Abstract
Objective
To assess the relative effectiveness of an interdisciplinary, family-centered, tertiary-care
pediatric weight management program for the treatment of patients with and without
cognitive disabilities (CD).
Methods
Retrospective analysis of the clinical database of a tertiary-care pediatric weight
management clinic (n = 453), extracting data from electronic health records including
longitudinal change in weight status (body mass index [BMI] z-score) and frequency of attrition from treatment. Upon review of medical records,
children enrolled in the treatment program were classified as having no CD (n = 342)
or CD (n = 111).
Results
At baseline, there were no between-group differences in BMI or BMI z-score. After 4 months of treatment, 66% (299) of patients remained enrolled, and
complete case data were available for 219 children in final analyses. There were no
statistically significant differences in attrition between the 2 groups (no CD vs
CD). Mean change in BMI z-score across all groups was −0.03 ± 0.13 (P < .001). Change in BMI z-score was significantly greater among patients with CD (−0.07 ± 0.15) compared to
those without CD (−0.03 ± 0.12) (difference 0.04, 95% confidence interval 0.005–0.08,
P = .029). These change estimates were observed after adjusting for processes potentially
associated with attrition.
Conclusions
Children with CD treated in an interdisciplinary, family-centered obesity clinic had
similar or better outcomes compared to peers without CD. This success may be attributable
to the patient-centered nature of this behavioral weight management program, which
focused on leveraging the unique strengths and capabilities of each individual patient
and family.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Academic PediatricsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Prevalence of obesity and trends in body mass index among US children and adolescents, 1999–2010.JAMA. 2012; 307: 483-490
- Prevalence of overweight in children with developmental disorders in the continuous National Health and Nutrition Examination Survey (NHANES), 1999–2002.J Pediatr. 2005; 146: 738-743
- The prevalence of obesity in children with autism: a secondary data analysis using nationally representative data from the National Survey of Children's Health.BMC Pediatr. 2010; 10: 11
- Obesity and overweight prevalence among adolescents with disabilities.Prev Chronic Dis. 2011; 8: A41
- The 2005 Surgeon General's Call to Action to Improve the Health and Wellness of Persons With Disabilities.US Department of Health and Human Services, Rockville, Md2005
- Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report.Pediatrics. 2007; 120: S164-S192
- Twenty-eighth Annual Report to Congress on the Implementation of the Individuals With Disabilities Education Act.US Dept of Education, Washington, DC2006
- Learning disorders.in: Diagnostic and Statistical Manual—Text Revision (DSM-IV-TR, 2000). 4th ed. American Psychiatric Association, Washington, DC2000 (49)
- Intellectual Disability: Definition, Classification, and Systems of Supports.11th ed. American Association on Intellectual and Developmental Disabilities, Washington, DC2010
- Obesity and obesity-related secondary conditions in adolescents with intellectual/developmental disabilities.J Intellect Disabil Res. 2010; 54: 787-794
- Food selectivity in children with autism spectrum disorders and typically developing children.J Pediatr. 2010; 157: 259-264
- What Do Families Say About Health Care for Children With Special Health Care Needs? Your Voice Counts!.Family Voices at the Federation for Children With Special Health Care Needs, Boston, Mass2000
Centers for Disease Control and Prevention; National Center for Health Statistics. CDC growth charts: United States. Available at: http://www.cdc.gov/growthcharts/. Accessed August 15, 2014.
- Predictors of attrition from a pediatric weight management program.J Pediatr. 2004; 144: 466-470
- Motivational interviewing in a family-based pediatric obesity program: a case study.Fam Syst Health. 2010; 28: 236-246
- Appointment attendance in a pediatric weight management clinic.Clin Pediatr. 2012; 51: 888-891
- Review of inverse probability weighting for dealing with missing data.Stat Methods Med Res. 2013; 22: 278-295
- Interventions for treating obesity in children.Cochrane Database Syst Rev. 2009; : CD001872
- 2-Year BMI changes of children referred for multidisciplinary weight management.Int J Pediatr. 2014; 2014: 152586
- A clinical model of obesity treatment is more effective in preschoolers and Spanish speaking families.Obesity (Silver Spring). 2013; 21: 1004-1012
- The relationship of health outcomes to improvement in BMI in children and adolescents.Obes Res. 2005; 13: 876-882
- Intervention in overweight children improves body mass index (BMI) and physical activity.J Am Board Fam Med. 2013; 26: 126-137
- Effectiveness of weight management interventions in children: a targeted systematic review for the USPSTF.Pediatrics. 2010; 125: 396-418
- Risk factors for poor attendance in a family-based pediatric obesity intervention program for young children.J Dev Behav Pediatr. 2010; 31: 705-712
- Attrition in pediatric weight management: a review of the literature and new directions.Obes Rev. 2011; 12: e273-e281
- Behavioral health in developmental disabilities: a comprehensive program of nutrition, exercise, and weight reduction.Int J Behav Consult Ther. 2008; 4: 287-296
Article info
Publication history
Accepted:
November 18,
2014
Received:
June 26,
2014
Footnotes
The authors declare that they have no conflict of interest.
Identification
Copyright
© 2015 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
