Importance of Age for 3-Year Continuous Behavioral Obesity Treatment Success and Dropout Rate

Abstract

Objective: To assess whether first year weight loss, age, and socioeconomic background correlate with the success rate of continuous long-term behavioral obesity treatment. Methods: In a 3-year longitudinal study, obese children (n = 684) were divided into three groups based on age at the start of treatment, age 6–9 years, 10–13 years, and 14–16 years. Results: The mean BMI standard deviation score (BMI-SDS) decline was age-dependent (p = 0.001), independently of adjustment for missing data: –1.8 BMI-SDS units in the youngest, –1.3 in the middle age group, and –0.5 in the oldest age group. SES and parental BMI status did not affect the results. 30% of the adolescents remained in treatment at year 3. There was only a weak correlation between BMI-SDS change after 1 and 3 years: r = 0.51 (p < 0.001). Among children with no BMI-SDS reduction during year 1 (n = 46), 40% had a clinically significantly reduced BMI-SDS after year 3. Conclusion: Behavioral treatment should be initiated at an early age to increase the chance for good results. Childhood obesity treatment should be continued for at least 3 years, regardless of the initial change in BMI-SDS.

Two-year outcome of laparoscopic Roux-en-Y gastric bypass in adolescents with severe obesity: results from a Swedish Nationwide Study (AMOS)

“…Conventional treatments for obesity in adolescents have a generally poor outcome 6 and new treatment alternatives are needed. A recent randomized controlled trial demonstrated that laparoscopic gastric banding is superior to conventional therapy in adolescents recruited directly from the community.…”

“…This treatment mainly consists of individualized or family-based counseling and cognitive behavior therapy concerning diet and physical activity. 6 Low-calorie diets and drugs (metformin, orlistat or sibutramin) were prescribed if found clinically indicated by the treating pediatrician. This treatment continued in the conventional treatment group.…”

“…We identified a matched adolescent group from the Swedish Childhood Obesity Treatment Register (BORIS) 6 at the end of the recruitment period of surgical subjects. Eighty-one adolescents (43% boys) were selected as conventional treatment comparisons using the same inclusion and exclusion criteria as for the adolescents undergoing surgery.…”

“…5 Among severely obese adolescents, favorable effects of non-surgical treatment seem to be very limited and clearly insufficient for long-term reduction of the health hazards associated with obesity. 6,7 Bariatric surgery in adults results in long-term weight loss, decrease in mortality and morbidity and improvements in quality of life. [8][9][10][11] However, surgery is not generally endorsed under the age of 18 years.…”

Bariatric and Metabolic Surgery in Adolescents: a Path to Decrease Adult Cardiovascular Mortality

“…Interventions involving lifestyle and dietary approaches, even when considered successful, achieve only modest weight reductions, often in a limited proportion of patients [65,[67][68][69][70][71]. Although wide-ranging and accessible to many, such programs are offset by inevitable relapse in most individuals.…”