European Journal of Pediatrics

, Volume 177, Issue 6, pp 1–12 | Cite as

Building a response criterion for pediatric multidisciplinary obesity intervention success based on combined benefits

  • Nelson Nardo Junior
  • Josiane Aparecida Alves BianchiniEmail author
  • Danilo Fernandes da Silva
  • Zachary M. Ferraro
  • Carlos Andres Lopera
  • Vanessa Drieli Seron Antonini
Original Article


To propose a response criterion for analyzing the intervention success by verifying patient outcomes after a multidisciplinary obesity treatment program in Brazilian children and adolescents. Obese children and adolescents (n = 103) completed a 16-week multidisciplinary intervention (IG) and were compared to the control group (CG) (n = 66). A cluster of parameters (e.g. total domain of HRQoL; BMI z-score; cardiorespiratory fitness; body mass; waist circumference; fat mass; lean mass) were measured pre and post-intervention, and the sum of the median percentage variation and the percentile 25 and 75 were used from IG and CG to determine the responsiveness to the program. We are proposing four ranges in which children and adolescents may be classified after the intervention: (1) CG percentile 50 values or lower are considered non-responsive to the intervention, (2) values greater than CG percentile 50 but lower than IG percentile 50 are considered slightly responsive, (3) values greater than IG percentile 50 but lower than IG percentile 75 were considered as moderately responsive, and (4) values greater than IG percentile 75 were considered very responsive.

Conclusions: This criterion may serve as a complementary tool that can be employed to monitor the response to this model of multidisciplinary intervention.

What is Known:

• The effectiveness of multidisciplinary obesity interventions is usually determined by comparing changes in selected outcomes in the intervention versus versus control group.

• There is no consensus about what should be assessed before and after the intervention program, which makes difficult to compare different programs and to determine their rate of responsiveness.

What is New:

• This study proposes a response criteria to pediatric obesity interventions following a similar model compared to ours based on key variables that presents low cost and high applicability in different settings.


Pediatric obesity Intervention studies Treatment outcome Eating habits Exercise Lifestyle 



Body mass index


Control group


Intervention group


Health-related quality of life


Moderately responsive to the intervention


Non-responsive to the intervention




Pediatric Quality of Life Inventory™


Multidisciplinary obesity treatment program


Slightly responsive to the intervention


Very responsive to the intervention



The authors thank the members of the Multiprofessional Nucleus of Obesity Treatment program for their contribution to data collection and intervention development; they also thank the Araucaria Foundation (Agreement 179/10, protocol 19213) and Capes (501100002322) for financial support.

Authors’ contributions

Nelson Nardo Junior: Dr. Nardo Junior conceptualized and designed the study, contributed to data collection, carried out the initial analyses, drafted the initial manuscript, critically reviewed the manuscript, and approved the final manuscript as submitted.

Josiane A. A. Bianchini: Mrs. Bianchini conceptualized and designed the study, contributed to data collection, carried out the initial analyses, drafted the initial manuscript, critically reviewed the manuscript, and approved the final manuscript as submitted.

Danilo F. da Silva: Mr. da Silva conceptualized and designed the study, contributed to data collection, carried out the initial analyses, drafted the initial manuscript, critically reviewed the manuscript, and approved the final manuscript as submitted.

Zachary M. Ferraro analyzed and interpreted data, critically reviewed the manuscript, and approved the final manuscript as submitted.

Carlos A. Lopera: Mr. Lopera contributed to data collection, drafted the initial manuscript, critically reviewed the manuscript, and approved the final manuscript as submitted.

Vanessa D. S. Antonini: Mrs. Antonini contributed to data collection, drafted the initial manuscript, critically reviewed the manuscript, and approved the final manuscript as submitted.


Araucaria Foundation (Agreement 179/10, protocol 19213).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

431_2018_3115_MOESM1_ESM.doc (160 kb)
ESM 1 (DOC 159 kb)


  1. 1.
    Ascenso A, Palmeira A, Pedro LM, Martins S, Fonseca H (2016) Physical activity and cardiorespiratory fitness, but not sedentary behavior, are associated with carotid intima-media thickness in obese adolescents. Eur J Pediatr 175(3):391–398CrossRefPubMedGoogle Scholar
  2. 2.
    Bacon L, Aphramor L (2011) Weight science: evaluating the evidence for a paradigm shift. Nutr J 10:9CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Bianchini JAA, da Silva DF, Nardo CC, Carolino ID, Hernandes F, Nardo Junior N (2013) Multidisciplinary therapy reduces risk factors for metabolic syndrome in obese adolescents. Eur J Pediatr 172(2):215–221CrossRefPubMedGoogle Scholar
  4. 4.
    Boreham C, Twisk J, Murray L, Savage M, Strain JJ, Cran G (2001) Fitness, fatness, and coronary heart disease risk in adolescents: the Northern Ireland Young Hearts Project. Med Sci Sports Exerc 33(2):270–274CrossRefPubMedGoogle Scholar
  5. 5.
    Bouzitas C, Koutedakis A, Ageli NE, Nikolau A, Nakou A (2004) Greek adolescents, fitness, fatness, fat intake, activity and coronary heart disease risk. Arch Dis Child 89(1):41–44CrossRefGoogle Scholar
  6. 6.
    Browning MG, Bean MK, Wickham EP, Stern M, Evans RK (2015) Cardiometabolic and fitness improvements in obese girls who either gained or lost weight during treatment. J Pediatr 166(6):1364–1369CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Bryant M, Ashton L, Nixon J, Jebb S, Wright J, Roberts K, Brown J, CoOR Scientific advisory group (2014) Framework of outcome measures recommended for use in the evaluation of childhood obesity treatment interventions: the CoOR framework. Pediatr Obes 9(6):e116–e131CrossRefPubMedGoogle Scholar
  8. 8.
    Caranti DA, de Mello MT, Prado WL, Tock L, Siqueira KO, de Piano A, Lofrano MC, Cristofalo DM, Lederman H, Tufik S, Dâmaso AR (2007) Short- and long-term beneficial effects of a multidisciplinary therapy for the control of metabolic syndrome in obese adolescents. Metabolism 56(9):1293–1300CrossRefPubMedGoogle Scholar
  9. 9.
    Chaput JP, Ferraro ZM, Prud'homme D, Sharma AM (2014) Widespread misconceptions about obesity. Can Fam Physician 60(11):973-975–981-984PubMedCentralGoogle Scholar
  10. 10.
    Cole TJ, Bellizzi MC, Flegal KM, Dietz WH (2000) Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 320(7244):1240–1243CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Freedhoff Y, Sharma AM (2010) Best weight: a practical guide to office-based obesity management. Alberta, Canada, Canadian Obesity NetworkGoogle Scholar
  12. 12.
    Fröhlich G, Pott W, Albayrak Ö, Hebebrand J, Pauli-Pott U (2011) Conditions of long-term success in a lifestyle intervention for overweight and obese youths. Pediatrics 128(4):e779–e785CrossRefPubMedGoogle Scholar
  13. 13.
    Jelalian E, Hart CN, Mehlenbeck RS, Lloyd-Richardson EE, Kaplan JD, Flynn-O'Brien KT, Wing RR (2008) Predictors of attrition and weight loss in an adolescent weight control program. Obesity (Silver Spring) 16(6):1318–1323CrossRefGoogle Scholar
  14. 14.
    Kalavainen MP, Korppi MO, Nuutinen OM (2007) Clinical efficacy of group-based treatment for childhood obesity compared with routinely given individual counseling. Int J Obes 31(10):1500–1508CrossRefGoogle Scholar
  15. 15.
    Klatchoian DA, Len CA, Terreri MT, Silva M, Itamoto C, Ciconelli RM, Varni JW, Hilário MO (2008) Quality of life of children and adolescents from São Paulo: reliability and validity of the Brazilian version of the Pediatric Quality of Life Inventory version 4.0 Generic Core Scales. J Pediatr 84(4):308–315CrossRefGoogle Scholar
  16. 16.
    Kodama S, Saito K, Tanaka S, Maki M, Yachi Y, Asumi M, Sugawara A, Totsuka K, Shimano H, Ohashi Y, Yamada N, Sone H (2009) Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. JAMA 301(19):2024–2035CrossRefPubMedGoogle Scholar
  17. 17.
    Kolotourou M, Radley D, Chadwick P, Smith L, Orfanos S, Kapetanakis V, Singhal A, Cole TJ, Sacher PM (2013) Is BMI alone a sufficient outcome to evaluate interventions for child obesity? Child Obes 9(4):350–356CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Leger LA, Lambert J (1982) A maximal multistage 20m shuttle run test to predict VO2 max. Eur J Appl Physiol 49:1–5CrossRefGoogle Scholar
  19. 19.
    Lofrano-Prado MC, Antunes HK, do Prado WL, de Piano A, Caranti DA, Tock L, Carnier J, Tufik S, de Mello MT, Dâmaso AR (2009) Quality of life in Brazilian obese adolescents: effects of a long-term multidisciplinary lifestyle therapy. Health Qual Life Outcomes 7:61–68CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Masquio DC, de Piano A, Sanches PL, Corgosinho FC, Campos RM, Carnier J, da Silva PL, Caranti DA, Tock L, Oyama LM, Oller do Nascimento CM, de Mello MT, Tufik S, Dâmaso AR (2013) The effect of weight loss magnitude on pro-/anti-inflammatory adipokines and carotid intima-media thickness in obese adolescents engaged in interdisciplinary weight loss therapy. Clin Endocrinol 79(1):55–64CrossRefGoogle Scholar
  21. 21.
    Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, Mullany EC, Biryukov S, Abbafati C, Abera SF, Abraham JP, Abu-Rmeileh NM, Achoki T, AlBuhairan FS, Alemu ZA, Alfonso R, Ali MK, Ali R, Guzman NA, Ammar W, Anwari P, Banerjee A, Barquera S, Basu S, Bennett DA, Bhutta Z, Blore J, Cabral N, Nonato IC, Chang JC, Chowdhury R, Courville KJ, Criqui MH, Cundiff DK, Dabhadkar KC, Dandona L, Davis A, Dayama A, Dharmaratne SD, Ding EL, Durrani AM, Esteghamati A, Farzadfar F, Fay DF, Feigin VL, Flaxman A, Forouzanfar MH, Goto A, Green MA, Gupta R, Hafezi-Nejad N, Hankey GJ, Harewood HC, Havmoeller R, Hay S, Hernandez L, Husseini A, Idrisov BT, Ikeda N, Islami F, Jahangir E, Jassal SK, Jee SH, Jeffreys M, Jonas JB, Kabagambe EK, Khalifa SE, Kengne AP, Khader YS, Khang YH, Kim D, Kimokoti RW, Kinge JM, Kokubo Y, Kosen S, Kwan G, Lai T, Leinsalu M, Li Y, Liang X, Liu S, Logroscino G, Lotufo PA, Lu Y, Ma J, Mainoo NK, Mensah GA, Merriman TR, Mokdad AH, Moschandreas J, Naghavi M, Naheed A, Nand D, Narayan KM, Nelson EL, Neuhouser ML, Nisar MI, Ohkubo T, Oti SO, Pedroza A, Prabhakaran D, Roy N, Sampson U, Seo H, Sepanlou SG, Shibuya K, Shiri R, Shiue I, Singh GM, Singh JA, Skirbekk V, Stapelberg NJ, Sturua L, Sykes BL, Tobias M, Tran BX, Trasande L, Toyoshima H, van de Vijver S, Vasankari TJ, Veerman JL, Velasquez-Melendez G, Vlassov VV, Vollset SE, Vos T, Wang C, Wang X, Weiderpass E, Werdecker A, Wright JL, Yang YC, Yatsuya H, Yoon J, Yoon SJ, Zhao Y, Zhou M, Zhu S, Lopez AD, Murray CJ, Gakidou E (2014) Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 384(9945):766–781CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Pires A, Martins P, Pereira AM, Marques M, Castela E, Sena C, Seiça R (2016) Childhood adiposity: being male is a potential cardiovascular risk factor. Eur J Pediatr 175(1):63–69CrossRefPubMedGoogle Scholar
  23. 23.
    Puhl RM, Heuer CA (2010) Obesity stigma: important considerations for public health. Am J Public Health 100(6):1019–1028CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Reinehr T, Widhalm K, l'Allemand D, Wiegand S, Wabitsch M, Holl RW, APV-Wiss STudy Group and German Competence Net Obesity (2009) Two-year follow-up in 21,784 overweight children and adolescents with lifestyle intervention. Obesity (Silver Spring) 17(6):1196–1199Google Scholar
  25. 25.
    Sox HC, Lewis RJ (2016) Pragmatic trials: practical answers to “real world” questions. JAMA 316(11):1205–1206CrossRefPubMedGoogle Scholar
  26. 26.
    Springer F, Ballweg V, Schweizer R, Schick F, Ranke MB, Binder G, Ehehalt S, DISKUS Study Group (2016) Changes in whole-body fat distribution, intrahepatic lipids, and insulin resistance of obese adolescents during a low-level lifestyle intervention. Eur J Pediatr 174(12):1603–1612CrossRefGoogle Scholar
  27. 27.
    Tanner JM (1986) Normal growth and techniques of growth assessment. Clin Endocrinol Metab 15(3):411–451CrossRefPubMedGoogle Scholar
  28. 28.
    Tomkinson GR, Lang JJ, Tremblay MS, Dale M, LeBlanc AG, Belanger K, Ortega FB, Léger L (2016) International normative 20 m shuttle run values from 1 142 026 children and youth representing 50 countries. Br J Sports Med [Epub ahead of print]Google Scholar
  29. 29.
    Varni JW, Seid M, Kurtin PS (2001) PedsQL 4.0: reliability and validity of the pediatric quality of life inventory version 4.0 generic core scales in healthy and patient populations. Med Care 39(8):800–812CrossRefPubMedGoogle Scholar
  30. 30.
    Vickers AJ, Altman DG (2001) Statistics notes: analysing controlled trials with baseline and follow up measurements. BMJ 323(7321):1123–1124CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Nelson Nardo Junior
    • 1
  • Josiane Aparecida Alves Bianchini
    • 2
    Email author
  • Danilo Fernandes da Silva
    • 3
  • Zachary M. Ferraro
    • 4
  • Carlos Andres Lopera
    • 1
  • Vanessa Drieli Seron Antonini
    • 1
  1. 1.Multiprofessional Nucleus of Obesity Study, Department of Physical EducationState University of Maringa, Clinical Research Center of University Hospital of MaringaMaringaBrazil
  2. 2.Faculty of Philosophy, Science and Letters of Mandaguari - FAFIMANMandaguariBrazil
  3. 3.Department of Physical EducationMidwest State University of ParanaGuarapuavaBrazil
  4. 4.Faculty of MedicineUniversity of OttawaOttawaCanada

Personalised recommendations