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Dec 2012

Response of Severely Obese Children and Adolescents to Behavioral Treatment

Author Affiliations

Author Affiliations: National Childhood Obesity Center, Departments of Pediatrics and of Clinical Science, Intervention, and Technology, Karolinska University Hospital, Karolinska Institutet (Drs Danielsson, Ekblom, and Marcus and Mr Kowalski), and Astrand Laboratory of Work Physiology, Swedish School of Sport and Health Sciences (Dr Ekblom), Stockholm, Sweden.

Arch Pediatr Adolesc Med. 2012;166(12):1103-1108. doi:10.1001/2013.jamapediatrics.319

Objectives To investigate whether the degree of obesity predicts the efficacy of long-term behavioral treatment and to explore any interaction with age.

Design A 3-year longitudinal observational study. Obese children were divided into 3 age groups (6-9, 10-13, and 14-16 years) and also into 2 groups (moderately obese, with a body mass index [BMI]–standard deviation [SD] score [or z score] of 1.6 to <3.5, and severely obese, with a BMI-SD score of ≥3.5).

Setting National Childhood Obesity Center, Stockholm, Sweden.

Participants Children 6 to 16 years of age who started treatment between 1998 and 2006.

Intervention Behavioral treatment of obesity.

Main Outcome Measure Change in BMI-SD score during 3 years of treatment; a reduction in BMI-SD score of 0.5 units or more was defined as clinically significant.

Results A total of 643 children (49% female children) met the inclusion criteria. Among the youngest moderately obese children, 44% had a clinically significant reduction in BMI-SD score (mean reduction, −0.4 [95% CI, −0.55 to −0.32]). Treatment was less effective for the older moderately obese children. Twenty percent of children who were 10 to 13 years of age and 8% of children who were 14 to 16 years of age had a reduction in BMI-SD score of 0.5 units or more; 58% of the severely obese young children showed a clinically significant reduction in BMI-SD score (mean reduction, −0.7 [95% CI, −0.80 to −0.54]). The severely obese adolescents showed no change in mean BMI-SD score after 3 years, and 2% experienced clinically significant weight loss. Age was found to be a predictor of a reduction in BMI-SD score (odds ratio, 0.68 units per year [95% CI, 0.60-0.77 units per year]).

Conclusions Behavioral treatment was successful for severely obese children but had almost no effect on severely obese adolescents.