Current United States Preventative Services Task Force guidelines recommend that children 6-18 years old be screened for obesity and, if needed, referred for more comprehensive therapy; however, recent research evaluating children ages 2-21 found that those aged 2-5 years responded nearly seven times more favorably than older children after completion of six months in the same obesity program.
Investigators led by Sandeep K. Gupta, M.D., professor of clinical pediatrics and clinical medicine at IU School of Medicine, employed a multidisciplinary behavioral intervention program to treat pediatric obesity. The 12-month program enrolled 462 children, ages 2-21, 44 of whom were 2-5 years old and involved an initial three-month clinic-based intensive phase, followed by a nine-month group phase.
“It is important to note that when compared with children ages 6-21, children ages 2-5 began the program similarly obese but responded significantly better to the program intervention and finished the program with the same rate of completion as children ages 6-21,” said Dr. Gupta. He added that it is particularly concerning that younger and older aged children shared the same rate of co-morbidity and this underscores that providers should screen and intervene early.
Patients and family or caregivers had seven clinic visits within the first three-month period and received care from a variety of health professionals including a dietician, physical therapist, child psychologist and pediatrician or nurse practitioner who acted as the overall liaison to the patients and caregivers. During months 4-6, patients met once a month in a group setting and bimonthly during months 7-12.
Patients and caregivers were taught behavior change techniques such as goal setting, accountability, self-monitoring and stimulus control. Strategic reward structures were also used to enable change and model parental techniques. Families were given and educated about a diet and exercise journal as well as a pedometer. Clinicians also assessed progress using exercise testing, food choice surveys and childhood depression scales.
Treatment for this study was provided by a tertiary care center with patients referred by regional primary- or specialty-care clinicians. Intensive behavioral intervention used in childhood obesity means having more than 25 clinician contact hours in 6 months, and is recommended only after a patient has tried and failed treatment options delivered over 6 months through primary care. Regarding its focus, this obesity program performs observational research from a “real-world” clinic with no research criteria to limit non-compliance or bolster outcomes.
Carl A. Sather, M.D., M.S., a clinical fellow at Indiana University School of Medicine and co-investigator cautioned, “Though our numbers are relatively small, our completion rate is consistent with other centers and we feel our data is convincing and appropriate to recommend that all children ages 2-18 be screened for obesity. However, not all pediatric centers should deliver intensive behavioral change therapy.”
He added that current research suggests that referral centers with resources to provide this kind of multidisciplinary approach to treatment achieve more success but only after patients have attempted and failed less intensive therapy. “With increased childhood obesity patient volume and complications, intervention outcome and rate of completion needs to improve.”
Drs. Sather and Gupta hope their encouraging data will prompt further research to examine the positive impacts of BMI screenings at younger ages and that the increased data will contribute to stronger conclusions and healthier pediatric populations.