title: Severely obese preschoolers in a tertiary care obesity program: characteristics and management.
abstract: OBJECTIVE
  To describe the characteristics and management of severely obese 2- to 5-year-olds children referred to a tertiary care multidisciplinary obesity center.
  
  
  METHODS
  A retrospective chart review was conducted of children 2 to 5 years old evaluated at the center from January 2009 to February 2011. Referral eligibility was a body mass index (BMI) ≥95th percentile.
  
  
  RESULTS
  Of the 2- to 5-year-olds seen at the center, 140 (94%) had a BMI >99th percentile. Of these children with severe obesity, 54% were female, 48% were Caucasian, and mean age was 4.60 years (SD = 1.00). Mean BMI and BMI z-score at initial visit was 26.5 kg/m(2) (SD = 4.12) and 3.59 (SD = 0.95), respectively. BMI z-scores varied significantly by age-χ(2)(3, N = 140) = 54.44, P < .001-and gender-χ(2)(1, N = 140) = -5.31, P < .001-with males and younger children presenting at much higher BMI z-scores. Most of the children had a family history of obesity, (85%), type 2 diabetes (74%), and hypertension (74%). Nearly one third of families reported history of mental health or substance abuse problems. Comorbidities were prevalent, particularly dyslipidemia and problematic eating behaviors. For the 53% of children who returned for at least one follow-up visit, mean BMI z-score decreased significantly by 0.15-t(79) = 5.31, P < .001.
  
  
  CONCLUSIONS
  Our findings underscore the severity of the condition facing these children and their families. With improved retention, the tertiary care multidisciplinary program may be a viable option for successful intervention for these children.
authors.affiliation: Center for Healthy Weight and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Baughcum
authors.affiliation: Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.
authors.forename: Kerri
authors.initials: K
authors.lastname: Gramling
authors.affiliation: Center for Healthy Weight and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA ihuoma.eneli@nationwidechildrens.org.
authors.forename: Ihuoma
authors.initials: I
authors.lastname: Eneli
mesh_terms: D000367:Age Factors; D015992:Body Mass Index; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D009765:Obesity / Q000628:therapy*; D012189:Retrospective Studies; D012737:Sex Factors; D063128:Tertiary Health Care / Q000379:methods*
keywords: management; preschoolers; severe obesity