Obesity in preschool and school-age children. Treatment early and often may be best

Abstract

Objective: To determine if timing and frequency of interventions affect the outcome of treatment of obesity in pediatric patients.

Design: Retrospective chart review; comparison of subgroups defined by age and frequency of visits.

Setting: A nutrition evaluation clinic, an outpatient referred care clinic at a metropolitan hospital.

Participants: All 93 obese children, aged 1 to 10 years, seen within 1 year and with one or more subsequent visits in the next year. Obesity was defined as greater than 120% ideal body weight for height age (IBWH). Mean percent IBWH was 171% (median, 199%; range, 127% to 251%).

Interventions: (1) Initial visit. Comprehensive history and physical examination, by physician, registered dietician, and licensed clinical social worker; design of individualized care plan, including prescribed frequency and size of meals and snacks; and type, frequency, and duration of exercise. (2) Subsequent visits (after 1 month, then with frequency tailored to need). Review of progress, adjustment of energy intake and expenditure; management of biopsychosocial obstacles to needed changes.

Measurements/main results: Four patient groups were defined by two variables: age (preschool vs school-age children) and frequency of visits in 1 year (two to three vs four or more). Groups were compared on change in mean percent IBWH and on mean change in percent IBWH. All groups showed significant change in percent IBWH (P < or = .040 for school-age children, P < or = .012 for preschool children). For all visits, the mean change was more than twice as great for preschool as for school-age children (4.7 +/- 5.4 vs 1.9 +/- 4.8, P = .027).

Conclusions: (1) The most successful treatment of pre-adolescent obesity may be in preschool children with frequent visits. (2) A randomized trial is warranted to test this possibility. (3) Many of the techniques used to treat early obesity can be adapted for prevention and intervention in early obesity during the preschool years, and this is the preferred approach.