Target Obesity Early to Succeed in Kids

Overweight children are more successful in losing weight and maintaining the loss when anti-obesity interventions begin early - as young as age 3, two European studies suggested.

In one study, 44% of those ages 6 to 9 years who were moderately obese at baseline experienced a clinically meaningful 0.5-unit decrease in body mass index (BMI) z-score with behavioral treatment, compared with only 8% of those ages 14 to 16, according to Pernilla Danielsson, RN, PhD, of the Karolinska Institute in Stockholm, and colleagues.

And in a randomized trial comparing a multidisciplinary intervention and usual care for children ages 3 to 5 years, the intervention led to multiple significant benefits in body weight and composition, including a mean decrease in BMI z-score of -0.5 units, and the changes persisted for a year, reported Gianni Bocca, MD, and colleagues from the University of Groningen in the Netherlands.

Both studies were published online in the Archives of Pediatrics and Adolescent Medicine, accompanied by an editorial by Jennifer A. Woo Baidal, MD, and Elsie M. Taveras, MD, of Harvard Medical School in Boston.

"More and more evidence points to early childhood as a pivotal time for preventing in young children an obesity trajectory that is hard to alter by the time they enter middle school," observed Baidal and Taveras.

The Swedish study enrolled 643 obese children ages 6 to 16, following them for 3 years. Moderate obesity was defined as a BMI z-score of 1.6 to 3.5, and severe obesity was a score above 3.5.

A total of 54 of the moderately obese children were ages 6 to 9, 194 were 10 to 13, and 124 were 14 to 16.

Among those who were severely obese, 91 were in the youngest group, 98 in the middle group, and 82 were in the older group.

Among the severely obese children in the youngest group, 58% had a reduction of at least 0.5 units in BMI z-scores at 3 years, while the severely obese adolescents had no change whatsoever at year 1, 2, or 3.

Further analyses revealed that severely obese boys in the middle age group had a BMI z-score decrease of −0.5 (95% CI −0.64 to −0.36) compared with a change of only −0.1 (95% CI −0.35 to 0.11, P<0.001) for girls.

Maternal obesity also influenced the outcome. For children who were severely obese but whose mothers' weight was normal, the decrease in z score was −0.6 (95% CI −0.79 to −0.37), while the change was −0.3 (95% CI −0.46 to −0.24, P=0.04) for those whose mothers also were obese.

Finally, the researchers determined that for each year earlier the treatment was begun there was a 47% greater likelihood of achieving a change of −0.5 units at year 3.

"The results show that the degree of obesity was an important predictor of treatment outcome and that treatment outcome varied by age," stated Danielsson and colleagues.