title: Response of severely obese children and adolescents to behavioral treatment.
abstract: OBJECTIVE
  To investigate whether the degree of obesity predicts the efficacy of long-term behavioral treatment and to explore any interaction with age.
  
  
  METHODS
  A 3-year longitudinal observational study. Obese children were divided into 3 age groups (6-9, 10-13, and 14-16 years) and also into 2 groups (moderately obese, with a body mass index [BMI]-standard deviation [SD] score [or z score] of 1.6 to <3.5, and severely obese, with a BMI-SD score of ≥3.5).
  
  
  METHODS
  National Childhood Obesity Center, Stockholm, Sweden.
  
  
  METHODS
  Children 6 to 16 years of age who started treatment between 1998 and 2006.
  
  
  METHODS
  Behavioral treatment of obesity.
  
  
  METHODS
  Change in BMI-SD score during 3 years of treatment; a reduction in BMI-SD score of 0.5 units or more was defined as clinically significant.
  
  
  RESULTS
  A total of 643 children (49% female children) met the inclusion criteria. Among the youngest moderately obese children, 44% had a clinically significant reduction in BMI-SD score (mean reduction, -0.4 [95% CI, -0.55 to -0.32]). Treatment was less effective for the older moderately obese children. Twenty percent of children who were 10 to 13 years of age and 8% of children who were 14 to 16 years of age had a reduction in BMI-SD score of 0.5 units or more; 58% of the severely obese young children showed a clinically significant reduction in BMI-SD score (mean reduction, -0.7 [95% CI, -0.80 to -0.54]). The severely obese adolescents showed no change in mean BMI-SD score after 3 years, and 2% experienced clinically significant weight loss. Age was found to be a predictor of a reduction in BMI-SD score (odds ratio, 0.68 units per year [95% CI, 0.60-0.77 units per year]).
  
  
  CONCLUSIONS
  Behavioral treatment was successful for severely obese children but had almost no effect on severely obese adolescents.
authors.affiliation: National Childhood Obesity Center, Department of Pediatrics, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden. pernilla.danielsson@karolinska.se
authors.forename: Pernilla
authors.initials: P
authors.lastname: Danielsson
authors.forename: Jan
authors.initials: J
authors.lastname: Kowalski
authors.forename: Örjan
authors.initials: Ö
authors.lastname: Ekblom
authors.forename: Claude
authors.initials: C
authors.lastname: Marcus
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001521:Behavior Therapy; D015992:Body Mass Index; D002648:Child; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D009765:Obesity / Q000145:classification / Q000628:therapy*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D015431:Weight Loss; D061217:Weight Reduction Programs / Q000379:methods*