Energy Management for Personalized Weight Reduction (EMPOWER) Program: Three-Year Outcome Data

Overview

Journal Adv Clin Endocrinol Metab

Date 2020 Jul 24

PMID 32699839

Authors

A P Vidmar

C Fink

B Torres

B Manzanarez

S D Mittelman

C P Wee

C Borzutzky

Affiliations

Soon will be listed here.

Abstract

Background: The current consensus guidelines for management of pediatric obesity recommend clinic-based, family-centered, multi-disciplinary interventions. It is well reported that these programs often only lead to modest improvements in BMI status. The individual factors that differentiate which patient's BMI status will improve vs. worsen remains understudied. A retrospective cohort study was conducted to evaluate the outcomes of EMPOWER clinic and identify the participant specific characteristics that predicted BMI status improvement in this population.

Methods: Youth who completed at least 6 visits in EMPOWER were included. Paired t-test was utilized to evaluate the mean change in zBMI, modified BMIz and %BMI from baseline to 6 visit, and multivariate mixed effect models were utilized to analyze effect of baseline characteristics on change in BMI status.

Results: 92 participants were included in the analysis, 87% with severe obesity and 66% Hispanic. At the 6 visit, there was a significant reduction in zBMI (-0.09 SD, p <0.001) and modified BMIz (-0.0003 SD, p = 0.04) with a small reduction in %BMI (-1.15 %, p = 0.20). Lower BMI status (p < 0.001) and absence of a comorbidity (p < 0.05) at baseline were predictors of BMI status improvement whereas age, gender, ethnicity, family history of obesity and insurance status were not significant predictors.

Conclusions: Given that implementation of the current guidelines for management of obesity in pediatrics only results in modest BMI status reduction, further investigation is required to understand how the determinants of obesity-related health outcomes can guide development of more innovative, effective interventions for this high risk population.

References

Thang C, Whitley M, Izadpanah N, DeUgarte D, Slusser W . Retrospective Review of Comorbid Conditions in a Multidisciplinary Pediatric Weight Management Clinic. Clin Pediatr (Phila). 2017; 57(7):815-820. DOI: 10.1177/0009922817734205. View

Reinehr T, Hoffmeister U, Mann R, Goldapp C, Westenhofer J, Egmond-Froehlich A . Medical care of overweight children under real-life conditions: the German BZgA observation study. Int J Obes (Lond). 2009; 33(4):418-23. DOI: 10.1038/ijo.2009.50. View

Zolotarjova J, Ten Velde G, Vreugdenhil A . Effects of multidisciplinary interventions on weight loss and health outcomes in children and adolescents with morbid obesity. Obes Rev. 2018; 19(7):931-946. DOI: 10.1111/obr.12680. View

Hales C, Fryar C, Carroll M, Freedman D, Ogden C . Trends in Obesity and Severe Obesity Prevalence in US Youth and Adults by Sex and Age, 2007-2008 to 2015-2016. JAMA. 2018; 319(16):1723-1725. PMC: 5876828. DOI: 10.1001/jama.2018.3060. View

Coles N, Birken C, Hamilton J . Emerging treatments for severe obesity in children and adolescents. BMJ. 2016; 354:i4116. DOI: 10.1136/bmj.i4116. View

Irby M, Boles K, Jordan C, Skelton J . TeleFIT: adapting a multidisciplinary, tertiary-care pediatric obesity clinic to rural populations. Telemed J E Health. 2012; 18(3):247-9. PMC: 3317399. DOI: 10.1089/tmj.2011.0117. View

Taveras E, Marshall R, Sharifi M, Avalon E, Fiechtner L, Horan C . Comparative Effectiveness of Clinical-Community Childhood Obesity Interventions: A Randomized Clinical Trial. JAMA Pediatr. 2017; 171(8):e171325. PMC: 6075674. DOI: 10.1001/jamapediatrics.2017.1325. View

Mameli C, Krakauer J, Krakauer N, Bosetti A, Ferrari C, Schneider L . Effects of a multidisciplinary weight loss intervention in overweight and obese children and adolescents: 11 years of experience. PLoS One. 2017; 12(7):e0181095. PMC: 5509286. DOI: 10.1371/journal.pone.0181095. View

Ogden C, Carroll M, Lawman H, Fryar C, Kruszon-Moran D, Kit B . Trends in Obesity Prevalence Among Children and Adolescents in the United States, 1988-1994 Through 2013-2014. JAMA. 2016; 315(21):2292-9. PMC: 6361521. DOI: 10.1001/jama.2016.6361. View

10.

Hunsaker S, Garland B, Rofey D, Reiter-Purtill J, Mitchell J, Courcoulas A . A Multisite 2-Year Follow Up of Psychopathology Prevalence, Predictors, and Correlates Among Adolescents Who Did or Did Not Undergo Weight Loss Surgery. J Adolesc Health. 2018; 63(2):142-150. PMC: 6113090. DOI: 10.1016/j.jadohealth.2017.12.021. View

11.

Sabin M, Ford A, Hunt L, Jamal R, Crowne E, Shield J . Which factors are associated with a successful outcome in a weight management programme for obese children?. J Eval Clin Pract. 2007; 13(3):364-8. DOI: 10.1111/j.1365-2753.2006.00706.x. View

12.

Janicke D, Steele R, Gayes L, Lim C, Clifford L, Schneider E . Systematic review and meta-analysis of comprehensive behavioral family lifestyle interventions addressing pediatric obesity. J Pediatr Psychol. 2014; 39(8):809-25. DOI: 10.1093/jpepsy/jsu023. View

13.

Walpole B, Dettmer E, Morrongiello B, McCrindle B, Hamilton J . Motivational interviewing as an intervention to increase adolescent self-efficacy and promote weight loss: methodology and design. BMC Public Health. 2011; 11:459. PMC: 3144459. DOI: 10.1186/1471-2458-11-459. View

14.

August G, Caprio S, Fennoy I, Freemark M, Kaufman F, Lustig R . Prevention and treatment of pediatric obesity: an endocrine society clinical practice guideline based on expert opinion. J Clin Endocrinol Metab. 2008; 93(12):4576-99. PMC: 6048599. DOI: 10.1210/jc.2007-2458. View

15.

Holm J, Gamborg M, Bille D, Gr Nb K H, Ward L, Faerk J . Chronic care treatment of obese children and adolescents. Int J Pediatr Obes. 2011; 6(3-4):188-96. DOI: 10.3109/17477166.2011.575157. View

16.

Skinner A, Ravanbakht S, Skelton J, Perrin E, Armstrong S . Prevalence of Obesity and Severe Obesity in US Children, 1999-2016. Pediatrics. 2018; 141(3). PMC: 6109602. DOI: 10.1542/peds.2017-3459. View

17.

Flegal K, Wei R, Ogden C, Freedman D, Johnson C, Curtin L . Characterizing extreme values of body mass index-for-age by using the 2000 Centers for Disease Control and Prevention growth charts. Am J Clin Nutr. 2009; 90(5):1314-20. DOI: 10.3945/ajcn.2009.28335. View

18.

Nowicka P, Hoglund P, Pietrobelli A, Lissau I, Flodmark C . Family Weight School treatment: 1-year results in obese adolescents. Int J Pediatr Obes. 2008; 3(3):141-7. DOI: 10.1080/17477160802102475. View

19.

Freedman D, Butte N, Taveras E, Goodman A, Ogden C, Blanck H . The Limitations of Transforming Very High Body Mass Indexes into z-Scores among 8.7 Million 2- to 4-Year-Old Children. J Pediatr. 2017; 188:50-56.e1. PMC: 5572545. DOI: 10.1016/j.jpeds.2017.03.039. View

20.

Kirk S, Armstrong S, King E, Trapp C, Grow M, Tucker J . Establishment of the Pediatric Obesity Weight Evaluation Registry: A National Research Collaborative for Identifying the Optimal Assessment and Treatment of Pediatric Obesity. Child Obes. 2016; 13(1):9-17. DOI: 10.1089/chi.2016.0060. View