title: Adolescents with severe obesity: outcomes of participation in an intensive obesity management programme.
abstract: BACKGROUND
  Most interventions for childhood obesity are randomized controlled studies. Less is known about the effectiveness of clinical obesity programmes.
  
  
  OBJECTIVE
  To assess outcomes in adolescents participating in the SickKids Team Obesity Management Program (STOMP) vs. a comparison group of obese adolescents.
  
  
  METHODS
  Severely obese adolescents (n = 75) in STOMP (15.1 ± 1.8 years, body mass index [BMI] 44.8 ± 7.8 kg m(-2) ) were compared with adolescents (n = 41) not in the programme (14.9 ± 2.0 years, BMI 34.5 ± 8.0 kg m(-2) ). Outcomes were change in BMI, cardiometabolic, psychological and health behaviour measures.
  
  
  RESULTS
  At 6 months, STOMP patients' BMI was unchanged (0.08 ± 0.3; P = 0.79) and they reported improvements in quality of life and depression (-3.6 ± 1.4; P = 0.009), and increases in measures of readiness to change (RTC). Between-group differences in change between 0 and 6 months, in favour of STOMP patients, were observed for homeostatic measurement assessment-insulin resistance (HOMA-IR; -2.7 ± 1.0; P = 0.007), depression scores (-3.5 ± 1.7; P = 0.04), diet-RTC (0.6 ± 0.2; P < 0.001) and physical activity (1.7 ± 0.9; P = 0.05). At 12 months, STOMP patients increased BMI (0.8 ± 0.5; P = 0.07), but they exhibited decreased waist circumference (-7.4 ± 2.1 cm; P = 0.001) and HOMA-IR (-1.9 ± 0.6; P = 0.002). Between-group differences in change between 0 and 12 months, in favour of STOMP patients, were observed for waist circumference (-5.9 ± 2.4 cm; P = 0.01), HOMA-IR (-2.9 ± 0.7; P < 0.001) and diet-RTC (0.9 ± 0.2; P < 0.001).
  
  
  CONCLUSIONS
  STOMP participants did not experience a significant reduction in BMI but did have improvements in cardiometabolic, psychological and health behaviour outcomes. Evaluation of paediatric clinical obesity programmes using multiple measures is essential to understanding real-world outcomes.
authors.affiliation: Department of Paediatrics, University of Toronto, Toronto, ON, Canada.|Division of Endocrinology, The Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: P
authors.initials: P
authors.lastname: Luca
authors.affiliation: Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: E
authors.initials: E
authors.lastname: Dettmer
authors.affiliation: Department of Paediatrics, University of Toronto, Toronto, ON, Canada.|Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Khoury
authors.affiliation: Department of Paediatrics, University of Toronto, Toronto, ON, Canada.|Division of Endocrinology, The Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: P
authors.initials: P
authors.lastname: Grewal
authors.affiliation: Department of Paediatrics, University of Toronto, Toronto, ON, Canada.|Division of Cardiology, The Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: C
authors.initials: C
authors.lastname: Manlhiot
authors.affiliation: Department of Paediatrics, University of Toronto, Toronto, ON, Canada.|Division of Cardiology, The Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: B W
authors.initials: BW
authors.lastname: McCrindle
authors.affiliation: Department of Paediatrics, University of Toronto, Toronto, ON, Canada.|Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: C S
authors.initials: CS
authors.lastname: Birken
authors.affiliation: Department of Paediatrics, University of Toronto, Toronto, ON, Canada.|Division of Endocrinology, The Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: J K
authors.initials: JK
authors.lastname: Hamilton
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D001521:Behavior Therapy / Q000379:methods*; D015992:Body Mass Index; D004032:Diet; D005247:Feeding Behavior / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D009767:Obesity, Morbid / Q000517:prevention & control* / Q000523:psychology / Q000628:therapy; D011788:Quality of Life; D016896:Treatment Outcome; D055105:Waist Circumference; D061217:Weight Reduction Programs
keywords: Adolescent obesity; clinical obesity programmes; outcomes; programme evaluation