Sustainability of weight loss from a family-centered pediatric weight management program integrated in primary care

Abstract

Background: A 6-month pediatric weight loss program showed modest success, but the sustainability of this success after 12 months was unclear. The present study aims tomeasure the medium-term effectiveness of family-based weight management in pediatric primary care to reduce body weight in children living with obesity.

Methods: In a retrospective cohort study, children ages 3 to 17 years with obesity in Kaiser Permanente Orange County, California, who enrolled in a weight management program between April 2014 and December 2018 (FB-WMG, n = 341) were compared to children referred but not enrolled (Ref-CG, n = 317) and controls matched by sex, age, zip code and BMI (Area-CG, n = 801). The relative distance from the median BMI-for-age at months 0, 6, and 12 were expressed as difference-in-differences (DID) using multivariable linear regressions with robust standard error.

Results: The baseline BMI-for-age was 98.6 (SD 1.08) percentile in FB-WMG, 98.2 (SD 1.22) percentile in Ref-CG, and 98.6 (1.13 in Area-CG). FB-WMG had a median of 3 visits (P25 1 visit, P75 5 visits) in the first 6 months. Despite a more considerable decrease in the relative distance to the median BMI-for-age in FB-WMG children with 3+ visits after 6 months, the success obtained was not sustained at 12 months (DID FB-WMG vs Area-CG -0.34, 95% CI - 3.00 to 2.33%, FB-WMG vs Ref-CG -0.39, 95% CI - 3.14 to 2.35%). At 12 months, there was no statistical significant difference between the three groups (FB-WWG, Ref-CG, Area-CG).

Conclusions: The initial success in weight management was not sustained in the absence of continued support for healthy lifestyle changes. Based on current evidence, continued support is necessary to maintain and promote success beyond a brief 6 month intervention. Long-term pediatric weight management programs are needed to promote continuing progress.

Keywords: Body mass index; Family-centered; Obesity; Sustainability; Weight management.

Fig. 1

Study flow chart

Fig. 2

Change in relative distance to the median BMI-for-age from baseline to 6 and 12 months in children of the family-based weight management group (FB-WMG) with at least one counselling session (a) and with 3 or more counselling sessions (b), their matched area control group (Area-CG), referred but untreated control group (Ref-CG)

Fig. 3

Change in the distance to the median BMI-for-age and difference-in differences (DID) in children of the family-based weight management group (FB-WMG), matched area control group (Area-CG), referred but untreated control group (Ref-CG) after 6 months (A) and after 12 months (B)