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Conservative treatment for childhood and adolescent obesity: real world follow-up profiling and clinical evolution in 1300 patients

Abstract:

Background: 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. Aims: 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. Patients and methods: 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; n= 252; 19.4%) as well as in “metabolically healthy” patients (n= 505; 38.8%). Results: 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, p< 0.001 in 72.5% of patients). At the end of the follow-up, improvements in glucose and lipid metabolism parameters were observed (both p< 0.05), that were highest in patients with the greatest weight reduction (all p< 0.01), independent of the time spent to achieve weight loss. The pubertal growth spurt negatively correlated with obesity severity (r=− 0.38; p< 0.01) but patients attaining adult height exceeded their predicted adult height (n= 308,+ 1.6±5.4 cm; p< 0.001 …