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Multi-disciplinary weight management compared to routine care in youth with obesity: what else should be monitored?

Abstract

Purpose

Efficacy of multi-disciplinary weight management (MDM) in youth has not been compared to their routine care.

Objectives

To compare body mass index z-score (zBMI) and blood test (lab) changes (Δ) in youth before and after MDM and to correlate bio-impedance analysis (BIA) and lab measurements.

Methods

We compared zBMI Δ (from referring providers’ records), within 3 months prior to MDM, to monthly zBMI Δ after MDM, in a retrospective cohort of youth at a tertiary MDM center. BIA and lab measurements after 6 months, MDM were compared to baseline.

Results

We reviewed 316 records (12.9 ± 3.5 years, 49% males, 104.8 ± 35.1 kgs). The pre-MDM zBMI Δ (0.02 ± 0.1) was reversed after MDM (−0.03 ± 0.09, visit 2, P < 0.001). The zBMI Δ progressed on follow-up (−0.14 ± 0.05, visit 6). Baseline BIA components correlated with Homeostatic Model Assessment of Insulin resistance (HOMA-IR), triglycerides, and systolic blood pressure. HbA1c, HOMA-IR, and liver functions significantly improved on follow-up. MDM participation showed progressive attrition and dropped to 11.6% at visit 6.

Conclusion

MDM in youth resulted in zBMI and lab improvements compared to their pre-MDM measurements. BIA provided additional outcome measures that correlated with metabolic markers. MDM follow-up was limited by the progressive participant drop-out. Behavioral economic strategies are needed to improve adherence.

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Author contributions

I.M. designed the study, collected, analyzed, interpreted the data, prepared figures and prepared first draft. K.B., L.M., B.E., and J.E. collected and analyzed data. C.M.H. contributed to manuscript revision. All authors were involved in writing the paper and had final approval of the submitted and published versions.

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Correspondence to Indrajit Majumdar.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants 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. The study was approved by the Institutional Review Board.

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All data were collected retrospectively from EMR. Informed consent was not obtained from participants included in this study.

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Majumdar, I., Espino, B., Bianco, K. et al. Multi-disciplinary weight management compared to routine care in youth with obesity: what else should be monitored?. Endocrine 65, 263–269 (2019). https://doi.org/10.1007/s12020-019-01988-9

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  • DOI: https://doi.org/10.1007/s12020-019-01988-9

Keywords

  • Youth with obesity
  • Multi-disciplinary management
  • Bio-impedance analysis