Results Long-term Weight Outcomes by Severity of Obesity in Children in Comprehensive,...
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Results Long-term Weight Outcomes by Severity of Obesity in Children in Comprehensive, Multidisciplinary Weight Management Compared to Standard Care Controls Sarah E. Hampl 1,2 , Brooke R. Sweeney 1,2 , Ashley K. Sherman 1 , Kelsey M. Dean 2 , Amy E. Papa 2 , Kelsey B. Borner 2,3 , Katrina Poppert Cordts 3 and Meredith L. Dreyer Gillette 1,2 1 Children's Mercy Hospital, Kansas City, MO; 2 Center for Children's Healthy Lifestyles & Nutrition, Kansas City, MO; 3 Clinical Child Psychology Program, University of Kansas, Lawrence, KS Background • The US Preventive Services Task Force recommends that children with obesity receive moderate- to high-intensity comprehensive multidisciplinary intervention of ≥26 contact hours (Whitlock et al, 2010). This is most consistent with Expert Committee Stage 3 (Comprehensive Multidisciplinary Intervention) treatment (Spear et al, 2007). • Information about how longer term outcomes of these programs may vary by obesity severity and how these outcomes compare to children receiving standard care is limited (Ho et al, 2012). • This study investigated long-term outcomes of a comprehensive multidisciplinary intervention based on obesity severity and as compared to standard care Conclusions • Children aged 9-18 presenting for a 24-week comprehensive, multidisciplinary group weight management program fell into evenly divided obesity severity classes. • Classifying children in obesity severity categories can be a useful tool in tailoring treatment. Children with Class II Obesity may most optimally benefit from a moderate intensity weight management intervention, while children with the most severe (Class III) obesity likely need higher treatment intensity than is currently recommended by the USPSTF to achieve successful weight outcomes. • Limitations of the study include small sample size, hindering evaluation of lab outcomes, and lack of examination of insurance status. Methods Procedures: • Group participants were children enrolled in the Promoting Health in Teens and Kids (PHIT Kids) program, a 24-week, 2 hour weekly behaviorally- based intervention at a Midwest children’s hospital. Participants began the group in 2006-2010 and were followed for 12 months. • Age-, sex-, race/ethnicity- and BMI- matched standard care participants with visits approximating baseline and 6- month intervals were drawn from the hospital’s General Pediatrics clinic. • Participant demographic and anthropometric data were drawn from the patient’s electronic medical record. The study was approved by the IRB. Measures: • Patient anthropometric data (i.e., height, weight) was measured at each visit. Child height and weight were used to calculate BMI, BMI percentile, and BMI z-score using the Centers for Disease Control BMI calculator for SAS™. • Participants were categorized with Obesity Class I (BMI≥95 th %ile), Class II (BMI≥120% of the 95 th %ile) or Class III (BMI≥140% of the 95 th %ile) (Gulati et al, 2012). Analyses: References • Whitlock EP, O’Connor EA, Williams SB, Beil TL, Lutz KW, Effectiveness of weight management interventions in children: A targeted systematic review for the USPSTF. Pediatr 2010;125:e396- e418. • Spear BA, Barlow SE, Ervin C, Ludwig DS, Saelens BE, Schetzina KE, Taveras EM. Recommendations for treatment of child and adolescent overweight and obesity. Pediatr 2007;120:S254-S288. • Ho M, Garnett SP, Baur L, Burrows T et al. Effectiveness of lifestyle interventions in child obesity: Systematic review with meta-analysis. Pediatr 2012;130:e1647-e1671. • Gulati AK, Kaplan DW, Daniels SR. Clinical tracking of severely obese children: A new growth chart. Pediatr 2012; 130:6 1136-1140. Acknowledgements The authors thank the Healthcare Foundation of Greater Kansas City and the Junior League of Kansas City for their support of the group program Contact Information For more information contact: Sarah Hampl, MD at [email protected] CD001872.pub2. Figure 1. Baseline weight status of Group program and Control participants • Figure 1: In the Group program, 31%, 34% and 35% of participants, respectively had Class I, II or III Obesity, while 34%, 35% and 31% of Controls, respectively fell into these classes. None of these differences were significant. • Figure 2: BMIz-score was not significantly different and did not significantly improve for Group program or Control participants with class I Obesity at 6 or 12 months. • Figure 3: BMIz-score significantly improved from baseline to 6 months (-0.04, p<0.01) and 12 months (-0.07, p<0.01) for Group program participants with Class II Obesity but not for Controls, though significant improvement from 6 to 12 months was seen for both groups. • Figure 4: BMIz-score significantly improved from baseline to 6 (-0.02, p<0.01) and 12 months (-0.03, p<0.01) for Group program participants and Controls with Class III Obesity. Figure 2. Change in BMIz-score in Group program participants and Controls with Class I Obesity over 12 months. Figure 3. Change in BMIz-score in Group program participants and Controls with Obesity Class II over 12 months. Figure 4. Change in BMIz-score in Group program participants and Controls with Obesity Class III over 12 months. Participants • 117 Group program and 189 control participants • Age: ≥9 years old (M age=12.36 years) • Group program participants versus controls did not significantly differ by demographics or baseline BMI • To examine anthropometric outcomes by severity of obesity, participants of group program and control participants were further divided into: • Class I Obesity (BMI 95-119.9% above the 95 th %ile) • Class II Obesity (BMI 120-139.9% above the 95 th %ile) • Class III Obesity (BMI≥140% above the 95 th %ile)
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Transcript of Results Long-term Weight Outcomes by Severity of Obesity in Children in Comprehensive,...
Results
Long-term Weight Outcomes by Severity of Obesity in Children in Comprehensive, Multidisciplinary Weight Management Compared to Standard Care Controls
Sarah E. Hampl1,2, Brooke R. Sweeney1,2, Ashley K. Sherman1, Kelsey M. Dean2, Amy E. Papa2, Kelsey B. Borner2,3, Katrina Poppert Cordts3 and Meredith L. Dreyer Gillette1,2 1Children's Mercy Hospital, Kansas City, MO;
2Center for Children's Healthy Lifestyles & Nutrition, Kansas City, MO; 3Clinical Child Psychology Program, University of Kansas, Lawrence, KS
Background• The US Preventive Services Task Force recommends that
children with obesity receive moderate- to high-intensity comprehensive multidisciplinary intervention of ≥26 contact hours (Whitlock et al, 2010). This is most consistent with Expert Committee Stage 3 (Comprehensive Multidisciplinary Intervention) treatment (Spear et al, 2007).
• Information about how longer term outcomes of these
programs may vary by obesity severity and how these outcomes compare to children receiving standard care is limited (Ho et al, 2012).
• This study investigated long-term outcomes of a comprehensive multidisciplinary intervention based on obesity severity and as compared to standard care
Conclusions• Children aged 9-18 presenting for a 24-
week comprehensive, multidisciplinary group weight management program fell into evenly divided obesity severity classes.
• Classifying children in obesity severity categories can be a useful tool in tailoring treatment. Children with Class II Obesity may most optimally benefit from a moderate intensity weight management intervention, while children with the most severe (Class III) obesity likely need higher treatment intensity than is currently recommended by the USPSTF to achieve successful weight outcomes.
• Limitations of the study include small sample size, hindering evaluation of lab outcomes, and lack of examination of insurance status.
MethodsProcedures:• Group participants were children enrolled in the Promoting
Health in Teens and Kids (PHIT Kids) program, a 24-week, 2 hour weekly behaviorally-based intervention at a Midwest children’s hospital. Participants began the group in 2006-2010 and were followed for 12 months.
• Age-, sex-, race/ethnicity- and BMI-matched standard care participants with visits approximating baseline and 6-month intervals were drawn from the hospital’s General Pediatrics clinic.
• Participant demographic and anthropometric data were drawn from the patient’s electronic medical record. The study was approved by the IRB.
Measures:• Patient anthropometric data (i.e., height, weight) was
measured at each visit. Child height and weight were used to calculate BMI, BMI percentile, and BMI z-score using the Centers for Disease Control BMI calculator for SAS™.
• Participants were categorized with Obesity Class I (BMI≥95th%ile), Class II (BMI≥120% of the 95th%ile) or Class III (BMI≥140% of the 95th%ile) (Gulati et al, 2012).
Analyses:• Chi-square test and mixed linear models were used to
compare groups and look for changes over time.
References• Whitlock EP, O’Connor EA, Williams SB, Beil TL, Lutz KW,
Effectiveness of weight management interventions in children: A targeted systematic review for the USPSTF. Pediatr 2010;125:e396-e418.
• Spear BA, Barlow SE, Ervin C, Ludwig DS, Saelens BE, Schetzina KE, Taveras EM. Recommendations for treatment of child and adolescent overweight and obesity. Pediatr 2007;120:S254-S288.
• Ho M, Garnett SP, Baur L, Burrows T et al. Effectiveness of lifestyle interventions in child obesity: Systematic review with meta-analysis. Pediatr 2012;130:e1647-e1671.
• Gulati AK, Kaplan DW, Daniels SR. Clinical tracking of severely obese children: A new growth chart. Pediatr 2012; 130:6 1136-1140.
AcknowledgementsThe authors thank the Healthcare Foundation of Greater Kansas City and the Junior League of Kansas City for their support of the group program
Contact InformationFor more information contact:
Sarah Hampl, MD at [email protected].
Figure 1. Baseline weight status of Group program and Control participants
• Figure 1: In the Group program, 31%, 34% and 35% of participants, respectively had Class I, II or III Obesity, while 34%, 35% and 31% of Controls, respectively fell into these classes. None of these differences were significant.
• Figure 2: BMIz-score was not significantly different and did not significantly improve for Group program or Control participants with class I Obesity at 6 or 12 months.
• Figure 3: BMIz-score significantly improved from baseline to 6 months (-0.04, p<0.01) and 12 months (-0.07, p<0.01) for Group program participants with Class II Obesity but not for Controls, though significant improvement from 6 to 12 months was seen for both groups.
• Figure 4: BMIz-score significantly improved from baseline to 6 (-0.02, p<0.01) and 12 months (-0.03, p<0.01) for Group program participants and Controls with Class III Obesity.
Figure 2. Change in BMIz-score in Group program participants and Controls with Class I Obesity over 12 months.
Figure 3. Change in BMIz-score in Group program participants and Controls with Obesity Class II over 12 months.
Figure 4. Change in BMIz-score in Group program participants and Controls with Obesity Class III over 12 months.
Participants
• 117 Group program and 189 control participants • Age: ≥9 years old (M age=12.36 years) • Group program participants versus controls did not significantly differ by
demographics or baseline BMI
• To examine anthropometric outcomes by severity of obesity, participants of group program and control participants were further divided into:• Class I Obesity (BMI 95-119.9% above the 95th%ile)• Class II Obesity (BMI 120-139.9% above the 95th%ile)• Class III Obesity (BMI≥140% above the 95th%ile)
