1.10. More efficient programs needed for childhood obesity treatment

Public examination of a doctoral dissertation in the field of clinical nutrition

Doctoral candidate: MSc (Agr. & For.) Marja Kalavainen

Time and venue: 1.10. 2011 at 12 noon, Kuopio University Hospital, Auditorium 2

Obesity has a severe impact on children's psychosocial and physical health. The aim of this randomised controlled study was to compare the efficacy of a behavioural family-based group program consisting of 15 sessions for parents and children with routine counselling ("current care") consisting of two appointments for children in the treatment of childhood obesity.

Seventy 7-9-year old obese children (weight for height 115% to 182%) were randomised to routine (n=35) or group (n=35) program. Children's weights and heights were measured at baseline, after the 6-month intervention, and at 2- and 3-year follow-ups. In addition, children's body composition and metabolic indicators were assessed pre- and post-intervention, and the mean costs of the programs were calculated from the perspective of the service provider. The changes of weight for height and BMI standard deviation scores (BMI-SDS) were used as main outcome measures.

After the intervention, there were significant differences between the treatment programs in favour of the group program in the changes of children's weight for height (on average, a 6.8% reduction vs. a 1.8% reduction, p=0.001) and BMI-SDS  (0.3 vs. 0.2, p=0.022). In addition, the decrease in waist/height was greater in the group program (mean 0.02, 95% CI 0.03 to 0.01) than in the routine program (0.01, 95% CI 0.02 to 0.00), respectively, but there were no significant differences between the treatment arms in the changes of other metabolic indicators. The costs per treated child were 392€ and 74€ in the group treatment and in routine counselling, respectively. Both group and routine programs were feasible with very low, 3% or less, attrition rate from the programs. In the long term, from baseline to 2 years or to 3 years, there were no significant differences in the changes of the adiposity indicators between the children in the two treatment arms. In both programs, children's BMI-SDS decreased moderately from baseline to three years (in group program on average a 0.3 reduction, 95% Cl from -0.5 to -0.2 and in routine counselling on average a 0.3 reduction, 95% Cl from -0.5 to -0.1). However, weight for height was rather similar to baseline at those points in time (in group program on average a 1.4% reduction, from -5.0 to 2.2 and in routine counselling on average a 0.8% increase, from -4.6 to 6.1).

In conclusion, the more intensive group program is more effective than routine program in reducing children's adiposity and abdominal adiposity, when assessed shortly after intervention. However, in the long term, there is no difference in efficacy between the programs and the routine counselling is cheaper. New approaches are needed to improve long-term efficacy of childhood obesity treatment.

The doctoral dissertation of Master of Science (Agr. & For.) Marja Kalavainen, entitled Treatment of Obesity in Children, a Study on the Efficacy of a Family-based Group Program Compared with Routine Counselling will be examined at the Faculty of Health Sciences. The opponent in the public examination will be Professor Pertti Mustajoki and the custos will be Professor (Emer.) Helena Gylling.

Photo available for download at http://www.uef.fi/vaitoskuvat

Publishing year: 2011

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