Response of Severely Obese Children and Adolescents to Behavioral Treatment

Abstract

ObjectivesTo investigate whether the degree of obesity predicts the efficacy of long-term behavioral treatment and to explore any interaction with age.DesignA 3-year longitudinal observational study. Obese children were divided into 3 age groups (6-9, 10-13, and 14-16 years) and also into 2 groups (moderately obese, with a body mass index [BMI]–standard deviation [SD] score [or z score] of 1.6 to <3.5, and severely obese, with a BMI-SD score of ≥3.5).SettingNational Childhood Obesity Center, Stockholm, Sweden.ParticipantsChildren 6 to 16 years of age who started treatment between 1998 and 2006.InterventionBehavioral treatment of obesity.Main Outcome MeasureChange in BMI-SD score during 3 years of treatment; a reduction in BMI-SD score of 0.5 units or more was defined as clinically significant.ResultsA total of 643 children (49% female children) met the inclusion criteria. Among the youngest moderately obese children, 44% had a clinically significant reduction in BMI-SD score (mean reduction, −0.4 [95% CI, −0.55 to −0.32]). Treatment was less effective for the older moderately obese children. Twenty percent of children who were 10 to 13 years of age and 8% of children who were 14 to 16 years of age had a reduction in BMI-SD score of 0.5 units or more; 58% of the severely obese young children showed a clinically significant reduction in BMI-SD score (mean reduction, −0.7 [95% CI, −0.80 to −0.54]). The severely obese adolescents showed no change in mean BMI-SD score after 3 years, and 2% experienced clinically significant weight loss. Age was found to be a predictor of a reduction in BMI-SD score (odds ratio, 0.68 units per year [95% CI, 0.60-0.77 units per year]).ConclusionsBehavioral treatment was successful for severely obese children but had almost no effect on severely obese adolescents.