Tailoring childhood obesity treatment to individual needs may promote better outcomes
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Key takeaways:
- Older age and higher number of comorbidities may predict response to obesity treatment.
- More research is needed to understand the impact of environmental factors among youth receiving obesity treatment.
DALLAS — Tailoring childhood obesity treatment to patients’ specific needs may promote adherence and improve outcomes, according to research presented at ObesityWeek.
“Outcomes are characterized by a high degree of heterogeneity in individual response to treatment,” Cody D. Neshteruk, PhD, with the Center for Childhood Obesity Research at Duke University School of Medicine, said in a presentation. “We aimed to identify predictors of change in weight status among youth receiving obesity treatment.”
Researchers collected electronic health record data from a diverse cohort of 3,930 youths who attended a weight management clinic from 2013 to 2023.
Patients, aged 2 years to 18 years at enrollment, were included in the study if they had at least one follow-up visit over 24 months. Neshteruk and colleagues analyzed predictors of change in weight status among youths receiving obesity treatment, including baseline age, sex, race and ethnicity, insurance status, number of comorbidities and socioeconomic factors such as neighborhood environment, which was calculated by linking patient addresses to the Child Opportunity Index. Obesity treatment included motivational interviewing, intensive health behavior and lifestyle therapies, anti-obesity medications, and metabolic and bariatric surgery.
The researchers then calculated BMI relative to the 95th percentile using height, weight, sex and age at the time of the visit. The goal was to examine the relationship between predictors and change in BMI relative to the 95th percentile from baseline, after controlling for medication, baseline BMI and time.
The patients’ mean age was 10.9 years, 54% were female, 36% were Hispanic and 34% were Black.
According to the findings, “we saw that age at first visit was a significant predictor of change in BMI as it relates to the 95th percentile,” Neshteruk said.
Older age at baseline and greater number of comorbidities were negatively associated with change in BMI relative to the 95th percentile at 6 and 12 months. According to the researchers, this indicated a slower increase or greater reduction in BMI relative to the 95th percentile.
“We also considered retention,” Neshteruk said. “Of the kids retained at 12 months, a higher age at baseline was significantly associated with decline in BMI.” This finding remained consistent throughout 24 months, according to the findings.
Black patients tended to demonstrate positive changes in BMI relative to the 95th percentile compared with white patients, which the researchers said indicates additional gain or less reduction in BMI relative to the 95th percentile.
In other findings, Child Opportunity Index z-scores were negatively associated with change in BMI relative to the 95th percentile, which may signal that an increase in child opportunity correlated with a decrease in BMI relative to the 95th percentile, according to the results.
No individual neighborhood predictors such as walkability, availability of green space or access to healthy foods were significantly associated with change in BMI relative to the 95th percentile.
Overall, “older age and a greater number of comorbidities at baseline predicted negative change in BMI,” Neshteruk said. “We tend to see literature that younger kids do better [with obesity treatments], but we have to remember these are the results of retainment. If we can get these kids in treatment and keep them, they can have better outcomes.”
Neshteruk said the current work is a launching point. “We need to understand the heterogeneous biological behavioral and upstream factors to really get on there and figure out how best to help these families.”
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Neshteruk C, et al. Oral-033. Presented at: ObesityWeek; Oct. 14-17, 2023; Dallas.
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