INTRODUCTION: A proportion of obese children who are treated with a multidisciplinary approach with behavior modification and parental involvement show no response to the consolidation phase of treatment.
OBJECTIVE: Our goal was to identify possible risk factors that led to failure of obesity management in children who were attending an equipped, busy, specialized outpatient clinic.
METHODS: We performed a case-control study in which cases were those whose conditions failed to respond to current multidisciplinary management as judged by no decrease in BMI z score. Controls were those who responded to treatment (lower subsequent BMI z scores).
RESULTS: Of the 519 children, 416 (80.2%) had BMI z scores of >3. Management was successful in 85% of the patients. In bivariate analysis, risk factors were age of <4 years (odds ratio [OR]: 4.00 [95% confidence interval (CI): 1.08–14.70]), previous obesity management (OR: 2.18 [95% CI: 1.10–4.32]), triglyceridemia (OR: 2.01 [95% CI: 1.10–3.65]), and higher abdominal fat content as measured directly by dual-energy radiograph absorptiometry (OR: 1.09 [95% CI: 1.00–1.19]) or relative to thigh (waist/hip index) (OR: 2.67 [95% CI: 1.13–6.72]). Duration of obesity, the initial BMI z score, and gender were not predictive of treatment failure. In multivariate analysis, central obesity was the single-most important factor. In more hierarchical conceptual framework, factors retained were maternal obesity (OR: 2.44 [95% CI: 1.22–4.86]), previous management of obesity (OR: 2.21 [95% CI: 1.11–4.37]), and waist/hip index (OR: 3.35 [95% CI: 1.18–9.49]).
CONCLUSIONS: We propose a model in which centrally obese children with obese mothers who have high triglyceride levels are more likely to show resistance to reversal of the pathologic process of excess fat accumulation. Central obesity is a well known correlate of increased morbidity.
Submitted by Adel El Tajuri
- Copyright © 2008 by the American Academy of Pediatrics