title: The outcome of childhood obesity management depends highly upon patient compliance.
abstract: Over the last 20 years, obesity in childhood and adolescence has become a major public health concern due to dramatically increasing prevalence rates. We evaluated the outcome of 294 children (135 girls, 159 boys) aged 6-16 years (median 10.9 years) enrolled in a single centre outpatient obesity intervention programme consisting of periodical visits to the outpatient unit with regular medical and dietetic counselling aiming at a modification of dietary and activity patterns of patients and parents. The average number of visits to the outpatient unit was 3.6 (SD 2.7) with a mean visit interval of 62.1 days. A mean drop-out rate of 27.5% between each scheduled appointment occurred. In a stepwise regression model, neither reduction of the standard deviation score of patients' body mass index (BMI-SDS) nor dietary counselling contributed to the total number of visits. The only significant contributor was the patients' initial BMI-SDS explaining 4.6% of the variance of attended visits adjusted for age and sex. Segregation of the patients into an "obesity" (initial BMI-SDS >/=90th percentile, at least three visits attended, n=59) and an "excessive obesity" (initial BMI-SDS >/=99th percentile, at least four visits attended, n=75) subgroup showed a mean reduction of BMI-SDS in the "obesity" group at visit three of 0.14 (SD 0.21, P<0.0001), and in the "excessive obese" group at visit four of 0.17 (SD 0.22, P<0.001). In a stepwise regression model, the mean interval between visits and regular dietary counselling explained 11.7% of the variance of BMI-SDS reduction at visit three in both subgroups.
  
  
  CONCLUSIONS
  there is an urgent need for efficient strategies to improve adherence of outpatients to obesity treatment since, in terms of reduction in body mass index standard deviation score, a beneficial outcome can be achieved for compliant obese children and adolescents.
authors.affiliation: Department of Paediatrics, University Hospital, Prittwitzstrasse 43, 89073 Ulm, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Denzer
authors.forename: Eva
authors.initials: E
authors.lastname: Reithofer
authors.forename: Martin
authors.initials: M
authors.lastname: Wabitsch
authors.forename: Kurt
authors.initials: K
authors.lastname: Widhalm
mesh_terms: D000293:Adolescent; D000886:Anthropometry; D015992:Body Mass Index; D002648:Child; D003376:Counseling; D005260:Female; D006801:Humans; D008297:Male; D009765:Obesity / Q000628:therapy*; D010349:Patient Compliance; D012044:Regression Analysis; D012189:Retrospective Studies; D016896:Treatment Outcome