The Key Role of Psychosocial Risk on Therapeutic Outcome in Obese Children and Adolescents. Results from a Longitudinal Multicenter Study

Röbl, Markus; Souza, Martin de; Schiel, Ralf; Gellhaus, Ines; Zwiauer, Karl; Holl, Reinhard W.; Wiegand, Susanna

doi:10.1159/000353468

Cited by 18 publications

(40 citation statements)

References 35 publications

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“…Third, our findings regarding associations between migration background and successful treatment were inconsistent, as patients with migration background had both lower odds for rapid success followed by weight maintenance and for initial success followed by rebound. Studies have reported that children with a migration background living in Germany have a higher risk of obesity/overweight [1,31] and metabolic comorbidities [32], and lower treatment success rates compared to their native counterparts [33]. …”

Section: Discussionmentioning

confidence: 99%

Predicting Weight Loss and Maintenance in Overweight/Obese Pediatric Patients

et al. 2014

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Background: Pediatric lifestyle interventions have positive short-term effects on obese patients. Studies on long-term effects are still scarce in Europe. We investigated long-term weight patterns and sociodemographic predictors of a weight change in a large Central European (Germany, Austria and Switzerland) overweight pediatric cohort. Methods: The APV (Adiposity Patients Verlaufsbeobachtung) database was retrospectively analyzed; 157 specialized childhood obesity centers contributed standardized data of 29,181 patients [body mass index (BMI) ≥90th percentile; 5-25 years old] presenting between 2000 and 2012. BMI standard deviation scores (BMI-SDS) were analyzed in a 2-year follow-up and grouped according to BMI-SDS changes. Multiple logistic regression analyses were conducted to assess associations between sociodemographic factors and weight patterns. Results: 2-year follow-up data were available in 3,135 patients (54.6% female). Five distinct weight trajectories ‘rapid weight loss' (n = 735, 23.4%), ‘delayed success' (n = 697, 22.2%), ‘cycling weight' (n = 43, 1.4%), ‘initial weight loss' and ‘weight rebound' (n = 383, 12.2%) and ‘no weight loss throughout' (n = 1,277, 40.7%) best characterized long-term BMI-SDS changes. Younger and male patients were more likely to reduce weight and maintain weight loss. Conclusions: Our results suggest that an intervention before the onset of puberty seems promising for long-term weight maintenance in overweight children. Thus, new concepts are needed to improve long-term treatment success in patients with lower success rates.

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Section: Discussionmentioning

confidence: 99%

Predicting Weight Loss and Maintenance in Overweight/Obese Pediatric Patients

et al. 2014

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“…At a broader level, studies have shown that social risk factors like parent education and employment status are associated with a child's ability to lose weight; families with higher social risk are less likely to have children who lose weight. 20 On a behavioral level, parents who successfully lose weight are more likely to have children (age 8 to 12 years) who can decrease their BMI or BMI z-score (BMI-Z). 10,21 These results suggest that parents may be modeling healthy behaviors or successfully making behavior changes to their own and their child's daily eating and activity habits.…”

Section: Introductionmentioning

confidence: 99%

Warm Parenting Associated with Decreasing or Stable Child BMI during Treatment

et al. 2016

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Background: While authoritative parenting, which includes high levels of warmth and behavioral control, has been associated with lower risk of obesity, little is known about how general parenting impacts child weight loss during treatment. Our goal was to examine the relationship between several general parenting dimensions and 'decreasing /stable' child BMI during a 16-week familybased behavioral weight control program.Methods: Forty-four overweight parent-child dyads (child age 8 to 12 years) enrolled in the program. Families were videotaped at baseline eating dinner in their home. Using the General Parenting Observational Scale (GPOS), meals were coded for several general parenting dimensions. Primary outcome was percent of children whose BMI 'decreased or stayed the same.' Multivariable logistic regression was used to determine the relationship between general parenting and decreasing/stable child BMI.Results: Forty families (91%) completed the program. Children had a mean BMI change of -0.40 (SD 1.57), which corresponds to a -0.15 (SD 0.20) change in BMI z-score (BMI-Z); 75% of children had decreasing/stable BMI. In the unadjusted models, lower parent BMI, higher parent education, and higher levels of parental warmth were significantly associated with decreasing/stable child BMI. In the multivariable model, only higher level of warmth was associated with increased odds of decreasing/stable child BMI (OR = 1.28; 95% CI, 1.01, 1.62).Conclusions: Baseline parental warmth may influence a child's ability to lower/maintain BMI during a standard family-based behavioral weight control program. Efforts to increase parent displays of warmth and emotional support towards their overweight child may help to increase the likelihood of treatment success.

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“…Another possible explanation may be the lower treatment barrier, as the intervention was offered at a job center, rather than in a medical institution. Contrastingly, in another study a small proportion of families with low socioeconomic status was enrolled into obesity treatment programs [26]. Indeed, the reduction of treatment barriers for individuals with low socioeconomic status forms an important issue for health care policies [27].…”

Section: Discussionmentioning

confidence: 99%

A Structured, Manual-Based Low-Level Intervention vs. Treatment as Usual Evaluated in a Randomized Controlled Trial for Adolescents with Extreme Obesity - the STEREO Trial

Mühlig

Scherag²,

Bickenbach³

et al. 2017

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Background: To compare efficacy and safety of a manual-based low-level psychological intervention with treatment as usual (weight loss treatment). Methods: A two-armed randomized controlled trial without blinding and computer-based stratified block randomization included adolescents and young adults (14.0-24.9 years) with a BMI ≥ 30 kg/m² at five German university hospitals. Primary outcomes were adherence (participation rate ≥ 5/6 sessions) and quality of life (DISABKIDS-37) 6 months after randomization. Secondary outcomes included depression, self-esteem, and perceived stress scores. Results: Of 397 screened adolescents, 119 (mean BMI 40.4 ± 7.0 kg/m², 49.6% female) were randomized to the manual-based low-level intervention (n = 59) or treatment as usual (n = 60). We observed no group difference for adherence (absolute risk reduction 0.4%, 95% CI -14.7% to 15.5%; p = 1.0) or health-related quality of life (score difference 8.1, 95% CI -2.1 to 18.3; p = 0.11). Among all secondary outcomes, we detected explorative evidence for an effect on the DISABKIDS-37 ‘social exclusion' subscale (score difference 15.5; 95% CI 1.6-29.4; p = 0.03). 18/19 adverse events occurred in 26 participants, none were classified as serious. Conclusion: Adherence to a coping-oriented intervention was comparable to weight loss treatment, although it was weak in both interventions. Psychological interventions may help to overcome social isolation; further confirmation is required.

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The Key Role of Psychosocial Risk on Therapeutic Outcome in Obese Children and Adolescents. Results from a Longitudinal Multicenter Study

Cited by 18 publications

References 35 publications

Predicting Weight Loss and Maintenance in Overweight/Obese Pediatric Patients

Predicting Weight Loss and Maintenance in Overweight/Obese Pediatric Patients

Warm Parenting Associated with Decreasing or Stable Child BMI during Treatment

A Structured, Manual-Based Low-Level Intervention vs. Treatment as Usual Evaluated in a Randomized Controlled Trial for Adolescents with Extreme Obesity - the STEREO Trial

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