A long-term follow-up of treatment for young children with obesity: a randomized controlled trial

Anna Ek; Markus Brissman; Karin Nordin; Karin Eli; Paulina Nowicka

doi:10.1038/s41366-023-01373-7

A long-term follow-up of treatment for young children with obesity: a randomized controlled trial

Int J Obes (Lond). 2023 Nov;47(11):1152-1160. doi: 10.1038/s41366-023-01373-7. Epub 2023 Oct 25.

Authors

Anna Ek^#¹, Markus Brissman^#^{2

3}, Karin Nordin², Karin Eli^{4

5}, Paulina Nowicka^{2

6}

Affiliations

¹ Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Pediatrics, Karolinska Institutet, Stockholm, Sweden. anna.ek@ki.se.
² Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Pediatrics, Karolinska Institutet, Stockholm, Sweden.
³ Allied Health Professionals Function, Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden.
⁴ Unit for Biocultural Variation and Obesity, School of Anthropology and Museum Ethnography, University of Oxford, Oxford, UK.
⁵ Warwick Medical School, University of Warwick, Coventry, UK.
⁶ Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden.

^# Contributed equally.

Abstract

Background: Early childhood obesity interventions supporting parents have the largest effects on child weight status. However, long-term follow-ups are lacking.

Objective: To examine weight status 48 months after obesity treatment initiation for 4- to 6-year-olds.

Methods: 177 families were recruited to the More and Less study, a 12-month randomized controlled trial (RCT) conducted in Sweden (2012-2017); 6 children were excluded due to medical diagnoses. Thus, 171 families (non-Swedish origin 59%, university degree 40%) were eligible for this 48-month follow-up with modified intention-to-treat (n = 114 had 48-month data, n = 34 dropped out, n = 23 lost to follow-up). The RCT compared 3 treatment approaches: a 10-week parent support program (1.5 h/w) with follow-up booster sessions (PGB) or without (PGNB), and standard outpatient treatment (ST). Treatment effects on primary outcome (BMI-SDS) and secondary outcomes (BMI, %IOTF25 i.e., the distance, in percent, above the cut-off for overweight) were assessed. Clinically significant reduction of BMI-SDS (≥0.5) was assessed with risk ratio. Sociodemographic factors and attendance were examined by three-way interactions.

Results: After 48 months (mean 50 months, range 38-67 months) mean (95% CI) BMI-SDS was reduced in all groups: PGB -0.45 (-0.18 to -0.73, p < 0.001), PGNB -0.34 (-0.13 to -0.55, p < 0.001), ST -0.25 (-0.10 to -0.40, p < 0.001), no significant difference between groups. A clinically significant reduction of BMI-SDS ≥ 0.5 was obtained in 53.7% of PGB which was twice as likely compared to ST, 33.0%, RR 2.03 (1.27 to 3.27, p = 0.003), with no difference to PGNB, 46.6% (p = 0.113). %IOTF25 was unchanged from baseline for PGB 4.50 (-1.64 to 10.63), and significantly lower compared to ST 11.92 (8.40 to 15.44) (p = 0.043). Sociodemographics or attendance had no effect.

Conclusion: The intensive parent-support early childhood obesity intervention led to better weight status outcomes over time, though BMI-SDS alone did not reflect this. Further research should investigate how to assess weight changes in growing children.

Clinical trial registration: Clinicaltrials.gov, NCT01792531 .

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Body Mass Index
Child
Child, Preschool
Follow-Up Studies
Humans
Overweight / therapy
Parents
Pediatric Obesity* / therapy
Sweden / epidemiology

Associated data

ClinicalTrials.gov/NCT01792531