Pediatric Weight Management Clinic Research Articles

Adolescents' and Parents' Perspectives of a Revised Protein-Sparing Modified Fast (rPSMF) for Severe Obesity.

The purpose of this pilot study was to assess the acceptability to adolescents (11–18 years old) and their parents using a revised protein-sparing modified fast (rPSMF) for 12 months as an intervention for severe obesity in a tertiary pediatric weight management clinic (PWMC). To assess acceptability (satisfaction, confidence) with the rPSMF protocol, surveys were completed by adolescents and parents at baseline, 1, 3, 6, and 12 months, with adolescent height and weight measured. Analyses were conducted to assess differences in satisfaction and confidence based on adolescent response (weight loss) and adherence to the rPSMF. Adolescents’ adherence with the rPSMF was close to 50% in the first 3 months, but dropped to 14.7% at 6 months. Adolescents were most confident with choosing low carbohydrate foods at baseline. Over 12 months, adolescents and parents reported weight loss as “the most liked” part of the rPSMF. Adolescents who were adherent were more satisfied with their weight loss than their non-adherent peers. Parents and adolescents reported lack of food variety and difficulty following the protocol as challenges with the rPSMF. Adolescents and their parents were able to follow the rPSMF protocol, with weight loss, but with decreased adherence over time.

Rationale and design of a pilot study to evaluate the acceptability and effectiveness of a revised protein sparing modified fast (rPSMF) for severe obesity in a pediatric tertiary care weight management clinic.

Aggressive dietary interventions may provide an accessible treatment option for children and adolescents with severe obesity who are not successful with traditional lifestyle behavioral interventions or do not want or qualify for weight loss surgery. One such intensive dietary option is the protein sparing modified fast (PSMF). The PSMF involves minimal carbohydrate intake to induce ketosis, while maintaining adequate or high protein intake to minimize catabolism. The PSMF, under medical supervision, can be an effective and safe intervention for children and adolescents, yet the PSMF diet is not regularly used in the treatment of pediatric severe obesity. This paper describes the rationale and design for a pilot study to evaluate the acceptability and effectiveness of a revised PSMF (rPSMF) implemented as a weight loss treatment option for children and adolescents with severe obesity in a pediatric tertiary care weight management clinic. The primary aim of the study is to evaluate the acceptability of the rPSMF as assessed by adherence, satisfaction with the intervention, and participation rate using quantitative and qualitative methods. The secondary aim is to investigate the effectiveness of the rPSMF on improving a) anthropometric measures (weight, body mass index [BMI], BMI z-score); b) metabolic measures (lipid profile, glycosylated hemoglobin, liver function tests); and c) quality of life. Results of this study will provide guidance for the standardization of a pediatric rPSMF protocol in a clinic setting, delineate which factors improve or hinder adherence and weight loss and provide preliminary data for a multicenter randomized controlled trial.Clinicaltrials.gov identifierNCT03899311.

Weight outcomes and attendance rates: the effect of introducing group workshops in a tertiary paediatric dietitian-led weight management clinic

Weight outcomes and attendance rates: the effect of introducing group workshops in a tertiary paediatric dietitian-led weight management clinic

Shelby Will Shine

Shelby Will Shine

Adolescents’ involvement in decision-making for pediatric weight management: A multi-centre, qualitative study on perspectives of adolescents and health care providers

ObjectiveTo explore adolescents’ and health care providers’ (HCPs) perspectives on adolescents’ involvement in decision-making within multidisciplinary clinical care for pediatric weight management. MethodsIn this multi-centre, qualitative description study, we purposefully recruited 13-17-year-olds with overweight or obesity and HCPs from two pediatric weight management clinics in Edmonton and Ottawa, Canada. Participants completed one-on-one, in-person, semi-structured interviews (adolescents) or focus groups (HCPs), which were audio-recorded, transcribed verbatim, and managed using NVivo 11. Data were analyzed by two independent researchers using inductive thematic analysis and the congruent methodological approach for group interactions. ResultsA total of 19 adolescents and 16 HCPs participated. Three themes were identified in relation to adolescents’ decision-making for weight management, including (i) conditions for adolescent involvement, (ii) preferences for adolescent involvement, and (iii) extent of parental involvement. ConclusionsAlthough adolescents and HCPs positively valued adolescents’ involvement in making decisions regarding their weight and health, the extent to which adolescents wished to be involved in the decision-making process varied between individuals and families. Practice ImplicationsHCPs are encouraged to include adolescents and families in their health services delivery, including consulting individually with adolescents and tailoring care to their expectations regarding decision-making.

An addiction-based mobile health weight loss intervention: protocol of a randomized controlled trial

BackgroundThe notion of obesity as an addictive process is controversial. However, studies show that between 5.9 and 30.7% of adolescents with obesity report food or eating addiction. Few weight management interventions have tested techniques based on addiction medicine principles. MethodsThis multi-center randomized control trial (RCT) is designed to test the effectiveness of a mobile health (mHealth) weight-loss intervention based on addiction principles, such as withdrawal and tolerance, in a sample of 180 adolescents (ages 14–18) recruited from four pediatric weight management clinics in Southern California. Akin to a Multiphase Optimization Strategy (MOST) design evaluating multicomponent behavioral interventions, we will compare the combination of an app + phone coaching (App+Coach) to app alone (App) and in-clinic multi-disciplinary (Clinic) intervention arms.The primary outcome is mean change in zBMI and %BMIp95 over 18 months. We hypothesize that youth who receive App+Coach will have a greater reduction in body weight over the 18-month study period at a lower cost than standard of care models. Secondary outcomes include adherence to treatment regimen, intervention satisfaction, effect of the intervention on metabolic factors and activity level. We will also explore potential moderators of intervention effectiveness such as addictive eating habits, self-regulation and executive functioning. ConclusionsNew and creative approaches are needed to address pediatric obesity. If successful, this RCT may provide an innovative and cost-effective mHealth approach, based on addiction methods, for weight loss among adolescents with overweight and obesity.

Barriers and enablers for adopting lifestyle behavior changes in adolescents with obesity: A multi-centre, qualitative study.

BackgroundMany adolescents with obesity do not meet recommendations for nutrition, physical and sedentary activities, and sleep habits, all of which can influence weight management.ObjectiveTo explore barriers and enablers that influenced the adoption of lifestyle behavior changes among adolescents receiving multidisciplinary clinical care for pediatric weight management.MethodsIn this multi-centre, qualitative description study, we used purposeful sampling to recruit 13–17 year olds (body mass index ≥85th percentile) enrolled in one of two pediatric weight management clinics in Edmonton and Ottawa, Canada. Adolescents participated in one-on-one, in-person, semi-structured interviews in English or French. Interviews lasted 30–60 minutes, were audio-recorded, transcribed verbatim, and managed using NVivo 11. Data were triangulated using transcripts, field notes, and memos and analyzed by two independent researchers using inductive, semantic thematic analysis.ResultsIn total, 19 adolescents (12 Anglophone and 7 Francophone; 15.1±1.7 years old; 3.5±0.6 BMI z-score; n = 11 female; n = 13 Caucasian) participated. Adolescents reported diverse barriers to and enablers of healthy nutrition, physical and sedentary activities, and sleep habits, which we organized into the following themes: physiological mechanisms and physical health status, self-regulation for behavior change, controllability and competence beliefs, social relationships and interactions, and accessibility to and availability of opportunities for lifestyle enhancement. Across these themes and lifestyle areas, we identified three shared barriers and/or enablers, including the degree of controllability, the impact of mental health, and social pressures related to weight management.ConclusionsThis research provides evidence that can be used to tailor interventions and health services delivery, including a focus on psychosocial well-being, to support adolescents with obesity in making and maintaining healthy lifestyle behavior changes.

Examining the Accuracy and Use of Portion Size Estimation Aids in Parents of Children With Obesity: A Randomized Controlled Trial

ObjectiveTo determine parents’ (1) accuracy in using portion size estimation aids (PSEAs) to estimate portion sizes and (2) use of PSEAs at home. MethodsParents (n = 37) of children in a pediatric weight management clinic were recruited, enrolled in a parallel-design, randomized, controlled trial, and assigned to receive a 2-dimensional (2D) or 3D PSEA. Percent absolute estimation accuracy was examined across groups and food types. Survey responses were organized according to frequencies and percentages were calculated. ResultsMain effects of group, food type, and group × food type interaction were significant (all P < .05). The 2D PSEAs yielded more accurate estimates of portion sizes for amorphous foods. Overall, parents’ estimation accuracy was poor. Participants were satisfied and found the PSEAs to be useful. Conclusions and ImplicationsThe 2D PSEAs led to greater accuracy in estimating portions of amorphous foods. Parents showed poor accuracy in estimating portion sizes. This study highlights the role of dietitians and nutrition educators in enhancing portion estimation accuracy.

The CANadian Pediatric Weight management Registry (CANPWR): lessons learned from developing and initiating a national, multi-centre study embedded in pediatric clinical practice

BackgroundThere is increasing recognition of the value of “real-world evidence” in evaluating health care services. Registry-based, observational studies conducted in clinical settings represent a relevant model to achieve this directive. Starting in 2010, we undertook a longitudinal, observational study (the CANadian Pediatric Weight management Registry [CANPWR]), which is embedded in 10 multidisciplinary, pediatric weight management clinics across Canada. The objective of this paper was to share the lessons our team learned from this multi-centre project.MethodsData sources included a retrospective review of minutes from 120 teleconferences with research staff and investigators, notes taken during clinical site visits made by project leaders, information from quality control processes to ensure data accuracy and completeness, and a study-specific survey that was sent to all sites to solicit feedback from research team members (n = 9). Through an iterative process, the writing group identified key themes that surfaced during review of these information sources and final lessons learned were developed.ResultsSeveral key lessons emerged from our research, including the (1) value of pilot studies and central research coordination, (2) need for effective and regular communication, (3) importance of consensus on determining outcome measures, (4) challenge of embedding research within clinical practice, and (5) difficulty in recruiting and retaining participants. The sites were, in spite of these challenges, enthusiastic about the benefits of participating in multi-centre collaborative studies.ConclusionDespite some challenges, multi-centre observational studies embedded in pediatric weight management clinics are feasible and can contribute important, practical insights into the effectiveness of health services for managing pediatric obesity in real-world settings.

Shape-Up and Eat Right Families Pilot Program: Feasibility of a Weight Management Shared Medical Appointment Model in African-Americans With Obesity at an Urban Academic Medical Center.

Disparities in obesity care exist among African-American children and adults. We sought to test the feasibility of a pilot program, a 1-year family-based intervention for African-American families with obesity [shape up and eat right (SUPER)], adopting the shared medical appointment model (SMA) at an urban safety net hospital. Primary outcomes: (1) family attendance rate and (2) program satisfaction. Secondary outcomes: change in body mass index (BMI), eating behaviors, and sedentary activity. Adult parents (BMI ≥ 25 kg/m2) ≥18 years and their child(ren) (BMI ≥ 85th percentile) ages 6-12 years from adult or pediatric weight management clinics were recruited. One group visit per month (n = 12) consisting of a nutrition and exercise component was led by a nurse practitioner and registered dietitian. Height and weight were recorded during each visit. Participants were queried on program satisfaction, food logs and exercise journals, Food Stamp Program's Food Behavior, and the Expanded Food and Nutrition Education Program food checklists. Thirteen participants from lower socioeconomic zip codes consented [n = 5 mothers mean age 33 years, BMI of 47.4 kg/m2 (31.4-73.6 kg/m2); n = 8 children; mean age 9 years, BMI of 97.6th percentile (94-99th percentile); 60% enrolled in state Medicaid]. Average individual attendance was 23.4% (14-43%; n = 13); monthly session attendance rates declined from 100 to 40% by program completion; two families completed the program in entirety. Program was rated (n = 5 adults) very satisfactory (40%) and extremely satisfactory (60%). Pre-intervention, families rated their eating habits as fair and reported consuming sugar-sweetened beverages or sports drinks, more so than watching more than 1 h of television (p < 0.002) or video game/computer activity (p < 0.006) and consuming carbonated sodas (p < 0.004). Post-intervention, reducing salt intake was the only statistically significant variable (p < 0.029), while children watched fewer hours of television and spent less time playing video games (from average 2 to 3 h daily; p < 0.03). Attendance was lower than expected though children seemed to decrease screen time and the program was rated satisfactory. Reported socioeconomic barriers precluded families from attending most sessions. Future reiterations of the intervention could be enhanced with community engagement strategies to increase participant retention.

Cardiometabolic risk factors in treatment-seeking youth versus population youth with obesity.

SummaryBackgroundAlthough obesity affects approximately one in five youths, only a fraction is treated in pediatric weight management clinics. Characteristics distinguishing youth with obesity who seek weight management treatment from those who do not are largely unknown. Yet identification of specific health characteristics which differentiate treatment‐seeking from non‐treatment seeking youth with obesity may shed light on underlying motivations for pursuing treatment.ObjectivesCompare the cardiometabolic profiles of an obesity treatment‐seeking sample of youth to a population‐based sample of youth with obesity, while controlling for body mass index (BMI).MethodsThis cross‐sectional study included participants, ages 12–17 years, with obesity from the Pediatric Obesity and Weight Evaluation Registry (POWER) and National Health and Nutrition Examination Survey, representing the treatment‐seeking and population samples, respectively. Mean differences were calculated for systolic and diastolic blood pressure percentiles, total cholesterol, low‐density and high‐density lipoprotein‐cholesterol, triglycerides, fasting glucose, glycated hemoglobin and alanine aminotransferase, while adjusting for age, sex, race/ethnicity, insurance status, and multiple of the 95th BMI percentile.ResultsThe POWER and National Health and Nutrition Examination Survey cohorts included 1,823 and 617 participants, respectively. The POWER cohort had higher systolic blood pressure percentile (mean difference 17.4, 95% confidence interval [14.6, 20.1], p < 0.001), diastolic blood pressure percentile (21.8 [19, 24.5], p < 0.001), triglycerides (42.3 [28, 56.5], p < 0.001) and alanine aminotransferase (7.5 [5.1, 9.8], p < 0.001) and lower fasting glucose (−6.9 [−8.2, −5.6], p < 0.001) and high‐density lipoprotein‐cholesterol (−2.3 [−3.8, −0.9], p < 0.002). There were no differences in total cholesterol or low‐density lipoprotein‐cholesterol or clinical differences in glycated hemoglobin.ConclusionFor a given BMI, obesity treatment‐seeking youth are more adversely affected by cardiometabolic risk factors than the general population of youth with obesity. This suggests that treatment‐seeking youth may represent a distinct group that is at particularly high risk for the development of future cardiometabolic disease.

Prevalence of comorbid conditions pre-existing and diagnosed at a tertiary care pediatric weight management clinic.

Childhood obesity places individuals at risk for a multitude of physical and mental health problems. The aim of this study was to assess the prevalence of obesity related comorbidities diagnosed prior to and after attending a tertiary care pediatric weight management clinic. A cross sectional retrospective chart review of patients 2-17 years old seen in the weight management clinic at Alberta Children's Hospital from May 2012 to May 2014. A total of 199 patients were included in the review. Comorbidity prevalences were: hypertension 6 (3%), prediabetes 11 (5.5%), type 2 diabetes 3 (1.5%), dyslipidemia 105 (52.8%), non-alcoholic fatty liver disease 31 (15.6%), asthma 45 (22.6%), obstructive sleep apnea 21 (10.6%), and polycystic ovarian syndrome (PCOS) 9 (12% of females ≥10 years at the first visit). Concerns related to depression and anxiety were present in 20 (10.1%) and 25 (12.6%) patients respectively. The majority of comorbidities were identified prior to joining the clinic. Conditions requiring more specialized tests, such as diabetes and PCOS, were more commonly identified after joining the clinic. These results give further insight into the prevalence of obesity-related comorbidities in overweight and obese children and adolescents, and demonstrate the importance of screening for these known comorbidities. It is important to have the resources and an experienced multi-disciplinary team to follow children and their families through treatment.

Weight up? Changes in children's anthropometry from time of referral to baseline assessment for paediatric weight management.

To examine children's wait time to access a multidisciplinary, tertiary-level weight management clinic and assess anthropometric changes from time of referral to baseline assessment. A retrospective medical record review was completed of children (5 to 17 years) enrolled in a multidisciplinary, tertiary-level paediatric weight management clinic from 2006 to 2015. Children's demographic and anthropometric data from their referral to and baseline assessment at the clinic were retrieved from medical records. Based on changes in body mass index (BMI) z-score from the time of referral to baseline assessment, children were categorized as decreasers (>0.05 unit decrease), increasers (>0.05 unit increase) or stabilizers (-0.05 to 0.05 unit change). The proportion of children with a ≥0.25 unit BMI z-score reduction was calculated. Analysis of variance and chi-squared tests were performed. Children (n=400) were 11.7 ± 2.9 years old at the time of referral, 52.8% (n=211) female, and had an average wait time of 4.5 ± 3.9 months. By 3 and 6 months postreferral, 44.0% (n=176) and 80.8% (n=323), respectively, had attended baseline assessments. Based on BMI z-score change, children were classified as decreasers (n=183; 45.8%), increasers (n=118; 29.5%) or stabilizers (n=99; 24.8%). One-fifth of children (n=86; 21.5%) experienced a BMI z-score reduction ≥0.25 units, a subgroup that was younger, had a higher BMI z-score at referral, and had a longer wait time between referral and baseline assessment (all P<0.05). Most children who enrolled in paediatric weight management initiated treatment within six months and experienced a modest decrease or stabilization in BMI z-score during their wait time.

Families' perceived benefits of home visits for managing paediatric obesity outweigh the potential costs and barriers.

Home visits have successfully been used to deliver various health services, but what role could they play in paediatric weight management? Low treatment initiation and high attrition prompted our multidisciplinary paediatric weight management clinic to investigate how families perceived the benefits and barriers of home visits. We focused on children with obesity aged 2-17 who were enrolled in our tertiary-level clinic in Alberta, Canada. None had received a home visit. The families were interviewed face-to-face from October 2015 to October 2016, and we used a qualitative description methodological framework and manifest content analysis. The parents were the main interviewees. Of the 56 families, 89% were interested in a home visit, 82% wanted support from a dietician and 54% from an exercise specialist. The perceived benefits of home visits included comprehensive assessment (95%), convenience (86%), tailored care (29%) and family involvement (13%), while the costs and barriers included clinicians' potential judgmental attitudes (30%), loss of privacy (19%) and distractions (10%). Some thought clinicians would find home visits inconvenient (25%), with bureaucratic challenges (14%) and sustainability issues (5%). Families felt home visits were a convenient option for managing paediatric obesity and identified important benefits and barriers that could guide such interventions.

Retrospective Review of Comorbid Conditions in a Multidisciplinary Pediatric Weight Management Clinic.

A retrospective medical chart review was conducted of patients enrolled in the Fit for Healthy Weight Clinic (Fit Clinic). At initial evaluation, comorbidities were identified by the patient and pediatrician. The number of comorbidities increased with age among patients. In reviewing the differences among the number of identified comorbidities among grade school age and adolescent patients, increases of 30% were observed in gastrointestinal-associated, 23% in psychiatric, 18% in endocrine, 16% in cardiovascular, and 14% in respiratory comorbidities. Fit Clinic patients already manifest many known obesity-related comorbidities as evidenced in identified conditions and abnormal laboratory values. The elevated blood pressures, blood glucose, and cholesterol levels raise concern for the future development of coronary artery disease and type 2 diabetes mellitus. With an average of five obesity-related comorbidities, Fit Clinic patients already have more comorbidities than what is evidenced in large US population-based studies, demonstrating that solely addressing body mass index is not sufficient.

Feasibility of a Clinic-Community Partnership to Treat Childhood Obesity.

"Bull City Fit" is a childhood obesity treatment partnership between Duke Children's pediatric weight management clinic and Durham Department of Parks and Recreation. Report on feasibility and implementation, characteristics of participants, and predictors of attendance. Mixed methods study consisting of (1) a retrospective cohort analysis (n = 171) reporting demographic, attendance, and clinical data and (2) structured focus groups among stakeholders to identify implementation facilitators and barriers. Higher attendance was associated with Spanish language ( P = .07), more clinic visits ( P = .03), shorter time to first attendance ( P = .06), lower child z-body mass index (BMI) at baseline ( P = .08), and lower parent BMI ( P = .02). Associations were mitigated after controlling for demographic characteristics. BMI z-score did not differ between low- and moderate/high attenders at 6 months. Family inclusion and community engagement emerged as positive themes during focus groups. Clinic-community partnerships engage diverse populations in fitness and nutrition activities, but no specific patient characteristics appear to predict greater attendance.

Vitamin D Status, Cardiometabolic, Liver, and Mental Health Status in Obese Youth Attending a Pediatric Weight Management Center.

Vitamin D (VitD) deficiency and obesity are reaching epidemic proportions in North America, particularly in those with comorbid conditions such as diabetes or liver disease. The study objective was to determine the prevalence of suboptimal vitD status and interrelationships with anthropometric, cardiometabolic, liver, mental health, and lifestyle (sleep/screen time) parameters in an ambulatory population of children with obesity. Children (2-18 years) attending a pediatric weight management clinic (n = 217) were retrospectively reviewed. Variables studied included anthropometric (weight, height, body mass index, waist circumference), vitD (serum 25-hydroxyvitamin D), cardiometabolic (systolic blood pressure, diastolic blood pressure, glucose, insulin, homeostasis model assessment for insulin resistance, triglyceride, high-density lipoprotein, low-density lipoprotein, total cholesterol), liver enzymes (alanine aminotransferase, gamma-glutamyl transferase), and mental health (number, diagnosis) parameters. Suboptimal vitD status (25-hydroxyvitamin D <75 nmol/L was present in 76% of children with obesity (12.0 ± 2.9 years). Blood pressure categorized as prehypertension, stage I hypertension, and stage II hypertension was present in 14%, 25%, and 7% of children, respectively. Mental health diagnoses including anxiety, attention-deficit hyperactivity disorder, mood disorders, and learning disabilities/developmental delays occurred in 18%, 17%, 10%, and 15%, of children, respectively. Waist circumferences >100 cm were associated with lower vitD levels (58 ± 18 vs 65 ± 17 nmol/L; P = 0.01). VitD status ≥50 nmol/L was associated with lower insulin (15.8 [11.7-23.1] mU/L vs 21.1 [14.3-34.2] mU/L; P < 0.01) and homeostasis model assessment for insulin resistance (3.5 [2.5-4.9] vs 4.8 [3.1-6.9]; P < 0.01) values and systolic blood pressure percentiles (73.0 ± 25.8 vs 80.6 ± 17.0; P = 0.04). Children with obesity had a high prevalence of vitD deficiency, particularly those at risk for hypertension, reduced insulin sensitivity, and central obesity.

A5064 - Improving Outcomes in a Tertiary Care Pediatric Weight Management Clinic: A Quality Improvement Project

A5064 - Improving Outcomes in a Tertiary Care Pediatric Weight Management Clinic: A Quality Improvement Project

Following Suit: Using Conversation Cards for Priority Setting in Pediatric Weight Management

ObjectiveTo describe families' selections of Conversation Cards (CCs), a priority-setting tool in pediatric weight management, and examine CC-related differences based on families’ anthropometric and sociodemographic characteristics. MethodsA retrospective medical record review was conducted of 2- to 17-year-olds with obesity and their families who enrolled in a pediatric weight management clinic between January, 2012 and September, 2016. ResultsMedical records of 146 children were included. On average, families selected 10 ± 6 CCs (range, 3–32 CCs); only 50% of families (n = 73) indicated perceived readiness to make healthy changes. Adolescents (vs children) revealed less healthy eating behaviors (P = .001) and physical activity habits (P = .002). Goal setting was perceived to be a motivator across several sociodemographic characteristics (all P < .05). Conclusions and ImplicationsThe CCs were useful in describing families' priorities. The diversity of issues identified by families highlighted the importance of multidisciplinary expertise in pediatric weight management.

Presence of Obesity Related Comorbidities Associated with Lower Attrition Rate in Pediatric Weight Management Program

Background: Multidisciplinary pediatric weight management clinics have reported varying effectiveness in childhood obesity and they faced a common issue of high attrition rate. The effectiveness of pediatric weight management clinic and predictors of attrition has not been described in a multiracial Singapore population. Objectives: The aim of the study is to determine whether a dedicated multidisciplinary pediatric weight management program in a single center tertiary institution effectively reduces Body Mass Index (BMI) Z-Scores and cardiovascular risk factors in children with obesity aged 2-16 years old pre post intervention and to examine the factors that predict attrition from the program. Methods: This is a single center retrospective study, where medical records of patients enrolled in KK Women’s and Children’s Hospital paediatric weight mangement clinic over a 14 months period was reviewed. The program is a multicomponent family based clinic that utilizes medical management, dietary and physical activity counseling and intervention. Inclusion criteria for enrollment in the program was more than 2 years of age with BMI of more than 90th percentile. Attenders were defined as attending more than ≥ 2 clinic visit. Analyses were performed to identify factors associated with changes in BMI Z-Score and cardiovascular risk factors and attrition from the program. Results: A total of 121 patients were enrolled in the pediatric weight management program and 68% had obesity related comorbidities with dyslipidemia being the most common followed by hypertension. There were 51 attenders and presence of obesity related comorbidities predicted lower attrition rate (p=0.05). The attenders had a significant reduction in mean BMI Z-Score of 0.082 (95% CI,-0.13 to -0.033) (p=0.001) with significant improvements in high-density lipoprotein level and total cholesterol to high- density lipoprotein level (p<0.05). Conclusions: A multidisciplinary pediatric weight management program can improve the overweight status and the cardiovascular risk factors. Attrition factors should be studied to minimize defaulting rates.