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This study found few demographic differences between patients completing the program and those defecting from services. Both families completing the program and those discontinuing prematurely rated the overall quality of the program as high. However, lower quality of care was related to increased service attrition even after controlling for the effects of demographic and health parameters. Although a considerable number of patients discontinued services, very few reported that they would not return to the program. The results provide further support for ongoing audit and examination of families' care perceptions in preventing attrition and promoting service recovery.

Objective To compare the effectiveness and safety of carbohydrate-modified diets with a standard portion-controlled diet among obese children. Study design Obese children (n=102) aged 7-12 years were randomly assigned to a 3-month intervention of low carbohydrate (LC), reduced glycemic load (RGL), or standard portion-controlled (PC) diet, along with weekly dietary counseling and bi-weekly group exercise. Anthropometry, dietary adherence, and clinical measures were evaluated at baseline, 3, 6 and 12 months. Analyses applied intention-to-treat longitudinal mixed models. Results Eighty-five children (83%) completed the 12-month assessment. Daily caloric intake decreased from baseline to all time points for all diet groups (p<0.0001), although LC diet adherence was persistently lower (p<0.0002). At 3 months BMI z-score was lower in all diet groups (LC: -0.27 ± 0.04; RGL: -0.20 ± 0.04; PC: -0.21 ± 0.04; p<0.0001) and maintained at 6 months, with similar results for waist circumference (WC) and percent body fat (%BF). At 12 months, participants in all diet groups had lower BMI z-scores than at baseline (LC: -0.21±0.04; RGL: -0.28±0.04; PC: -0.31±0.04; p<0.0001), and lower %BF, but no reductions in WC were maintained. All diets demonstrated some improved clinical measures. Conclusions Diets with modified carbohydrate intake were as effective as a PC diet for weight management in obese children. However, lower adherence to the LC diet suggests this regimen is more difficult for children to follow, particularly in the long-term.

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Research Methods and Procedures:Based on a retrospective chart review, 394 physician-referred obese youth (BMI Ͼ 95th percentile), 5 to 19 years of age, were treated in an interdisciplinary, family-centered, behavioral weight management program in a hospital-based outpatient setting. Treatment included group exercise, parent education, and behavioral intervention therapies to improve diet and physical activity. Results: A total of 177 (45%) completed the initial phase of treatment (mean duration ϭ 5.6 months). For the completion group, there were significant improvements (all p Ͻ 0.001) in weight (Ϫ2.0 Ϯ 4.9 kg), BMI (Ϫ1.7 Ϯ 1.9 kg/m 2 ), and BMI z score (Ϫ0.15 Ϯ 0.15), without interfering with growth (height, 2.2 Ϯ 1.3 cm; p Ͻ 0.001). Significant improvement was also found for blood pressure, total cholesterol, low-density lipoprotein (LDL)-cholesterol, triglycerides, insulin, and aerobic fitness. At onset of treatment, 134 (84%) patients had abnormal fasting insulin concentration, 88 (50%) had abnormal total cholesterol, 14 (8%) had abnormal diastolic blood pressure, and 69 (40%) had abnormal LDL-cholesterol. At the end of treatment, a significant proportion of patients with baseline abnormal blood pressure, total cholesterol, and LDL-cholesterol had normal values (p Ͻ 0.001). A decrease in BMI z score was associated with significant improvements in insulin and lipid values (all p Ͻ 0.05). Discussion: We have demonstrated that a modest decrease in BMI in an ongoing clinical pediatric weight management program is accompanied by significant improvements in related health measures. These results may be helpful in counseling families with overweight children and adolescents.

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