.1% of excess weight. However, data were scant after balloon removal. Yet, efficacy at balloon removal was estimated with a meta-analysis of two randomized controlled trials (75 patients) that compared balloon versus placebo, indicating the balloon group lost more weight than the placebo group. These differences in weight lost were 6.7 kg, 1.5% of initial weight, 3.2 kg/m(2), and 17.6% of excess weight. Regarding BIB safety, the majority of complications were mild and the early removal rate was 4.2%. The use of the BIB, within a multidisciplinary weight management program, is a short-term effective treatment to lose weight, but it is not yet possible to verify its capacity to maintain the weight lost over a long period of time.

A structured weight management programme can achieve improved functional ability and significant weight loss in obese patients with chronic kidney disease

Kidney transplantation in obese patients [body mass index (BMI) >30 kg/m(2)] is associated with a poorer outcome, and these patients are therefore often excluded from transplant waiting lists. Conventional weight loss strategies based on a high fibre, low energy diet and exercise are often unsuitable in the chronic kidney disease (CKD) population. A comprehensive multidisciplinary weight management programme comprising a low fat, reduced energy diet, individual exercise prescription and pharmacotherapy with orlistat 120 mg tds, was initiated to determine whether obese patients with CKD could reach an acceptable weight for transplantation. Thirty-two patients who completed 12 months in the programme were monitored regularly for weight and waist circumference measures as well as exercise performance tests. Twenty-two patients formed a contemporaneous control group. Exercise performance tests included the 6 min timed walk test (6MTWT), sit to stand transfers in 60 s (STS60), timed up and go 3 m (TUAG) and the Duke's activity status index (DASI), a measure of functional ability. Friedman's test analyses were performed to assess differences between baseline and 12-month data. Mean body weight reduced by 7.1% from 102.9 kg to 95.7 kg (P<0.001) This equates to a reduction in BMI from 35.7 kg/m(2) at baseline to 33.2 kg/m(2) at 12 months. Waist circumference decreased by 12.9 cm from 112.9 cm to 100.0 cm (P<0.005) at 12 months. The 6MTWT improved by 45% (P<0.001), STS60 by 30% (P<0.001), TUAG by 37% (P<0.001) and DASI by 50% (P<0.001) after 12 months. To date, two of the patients have received live-related renal transplants and an additional seven patients have now been successfully enrolled onto the transplant waiting list. Preliminary experience from this multidisciplinary programme combining diet, exercise and orlistat suggests that significant weight loss and improved physical functioning can be achieved in obese CKD patients, potentially allowing them the opportunity of kidney transplantation and the associated benefits of this compared with long-term dialysis.