title: Inpatient treatment of children and adolescents with severe obesity in the Netherlands: a randomized clinical trial.
abstract: OBJECTIVE
  Severe childhood obesity has become a major health problem, and effective, evidence-based interventions are needed. The relative effectiveness of inpatient compared with ambulatory treatment remains unknown.
  
  
  OBJECTIVE
  To determine whether an inpatient treatment program is more effective than an ambulatory treatment program at achieving a sustained weight loss in children and adolescents with severe obesity.
  
  
  METHODS
  We conducted a randomized clinical trial with a 2-year follow-up at a tertiary referral center for pediatric obesity in the Netherlands. We recruited 90 children and adolescents aged 8 to 18 years with severe obesity (body mass index [BMI] z score, ≥3.0 or >2.3 with obesity-related health problems).
  
  
  METHODS
  Patients were randomly assigned to an inpatient (6 months of hospitalization on working days) or an ambulatory (12 days of hospital visits at increasing intervals during a 6-month period) treatment program. Both treatment programs involved an intensive, family-based, lifestyle intervention, including exercise, nutritional education, and behavior modification for the patients and their caregiver(s).
  
  
  METHODS
  Change in BMI z score. Secondary outcomes included fasting insulin, fasting plasma glucose, 2-hour plasma glucose, and lipid levels, insulin sensitivity, liver function test results, waist circumference, blood pressure, body composition, and aerobic fitness (peak oxygen consumption, Vo₂). Outcomes were analyzed by intention to treat.
  
  
  RESULTS
  Immediately after treatment, reductions in the BMI z score were significantly larger for the inpatient than the ambulatory groups (mean [SE] difference, -0.26 [0.12; 95% CI, -0.59 to -0.01]; P = .04). Change from baseline for the BMI z score in the inpatient group was -18.0% (P = .001) immediately after treatment, -8.5% (P = .008) at 18 months, and -6.3% (P = .38) at 30 months; in the ambulatory group, changes from baseline were -10.5% (P = .001), -6.2% (P = .39), and -1.5% (P > .99), respectively. The favorable outcomes of the inpatient group could not be sustained at 12 and 24 months after treatment. In addition, significant differences in favor of the inpatient group immediately after treatment were found for levels of fasting insulin (-6.37 IU/L; P = .02), total cholesterol (-19.51 mg/dL; P = .01), low-density lipoprotein cholesterol (-13.48 mg/dL; P = .03), and triglycerides (-25.39 mg/dL; P = .01), and insulin sensitivity (-1.37; P = .02), fat mass (-3.31%; P = .03), and peak Vo₂ (378.2 mL/min; P = .01).
  
  
  CONCLUSIONS
  In severely obese children and adolescents, inpatient treatment was superior to ambulatory treatment immediately after treatment, but effects were not sustained at long-term follow-up. These findings stress the need to further study maintenance strategies for sustainable weight loss.
  
  
  BACKGROUND
  trialregister.nl Identifier: NTR1172.
authors.affiliation: Pediatric Department, Merem Childhood Obesity Centre Heideheuvel, Hilversum, the Netherlands2Pediatric Department, Academic Medical Center, Emma Children's Hospital, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Olga
authors.initials: O
authors.lastname: van der Baan-Slootweg
authors.affiliation: Pediatric Department, Academic Medical Center, Emma Children's Hospital, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Benninga
authors.affiliation: Pediatric Department, Merem Childhood Obesity Centre Heideheuvel, Hilversum, the Netherlands3Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Anita
authors.initials: A
authors.lastname: Beelen
authors.affiliation: Department of Research Methodology, Measurement, and Data Analysis, University of Twente, Enschede, the Netherlands5Medical School Twente, Medisch Spectrum Twente, Enschede, the Netherlands.
authors.forename: Job
authors.initials: J
authors.lastname: van der Palen
authors.affiliation: Pediatric Department, Merem Childhood Obesity Centre Heideheuvel, Hilversum, the Netherlands.
authors.forename: Christine
authors.initials: C
authors.lastname: Tamminga-Smeulders
authors.affiliation: Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Jan G P
authors.initials: JG
authors.lastname: Tijssen
authors.affiliation: Pediatric Department, Academic Medical Center, Emma Children's Hospital, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Wim M C
authors.initials: WM
authors.lastname: van Aalderen
mesh_terms: D000293:Adolescent; D000553:Ambulatory Care / Q000379:methods*; D001521:Behavior Therapy; D015992:Body Mass Index; D002648:Child; D004035:Diet Therapy; D005081:Exercise Therapy; D005260:Female; D005500:Follow-Up Studies; D006266:Health Education; D006293:Health Promotion; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients; D008297:Male; D009426:Netherlands; D009767:Obesity, Morbid / Q000628:therapy*; D063766:Pediatric Obesity / Q000628:therapy*; D016896:Treatment Outcome; D015431:Weight Loss