Long and Short of It: Early Response Predicts Longer‐Term Outcomes in Pediatric Weight Management

Abstract

Objective: This study aimed to examine whether 1-month BMI improvement is predictive of superior 6-and 12-month BMI changes in a national sample of youth in pediatric weight management treatment. Methods: Participants were 4-to 18-year-olds from the Pediatric Obesity Weight Evaluation Registry, a prospective study collecting data from 31 pediatric weight management programs across the United States. Response at 1 month was defined as ≥ 3% BMI reduction; success at 6 and 12 months was defined as ≥ 5% BMI reduction from baseline. Analyses used linear and logistic regression with robust variance estimation. Results: Primary analyses were completed with 687 participants (mean age 12.2 years). One-month responders demonstrated significant improvements in BMI compared with nonresponders at 6 months (BMI, −2.05 vs. 0.05; %BMI, −5.81 vs. 0.23; P < 0.001 for all) and 12 months (BMI, −1.87 vs. 0.30; %BMI, −5.04 vs. 1.06; P < 0.001 for all). The odds of success for 1-month responders were 9.64 (95% CI: 5.85-15.87; P < 0.001) times that of nonresponders at 6 months and 5.24 (95% CI: 2.49-11.02; P < 0.001) times that of nonresponders at 12 months. Conclusions: In treatment-seeking youth with obesity, early BMI reduction was significantly associated with greater long-term BMI reduction. Nonresponders may benefit from early treatment redirection or intensification.

Defining and identifying predictors of rapid response to pediatric obesity treatment

“…However, no rate of early weight loss was associated with 10% decrease in any child weight metrics at 18‐month follow‐up. These results are consistent with previous research that showed that child weight loss in the first month was related to 6‐ and 12‐month weight loss . While our current study did not find an association between RR and the 18‐month follow‐up, Goldschmidt and colleagues found that 8‐week RR predicted 2 year follow‐up weight loss .…”

“…Current guidelines suggest waiting 3 to 6 months before changing or intensifying interventions for pediatric obesity . However, this study, in combination with a previous study, suggests that weight loss at 1 month can predict longer term weight loss. Future research should evaluate whether clinical decisions about changing treatment can be made at 4 weeks and whether these specific characteristics should be incorporated into clinical decision making.…”

“…Rapid response (RR; ie, losing more weight early in treatment) in adults predicts improved weight status up to 8 years later . RR research in children and adolescents is sparse and has several limitations including small sample sizes, few studies with long‐term follow‐up (>1 year), and wide ranges in age spanning several developmental periods (eg, 5‐25 years) . One study in children age 7 to 12 years showed that a loss of 4% to 8% of initial child body weight by the eighth session of a family‐based behavioral weight‐loss treatment (FBT) programme was associated with children achieving short‐term (20 weeks) and long‐term (2‐year follow‐up) weight‐loss success (ie, 5% to 10% body mass index [BMI] z score reduction) .…”

“…This study also showed that parent RR and treatment attendance were related to child RR. Another large (n = 687) prospective study of children age 4 to 18 years in the United States demonstrated that BMI reduction in the first month of treatment was significantly associated with greater 6‐ and 12‐month BMI reduction.…”

Efficacy of weight loss intervention can be predicted based on early alterations of fMRI food cue reactivity in the striatum

“…Taken together, these results suggest that alteration of food cue reactivity in the striatum might serve as an fMRI marker of weight loss intervention efficacy. Furthermore, based on previous findings (Elfhag and Rössner, 2010; Gripeteg et al, 2010; Gross et al, 2019; Handjieva-Darlenska et al, 2010; Nackers et al, 2010; Tronieri et al, 2019; Unick et al, 2014; Wadden et al, 1992) showing that initial weight loss—observed during the first 1–2 month of the intervention—might be closely associated with the weight loss program outcome, it is tempting to hypothesize that alterations in the striatum's fMRI food cue reactivity might take place already at the early stage of the intervention and could be used to predict its outcome. Here we addressed this possibility by investigating the relationship between food cue reactivity in the striatum measured one month after the onset of a weight loss program and weight changes obtained by the end of the six-month intervention.…”