Modest treatment effects and high program attrition: The impact of interdisciplinary, individualized care for managing paediatric obesity.
BACKGROUND
There is an urgent need to identify effective weight management interventions in real-world, clinical settings to improve the health of children with obesity.


OBJECTIVE
To determine the impact of individualized, interdisciplinary care on the weight status of children with obesity; to assess the relationship between clinical interactions and change in participants' weight status; and to document the degree of program attrition.


METHODS
A retrospective medical record review of clinical and administrative data from a paediatric weight management clinic in Edmonton, Alberta, was performed, which included data from a group of five- to 18-year-olds (body mass index [BMI] ≥85th percentile) collected from 2008 to 2012. Demographic, anthropometric and attendance data were retrieved from baseline and follow-up at three-, seven- and 11-month timepoints. The primary outcomes were participants' BMI z-score and change in BMI z-score over time.


RESULTS
Data from 165 individuals were included. Among those with follow-up anthropometric data, weight stabilization occurred at three (n=127) and seven months (n=84). For individuals with follow-up anthropometric data at 11 months (n=44), BMI z-score tended to decrease over time (-0.05±0.12 units; P=0.06). Program attrition increased over time (23%, 49% and 73% at three-, seven- and 11-month follow-ups, respectively). Between presentation and three-month follow-up, there was an inverse relationship between the number of clinical appointments attended and change in BMI z-score (r= -0.18; P=0.04), an association that became nonsignificant at seven and 11 months (both P>0.05).


CONCLUSIONS
An individualized, interdisciplinary weight management intervention led to weight stabilization and a modest weight reduction in children with obesity. Strategies to minimize program attrition are needed to optimize family engagement in care and success in managing paediatric obesity.
Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta;
Jillian Ls
JL
Avis
Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta; ; Pediatric Centre for Weight and Health, Stollery Children's Hospital, Alberta Health Services, Edmonton, Alberta.
Kathryn A
KA
Ambler
Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta; ; Pediatric Centre for Weight and Health, Stollery Children's Hospital, Alberta Health Services, Edmonton, Alberta.
Mary M
MM
Jetha
Pediatric Centre for Weight and Health, Stollery Children's Hospital, Alberta Health Services, Edmonton, Alberta.
Henrietta
H
Boateng
Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta; ; Pediatric Centre for Weight and Health, Stollery Children's Hospital, Alberta Health Services, Edmonton, Alberta.
Geoff Dc
GD
Ball
Canada; Family; Health Services; Intervention; Obesity; Paediatric; Treatment