Obese Kids Can Benefit From a Nonintensive Weight Management Program

Jill Stein

June 24, 2010

June 24, 2010 (San Diego, California) — A nonintensive weight management program can improve the metabolic profile of obese children who remain in a supervised program for several years, researchers reported here at ENDO 2010: The Endocrine Society 92nd Annual Meeting.

The study, by a group of endocrinologists from St. Christopher's Hospital for Children in Philadelphia, Pennsylvania, found that the extent of benefit depended on the number of clinic visits.

"Our data showed that obese children who return to the weight management clinic for a follow-up visit with a nurse and nutritionist more than twice a year after their initial evaluation by a physician do significantly better than children who return less often," Rita Ann Kubicky, MD, the study's first author, told Medscape Endocrinology.

"Given that the mean number of yearly clinic visits in the group with a significant improvement at 4 years was 3.2, [compared with] 1.5 for the group without significant improvement, we believe that perhaps a return visit every 3 to 4 months is sufficient to lower the risk of long-term complications in obese children."

According to the Centers for Disease Control and Prevention, childhood obesity has more than tripled in the past 30 years. The prevalence of obesity in children from 6 to 11 years of age increased from 6.5% in 1980 to 19.6% in 2008, while the prevalence of obesity in those 12 to 19 years old increased from 5.0% to 18.1%.

Although intensive weight management programs have produced weight loss and improved the metabolic profile of obese children, most of the beneficial effects of a short-term intervention do not persist after the program is completed, Dr. Kubicky pointed out. Intensive weight management programs involve frequent interactions with a multidisciplinary team. For example, the patient might meet with the team twice a week for 6 months and then once a week for an additional 6 months.

Multidisciplinary teams can include an endocrinologist, nurse, nutritionist, exercise physiologist, social worker, and psychologist, among others.

Dr. Kubicky and her colleagues reviewed the charts of a group of obese nondiabetic children who participated in a nonintensive weight management program at her institution's Weight Management Center.

After being initially evaluated by an endocrinologist and screened for metabolic comorbidities, children periodically met with a nurse practitioner and a clinical nutritionist. During follow-up visits, weight and height measurements, a review of systems, and an interim history were obtained. In addition, children were counseled about age-appropriate caloric intake and regular physical activity.

"The initial meeting usually lasts about an hour," Dr. Kubicky said. "After the initial session, the patient generally returns every 3 to 4 months. It all depends. We may decide that we want them to come in sooner based on the results of a routine lipid panel and oral glucose tolerance test [OGTT], or if there is an obvious weight gain."

Improvements Correlate With Frequency of Clinic Visits

The analysis involved 61 children who were followed for at least 2 years and in whom a fasting blood sample was obtained at the first and last visits of the follow-up period.

At the initial visit, the mean age was 11.1 ± 2.6 years. The mean number of annual clinic visits was 2.9 ± 0.9, and the mean duration of the follow-up period was 47.3 ± 11.1 months.

Children were divided into 2 groups, based on whether they had more than 2 yearly clinic visits or 2 or fewer visits. The 2 groups were similar at baseline in all of the metabolic variables analyzed and in body mass index (BMI).

At the end of the follow-up period, children with more than 2 annual clinic visits had a significant decrease in their low-density-lipoprotein cholesterol (from 111.3 ± 36.7 mg/dL at their initial visit to 96.4 ± 23.5 mg/dL at their last visit; P = .022), 2-hour glucose (113.2 ± 21.6 mg/dL to 93.4 ± 18.3 mg/dL; P = .0001), and peak insulin (212.0 ± 117.7 μIU/mL to 137.2 ± 81.1 μIU/mL; P = .0036). The BMI Z-score in this group also decreased significantly.

Children who visited the clinic 2 times a year or less did not have significant improvement in any of the metabolic measures or BMI Z-score.

No change in homeostatic model assessment to quantify insulin resistance and beta-cell function, high-density-lipoprotein cholesterol, or triglycerides occurred in either group.

Five children were found to have impaired glucose tolerance on the initial OGTT. At the end of the follow-up period, the OGTT had normalized in 4 children and 1 child had developed diabetes.

Finally, Dr. Kubicky emphasized that obese children, even those cared for by a pediatrician who participate in a weight management program, should be referred to an endocrinologist when "there is a suspicion" of either excess cortisol or a genetic cause for their obesity, or when they are prediabetic.

"This is an interesting study that has practical implications," Jeffrey I. Mechanick, MD, clinical professor of medicine in the endocrine and metabolism division at Mount Sinai School of Medicine in New York City, told Medscape Endocrinology.

"Formalized/intensive weight reduction programs tend to be expensive and labor intensive and have decreased adherence."

"Also, as pointed out by the study authors, patients tend to regain weight after the program has been completed, and it is impractical to remain in such a program indefinitely," he said. "In addition, many of the well-controlled clinical trials looking at specialized diets (Zone vs Atkins vs Ornish, etc.) demonstrate that adherence is one of the more important factors and not the specific diet itself."

Dr. Mechanick pointed out that the study demonstrates that "less formalized programs actually have an effect and that the effect is associated with the number of clinic visits — a dose-dependent effect, so to speak."

The study also shows that the beneficial changes with increased visits are metabolic even without differences in weight loss between the 2 groups, "although I can't confirm this without having seen the data," he added.

"The implication," he said, "is that in this population, informal clinic visits for weight management work if the patient actually comes to the clinic."

"The significance of this study, and others like it in children and adults, is to remind us of the importance of maintaining regular contact with a health professional during and after weight loss," Michael Rosenbaum, MD, professor of clinical pediatrics and clinical medicine at Columbia University Medical Center in New York City, told Medscape Endocrinology in an interview.

"Learning to manage weight is not like learning to ride a bicycle," Dr. Rosenbaum explained. "Once you have learned to ride a bicycle, you can translate that knowledge back into action without too much difficulty. In contrast, just counseling, prescription of diet, or a recommendation for exercise by a physician, nutritionist, nurse, or trainer is not sufficient. The individual trying to lose weight and sustain weight loss should continue to see a health professional regularly to assess their progress and to help them sustain whatever progress has been made."

Dr. Rosenbaum has disclosed no relevant financial relationships.

ENDO 2010: The Endocrine Society 92nd Annual Meeting. Abstract P2-725. Presented June 20, 2010.

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