Inpatient Treatment of Children and Adolescents With Severe Obesity in the Netherlands

Abstract

IMPORTANCESevere childhood obesity has become a major health problem, and effective, evidence-based interventions are needed. The relative effectiveness of inpatient compared with ambulatory treatment remains unknown.OBJECTIVE To determine whether an inpatient treatment program is more effective than an ambulatory treatment program at achieving a sustained weight loss in children and adolescents with severe obesity. DESIGN, SETTING, AND PARTICIPANTSWe conducted a randomized clinical trial with a 2-year follow-up at a tertiary referral center for pediatric obesity in the Netherlands. We recruited 90 children and adolescents aged 8 to 18 years with severe obesity (body mass index [BMI] z score, Ն3.0 or >2.3 with obesity-related health problems).INTERVENTIONS Patients were randomly assigned to an inpatient (6 months of hospitalization on working days) or an ambulatory (12 days of hospital visits at increasing intervals during a 6-month period) treatment program. Both treatment programs involved an intensive, family-based, lifestyle intervention, including exercise, nutritional education, and behavior modification for the patients and their caregiver(s). MAIN OUTCOMES AND MEASURESChange in BMI z score. Secondary outcomes included fasting insulin, fasting plasma glucose, 2-hour plasma glucose, and lipid levels, insulin sensitivity, liver function test results, waist circumference, blood pressure, body composition, and aerobic fitness (peak oxygen consumption, V o 2 ). Outcomes were analyzed by intention to treat. RESULTSImmediately after treatment, reductions in the BMI z score were significantly larger for the inpatient than the ambulatory groups (mean [SE] difference, −0.26 [0.12; 95% CI, −0.59 to −0.01]; P = .04). Change from baseline for the BMI z score in the inpatient group was −18.0% (P = .001) immediately after treatment, −8.5% (P = .008) at 18 months, and −6.3% (P = .38) at 30 months; in the ambulatory group, changes from baseline were −10.5% (P = .001), −6.2% (P = .39), and −1.5% (P > .99), respectively. The favorable outcomes of the inpatient group could not be sustained at 12 and 24 months after treatment. In addition, significant differences in favor of the inpatient group immediately after treatment were found for levels of fasting insulin (−6.37 IU/L; P = .02), total cholesterol (−19.51 mg/dL; P = .01), low-density lipoprotein cholesterol (−13.48 mg/dL; P = .03), and triglycerides (−25.39 mg/dL; P = .01), and insulin sensitivity (−1.37; P = .02), fat mass (−3.31%; P = .03), and peak V o2 (378.2 mL/min; P = .01). CONCLUSIONS AND RELEVANCEIn severely obese children and adolescents, inpatient treatment was superior to ambulatory treatment immediately after treatment, but effects were not sustained at long-term follow-up. These findings stress the need to further study maintenance strategies for sustainable weight loss.

Predicting Short-term Morbidity in Patients Undergoing Posterior Spinal Fusion for Neuromuscular Scoliosis

“…19,39 Although obesity is potentially modifiable for elective procedures, it is very difficult to address in patients with neuromuscular disorders. 40 Strategies for pediatric weight loss that may be useful in a healthier pediatric population, such as weight management programs, medication, and bariatric surgery, may be unfeasible or dangerous in the NMS population. [40][41][42][43] The current study highlights the need for improved strategies for addressing obesity in patients with NMS.…”

Intensive lifestyle treatment for non-alcoholic fatty liver disease in children with severe obesity: inpatient versus ambulatory treatment

“…11 The ambulatory program is described in detail in a previous study from our center. 12 In short, during hospitalization in the inpatient program exercise was scheduled 4 days per week (30-60 min each) for participants, and nutrition and behavior modification sessions once per week (60 min each) for participants and their caregivers. During the subsequent 2-day return visits 2 exercise sessions and 3-5 nutrition and behavior modification sessions were planned.…”

Economic Evaluation of Intensive Inpatient Treatments for Severely Obese Children and Adolescents

“…For severely obese children and adolescents with insufficient response to ambulatory obesity treatment, inpatient treatment may be a promising alternative [41]. However, definitive conclusions regarding the cost-effectiveness of the short-stay treatment should be postponed until information is available about the cost-effectiveness in comparison with usual care.…”

“…The sample size was calculated to detect a 0.5 SDS-BMI difference between the two groups after 1 year of treatment which is considered a clinically meaningful effect size [41]. Based on a power of 80% and a two-tailed significance level of 5%, two groups of 40 participants were needed [28].…”