Effectiveness of behavioral therapy in obese children in outpatient clinic

Objective
The aim of the study was to evaluate the effectiveness of behavioral therapy in childhood obesity in metabolic outpatient clinic.

Material and methods
Records of the 587 (289 boys) obese children in the age of 10.73 ± 3.57 were retrospectively analyzed (2005-2016). The therapy included lifestyle modification (increased physical activity, and support from the dietician and psychologist). Anthropometrical assessment was based on BMI z-score index.

Results
Initial BMI z-score was higher in boys (3.29 SD vs. 2.66 SD, p < 0.00001). At follow-up visit for an average of 3 months, with a 66.8% of the children reported, an improvement was observed in 70% of them, and greater weight loss was found in boys (∆BMI Z-score: 0.28 SD vs. –0.15 SD). Improvement of the nutritional status (∆BMI Z-score) correlated with the age of children and the initial weight (vs. age: r = 0.233, p < 0.01; vs. BMI Z-score: r = –0.610, p < 0.00001). Further follow-up showed a reduction in the number of children continuing the treatment (at the 3rd visit: 28.3%; at the 4th visit: 19.1%; at the 5th visit or more: 12.7%). In children, who remained under control of the outpatient clinic, a reduction in BMI z-score (p < 0.00001) was observed from the 3rd visit.

Conclusions
Behavioral therapy on the outpatient clinic level is effective, but its effectiveness is pointedly reduced by the high number of children and their parents who avoid the treatment or refuse to continue this model of therapy. The essential challenge is to keep the motivation of both parents and children.