Health Outcomes of Youth in Clinical Pediatric Weight Management Programs in POWER - 24/04/19

Doi : 10.1016/j.jpeds.2018.12.049

Seema Kumar, MD ¹, Eileen C. King, PhD ^2,³, Amy L. Christison, MD ⁴, Aaron S. Kelly, PhD ⁵, Adolfo J. Ariza, MD ^6,⁷, Claudia Borzutzky, MD ^8,⁹, Suzanne Cuda, MD ¹⁰, Shelley Kirk, PhD, RD, LD ^3,^11,^⁎
on behalf of the
POWER Work Group^{^∗}
List of additional members of the POWER Work Group is available at www.jpeds.com (Appendix).
I. Abraham-Pratt, L. Ali, S. Armstrong, H. Binns, J. Brubaker, A. Cristison, C. Fox, C. Gordon, S. Hendrix, D. Hes, L. Jenkins, M. Joseph, M. Heyrman, L. Liu, A. McClure, M. Hofley, S. Negrete, M. Novick, V. O'Hara, J. Rodrue, M. Santos, J. Stoll, W. Stratbucker, B. Sweeney, J. Tester, S. Walka, H. deHeer, S. Wallace, S. Walsh, C. Wittcopp, A. Weedn, J. Yee, B. Grace

¹ Division of Pediatric Endocrinology and Metabolism, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
² Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
³ Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH
⁴ Department of Pediatrics, University of Illinois College of Medicine at Peoria, Peoria, IL
⁵ Department of Pediatrics, Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, MN
⁶ Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
⁷ Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL
⁸ Department of Pediatrics, Keck School of Medicine of USC, Los Angeles, CA
⁹ Diabetes and Obesity Program, Children's Hospital Los Angeles, Los Angeles, CA
¹⁰ Department of Pediatrics, Pediatric Weight Management, Children's Hospital of San Antonio, Baylor College of Medicine, Houston, TX
¹¹ The Heart Institute, Center for Better Health and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH

^∗Reprint requests: Shelley Kirk, PhD, RD, LD, Associate Professor, University of Cincinnati College of Medicine, Department of Pediatrics, Director, HealthWorks!, Cincinnati Children's Hospital Medical Center, The Heart Institute – Center for Better Health and Nutrition, 3333 Burnet Avenue, MLC 5016, Cincinnati, OH 45229-3039.Associate ProfessorUniversity of Cincinnati College of MedicineDepartment of PediatricsDirector, HealthWorks!Cincinnati Children's Hospital Medical CenterThe Heart Institute – Center for Better Health and Nutrition3333 Burnet AvenueMLC 5016CincinnatiOH45229-3039

Abstract

Objective

To describe treatment outcomes of children and adolescents enrolled in the Pediatric Obesity Weight Evaluation Registry, a consortium of multicomponent pediatric weight management programs in the US.

Study design

This multicenter prospective observational cohort study, established in 2013, includes youth (2-18 years of age) with obesity enrolled from 31 Pediatric Obesity Weight Evaluation Registry (POWER) sites over a 2-year period and followed up to 12 months. Weight status was evaluated by the percentage of the 95th percentile for body mass index (%BMIp95). Associations of weight status outcomes with patient characteristics and program exposure were analyzed with multivariable mixed effects modeling.

Results

We included 6454 children and adolescents (median age, 11 years; IQR, 9-14 years; 53% white, 32% Hispanic; 73% with severe obesity) who were enrolled in POWER. Median changes in %BMIp95 for this cohort were −1.88 (IQR, −5.8 to 1.4), −2.50 (IQR, −7.4 to 1.8), −2.86 (IQR, −8.7 to 1.9), at 4-6, 7-9, and 10-12 of months follow-up, respectively (all P < .05). Older age (≥12 years), greater severity of obesity, and Hispanic race/ethnicity were associated with better improvement in %BMIp95. A 5-percentage point decrease in %BMIp95 was associated with improvement in cardiometabolic risk factors.

Conclusions

Overall, treatment in pediatric weight management programs is associated with a modest median decrease in BMI as measured by change in %BMIp95. Further studies are needed to confirm these findings, as well as to identify additional strategies to enhance the effectiveness of these multicomponent interventions for youth with severe obesity.

Trial registration

ClinicalTrials.gov: NCT02121132.

Le texte complet de cet article est disponible en PDF.

Abbreviations : ALT, BMI, %BMIp95, ΔBMIp95, BMIz, DSCF, HbA1c, HDL-C, POWER, PWM, TG

Plan

	Funded by site enrollment fees for their participation in the Pediatric Obesity Weight Evaluation Registry. A.K. receives research support (drug/placebo) from AstraZeneca Pharmaceuticals and serves as a consultant for Novo Nordisk, Orexigen, and Vivus Pharmaceuticals, but does not accept personal or professional income for these activities. The other authors declare no conflicts of interest.
	The other authors declare no conflicts of interest.
	Portions of this study were presented at the Pediatric Academic Societies annual meeting, May 6-9, 2017, San Francisco, California.

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Health Outcomes of Youth in Clinical Pediatric Weight Management Programs in POWER - 24/04/19

Abstract

Objective

Study design

Results

Conclusions

Trial registration

Plan

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