Conservative Treatment for Childhood and Adolescent Obesity: Real World Follow-Up Profiling and Clinical Evolution in 1300 Patients

<b>Background:</b> Limited therapeutic tools and an overwhelming clinical demand are the major limiting factors in pediatric obesity management. The optimal protocol, environment, body mass index (BMI) change targets and duration of obesity-oriented interventions remain to be elucidated....

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Autores principales:	Gabriel Á. Martos-Moreno, Julián Martínez-Villanueva Fernández, Alicia Frías-Herrero, Álvaro Martín-Rivada, Jesús Argente
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	childhood obesity attrition rate follow-up success rate metabolically healthy Nutrition. Foods and food supply TX341-641
Acceso en línea:	https://doaj.org/article/bccf0ce530fe4db8bdc2370617727183
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spelling	oai:doaj.org-article:bccf0ce530fe4db8bdc23706177271832021-11-25T18:34:36ZConservative Treatment for Childhood and Adolescent Obesity: Real World Follow-Up Profiling and Clinical Evolution in 1300 Patients10.3390/nu131138472072-6643https://doaj.org/article/bccf0ce530fe4db8bdc23706177271832021-10-01T00:00:00Zhttps://www.mdpi.com/2072-6643/13/11/3847https://doaj.org/toc/2072-6643<b>Background:</b> Limited therapeutic tools and an overwhelming clinical demand are the major limiting factors in pediatric obesity management. The optimal protocol, environment, body mass index (BMI) change targets and duration of obesity-oriented interventions remain to be elucidated. <b>Aims:</b> We aimed to characterize the singularities of follow-up, anthropometric and metabolic evolution of a large cohort of pediatric patients with obesity in a specialized university hospital outpatient obesity unit. <b>Patients and methods:</b> Follow-up duration (up to seven years), attrition rate and anthropometric and metabolic evolution of 1300 children and adolescents with obesity were studied. An individualized analysis was conducted in patients attaining a high level of weight loss (over 1.5 BMI-SDS (standard deviation score) and/or 10% of initial weight; <i>n</i> = 252; 19.4%) as well as in “metabolically healthy” patients (<i>n</i> = 505; 38.8%). <b>Results:</b> Attrition rate was high during the early stages (11.2% prior to and 32.5% right after their initial metabolic evaluation). Mean follow-up time was 1.59 ± 1.60 years (7% of patients fulfilled 7 years). The highest BMI reduction occurred in the first year (−1.11 ± 0.89 SDS, <i>p</i> < 0.001 in 72.5% of patients). At the end of the follow-up, improvements in glucose and lipid metabolism parameters were observed (both <i>p</i> < 0.05), that were highest in patients with the greatest weight reduction (all <i>p</i> < 0.01), independent of the time spent to achieve weight loss. The pubertal growth spurt negatively correlated with obesity severity (<i>r</i> = −0.38; <i>p</i> < 0.01) but patients attaining adult height exceeded their predicted adult height (<i>n</i> = 308, +1.6 ± 5.4 cm; <i>p</i> < 0.001). “Metabolically healthy” patients, but with insulin resistance, had higher blood pressure, glucose, uric acid and triglyceride levels than those without insulin resistance (all <i>p</i> < 0.05). Preservation of the “metabolically healthy” status was associated with BMI improvement. <b>Conclusions:</b> Behavioral management of children with obesity can be effective and does not impair growth but is highly conditioned by high attrition. The best results regarding BMI reduction and metabolic improvement are achieved in the first year of intervention and can be preserved if follow-up is retained.Gabriel Á. Martos-MorenoJulián Martínez-Villanueva FernándezAlicia Frías-HerreroÁlvaro Martín-RivadaJesús ArgenteMDPI AGarticlechildhood obesityattrition ratefollow-upsuccess ratemetabolically healthyNutrition. Foods and food supplyTX341-641ENNutrients, Vol 13, Iss 3847, p 3847 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	childhood obesity attrition rate follow-up success rate metabolically healthy Nutrition. Foods and food supply TX341-641
spellingShingle	childhood obesity attrition rate follow-up success rate metabolically healthy Nutrition. Foods and food supply TX341-641 Gabriel Á. Martos-Moreno Julián Martínez-Villanueva Fernández Alicia Frías-Herrero Álvaro Martín-Rivada Jesús Argente Conservative Treatment for Childhood and Adolescent Obesity: Real World Follow-Up Profiling and Clinical Evolution in 1300 Patients
description	<b>Background:</b> Limited therapeutic tools and an overwhelming clinical demand are the major limiting factors in pediatric obesity management. The optimal protocol, environment, body mass index (BMI) change targets and duration of obesity-oriented interventions remain to be elucidated. <b>Aims:</b> We aimed to characterize the singularities of follow-up, anthropometric and metabolic evolution of a large cohort of pediatric patients with obesity in a specialized university hospital outpatient obesity unit. <b>Patients and methods:</b> Follow-up duration (up to seven years), attrition rate and anthropometric and metabolic evolution of 1300 children and adolescents with obesity were studied. An individualized analysis was conducted in patients attaining a high level of weight loss (over 1.5 BMI-SDS (standard deviation score) and/or 10% of initial weight; <i>n</i> = 252; 19.4%) as well as in “metabolically healthy” patients (<i>n</i> = 505; 38.8%). <b>Results:</b> Attrition rate was high during the early stages (11.2% prior to and 32.5% right after their initial metabolic evaluation). Mean follow-up time was 1.59 ± 1.60 years (7% of patients fulfilled 7 years). The highest BMI reduction occurred in the first year (−1.11 ± 0.89 SDS, <i>p</i> < 0.001 in 72.5% of patients). At the end of the follow-up, improvements in glucose and lipid metabolism parameters were observed (both <i>p</i> < 0.05), that were highest in patients with the greatest weight reduction (all <i>p</i> < 0.01), independent of the time spent to achieve weight loss. The pubertal growth spurt negatively correlated with obesity severity (<i>r</i> = −0.38; <i>p</i> < 0.01) but patients attaining adult height exceeded their predicted adult height (<i>n</i> = 308, +1.6 ± 5.4 cm; <i>p</i> < 0.001). “Metabolically healthy” patients, but with insulin resistance, had higher blood pressure, glucose, uric acid and triglyceride levels than those without insulin resistance (all <i>p</i> < 0.05). Preservation of the “metabolically healthy” status was associated with BMI improvement. <b>Conclusions:</b> Behavioral management of children with obesity can be effective and does not impair growth but is highly conditioned by high attrition. The best results regarding BMI reduction and metabolic improvement are achieved in the first year of intervention and can be preserved if follow-up is retained.
format	article
author	Gabriel Á. Martos-Moreno Julián Martínez-Villanueva Fernández Alicia Frías-Herrero Álvaro Martín-Rivada Jesús Argente
author_facet	Gabriel Á. Martos-Moreno Julián Martínez-Villanueva Fernández Alicia Frías-Herrero Álvaro Martín-Rivada Jesús Argente
author_sort	Gabriel Á. Martos-Moreno
title	Conservative Treatment for Childhood and Adolescent Obesity: Real World Follow-Up Profiling and Clinical Evolution in 1300 Patients
title_short	Conservative Treatment for Childhood and Adolescent Obesity: Real World Follow-Up Profiling and Clinical Evolution in 1300 Patients
title_full	Conservative Treatment for Childhood and Adolescent Obesity: Real World Follow-Up Profiling and Clinical Evolution in 1300 Patients
title_fullStr	Conservative Treatment for Childhood and Adolescent Obesity: Real World Follow-Up Profiling and Clinical Evolution in 1300 Patients
title_full_unstemmed	Conservative Treatment for Childhood and Adolescent Obesity: Real World Follow-Up Profiling and Clinical Evolution in 1300 Patients
title_sort	conservative treatment for childhood and adolescent obesity: real world follow-up profiling and clinical evolution in 1300 patients
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/bccf0ce530fe4db8bdc2370617727183
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Conservative Treatment for Childhood and Adolescent Obesity: Real World Follow-Up Profiling and Clinical Evolution in 1300 Patients

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