The Effect of a Multidisciplinary Lifestyle Intervention on Health Parameters in Children versus Adolescents with Severe Obesity

Abstract

Lifestyle interventions are the common treatment for children and adolescents with severe obesity. The efficacy of these interventions across age groups remain unknown. Therefore, this study aimed to compare the effectiveness of a lifestyle intervention on health parameters between children and adolescents with severe obesity. A longitudinal design was carried out at the Centre for Overweight Adolescent and Children’s Healthcare (COACH) between December 2010 and June 2020. Children (2–11 years old, n = 83) and adolescents (12–18 years old, n = 77) with severe obesity received a long-term, tailored, multidisciplinary lifestyle intervention. After 1 year, 24 children (28.9%) and 33 adolescents (42.9%) dropped out of the intervention. The primary outcome was the change in body mass index (BMI) z-score after one and two years of intervention. The decrease in BMI z-score over time was significantly higher in children compared to adolescents, the mean decrease was 0.15 (0.08–0.23) versus 0.03 (−0.05–0.11) after one year and 0.25 (0.15–0.35) versus 0.06 (−0.06–0.17) after two years of intervention; p values for the difference between children and adolescents were 0.035 and 0.012. After two years, multiple improvements in cardio metabolic health parameters were observed, especially in children. In conclusion, during our tailored lifestyle intervention, a positive and maintained effect on health parameters was observed in children with severe obesity. Compared to children, the effect on health parameters was less pronounced in adolescents.

Who benefits most from outpatient lifestyle intervention? An IMI‐SOPHIA study on pediatric individuals living with overweight and obesity

“…Compared with previous cross‐sectional studies focusing on average weight loss, the achievable BMIz reduction with LI has been shown to fall within a range of −0.15 to −0.3 after 1 year [22, 23] or −0.25 to −0.6 after 2 years [10, 22, 24]. Systematic reviews have reported BMIz reductions by LI of various length and intensity between −0.06 (95% CI: −0.10 to −0.02) [25] and −0.34 (95% CI: −0.66 to −0.02) [26].…”

“…Many previous studies have identified a link between younger age or lower degree of overweight at LI initiation with greater weight reduction [10, 29, 34–36]. Among a Dutch cohort, age ≤11 years also was linked with significantly higher BMIz loss compared with those aged 12 to 18 years [22]. Some aspect of BMIz reduction, particularly in those aged <12 years, may be attributable to spontaneous resolution of overweight (up to −0.18 BMIz within 1 year), albeit the chance decreases with severity of obesity and age [37].…”

“…Age‐specific physiologic development may additionally contribute to weight reduction. Adolescence and puberty have been shown to be a challenging period, with increasing autonomy, conflicts with parents, stress, less physical activity, and diminished parental but increasing peer‐group influence all contributing to the often unfavorable weight course during this period of life [10, 22, 36]. Nevertheless, in successful adolescents, a greater responsibility for weight loss and weight loss maintenance compared with younger adolescents (aged <16 years) was reported, which underlines the importance of an individual's age and ability to take responsibility for his/her health [38].…”

“…To validate our findings, we applied group-based trajectory modeling using SAS PROC TRAJ (SAS Institute Inc., Cary, North Carolina) [20,21], in addition to KmL.…”