Pediatric multidisciplinary weight management—how can we improve further?

Abstract

Purpose: Multidisciplinary weight management (MDM) signi cantly improves outcomes in youth, when compared to their routine care. However, this progress may be undermined by high follow-up attrition. We hypothesized that a pre-de ned time-limited MDM clinic follow-up plan given to families from the "get-go" will improve individual clinic participation, weight, and metabolic parameters.Methods: Participant follow-up rates in 7 consecutive visits in a retrospective cohort of youth followed at an urban MDM clinic between April 2017 to September 2019 after the clinic follow-up protocol was changed (Post-PC) were compared to our previously published data (Pre-PC, December 2014 to January 2017). Secondary outcomes include changes (Δ) in body mass index z-score (z-BMI), body composition analysis (BCA), and laboratory parameters.Results: 615 records (12.3 + 3.7 years, 46% male) were reviewed. Participants' follow up rates improved signi cantly starting visit 3 (Post-PC (49.2%) vs. Pre-PC (40.2%); p=0.03). With continued MDM participation, mean z-BMI Δ progressively improved. BCA Δ included a mean total body fat mass (FM) decrease (-2.07+7.3 kg) along with total body muscle mass (MM) increase (3.3+5.6 kg). Signi cant improvements were noted with hemoglobin A1c %, total cholesterol (TC), triglyceride, AST, and ALT concentrations. FM Δ correlated signi cantly with glucose and HOMA-IR Δ, while MM Δ was inversely associated with TC and LDL-cholesterol Δ.Conclusion: A protocolized MDM follow plan resulted in a small but signi cant improvement in the participants' follow-up along with signi cant improvements in weight and metabolic outcomes. Further improvements will likely require additional behavioral economic strategies.

Role of Dual-Contingency Management in Family-Based Obesity Therapy and the Effects of Weight Loss on Liver Transient Elastography Parameters in Youth: A Pilot Study

“…Due to the recalcitrant nature of the disease, maintaining healthy changes requires ongoing contact between families and their healthcare team to provide constant support and encouragement. However, improvements in weight and metabolic parameters may not be sufficient to motivate families facing socioeconomic challenges to continue their close follow-ups with their providers [ 19 ]. Therefore, more powerful behavioral economic strategies are required to maintain healthy outcomes.…”