Elsevier

Nutrition

Volume 27, Issue 1, January 2011, Pages 50-54
Nutrition

Applied nutritional investigation
Outcome of a hospital based multidisciplinary weight loss program in obese Filipino children

https://doi.org/10.1016/j.nut.2009.11.028Get rights and content

Abstract

Background

Childhood obesity is becoming a problem for Filipino children with an increasing national prevalence of pediatric overweight and obesity. A multidisciplinary approach combining behavioral therapy with diet and exercise is often advocated as having the greatest impact in pediatric weight management.

Objective

To determine the effects of a weight loss program, which is a staged 3-mo, multidisciplinary intervention consisting of combined dietary, exercise, and behavioral methods in obese children.

Research methods and procedures

Prospective study done in a hospital-based weight management center; duration of study: 15 mo (November 2005 to January 2008); participants: 44 obese children (aged 5–17 y; body mass index [BMI] 85th–99th percentile); outcome measures: change in weight, BMI, BMI z-score (SD score); secondary measures included changes in waist circumference, blood pressure, and body fat. Statistical tests: paired t tests, χ2 test, Wilcoxon ranked sum test, regression analysis, and ANOVA.

Results

At the end of the program, the patients demonstrated a decrease in weight, BMI, BMI z-score, body fat, systolic blood pressure, and waist circumference. Mean weight loss is 4.2 kg (P < 0.01) with an average of 5.3% weight loss; BMI decreased by 1.5 units (P < 0.01), BMI z-score by 0.15 (P < 0.004), body fat by 14% (P < 0.01), systolic blood pressure by 7.25 mm Hg (P < 0.05), and waist circumference by 5.4 cm (P < 0.05). Decrease in weight, BMI, and body fat were significantly correlated with number of sessions attended.

Conclusion

The use of a multidisciplinary 3-mo staged program resulted in an effective weight loss in obese Filipino children, which was directly related to the frequency of sessions attended.

Introduction

Obesity is the scourge of the new millennium. The incidence of adult and childhood obesity has soared to epidemic proportions in the United States [1], [2], [3], Canada [4], [5], and Asia [6], [7]. In the United States the prevalence of obesity (body mass index or BMI of 95th percentile) was 10% among children 2 to 5 y of age and 15% among children 6 to 19 y of age [8]. These values increased to 30% when children at risk for obesity (BMI of 85th to 94th percentile) between the ages of 6 and 10 y were included. In the Philippines, the latest national nutrition survey (2003) documented an increasing trend in the incidence of overweight and obesity in Filipino children [9]. As of 2003, the prevalence of overweight and obesity among children 11–19 y was 3.5%.

Pediatricians are managing more patients with weight-related chronic diseases such as metabolic syndrome, type 2 diabetes, and hypertension, which used to be the domain of internists. It is therefore paramount that effective programs be developed to address this issue. Behavioral modification appears to be one key in addressing pediatric obesity. Epstein et al. [10] have shown that long-term weight reductions can be achieved using family-based behavior treatment. Other studies have tried weight reduction programs utilizing the school [11], [12], church [13], or internet [14]. Obesity appears to be a multifactorial condition; hence, a multidisciplinary approach is often advocated for its management. There are few published studies on outcomes of ambulatory weight management program for Asian children [15], hence this study, which describes the experience of one center in treating overweight and obese children in the Philippines.

This study aimed to describe the population of overweight and obese children who enrolled at a pediatric ambulatory weight management program and to analyze the outcome of the program. The outcome measures include weight, BMI, BMI z-score, body fat, blood pressure, and waist circumference. The specific objectives were as follows: 1) to determine changes in weight, BMI, BMI z-score, body fat, blood pressure, and waist circumference among patients who participated in the program; and 2) to determine the minimum number of sessions needed to achieve results.

Section snippets

Materials and methods

The St. Luke's Medical Center Obesity and Weight Management Program offers a multidisciplinary approach that involves a pediatrician, endocrinologist, cardiologist, registered dietitian, rehabilitation medicine physician, physical therapist, and psychiatrist. All patients are initially screened by a pediatric consultant who determines which program would best suit their needs. For overweight and obese patients, an individualized behavioral modification and exercise program is implemented. The

Results

A total of 44 obese patients were included in the study. There were 28 males and 16 females with a male-to-female ratio of 1.7:1. Age ranged from 5 to 17 y with median age of 13.3 y. Patients were further classified based on age as pre-adolescent (5–9 y), early adolescent (10–13 y), mid adolescent (14–16 y), and late adolescent (17–18 y) (Table 1).

The mean weight at the start of the program was 79.31 kg among all age groups. Mean weight loss was 4.2 kg, which was significant (P < 0.05) with an

Discussion

There is growing awareness of the rapid increase in the number of overweight and obese children in the Philippines. However up to the present there is no concrete national program developed or implemented to address the issue. The current programs and studies have focused on preventive programs for obese adults with its associated comorbidities. At present, management of pediatric obesity in the Philippines has been confined to individual practitioners in their clinics and has been limited to

Conclusion

The use of a multidisciplinary 3-mo staged program was effective in promoting weight loss in obese Filipino children with corresponding decreases in BMI, BMI z-score, body fat, systolic blood pressure, and waist circumference. The degree of weight loss, BMI change, and body fat loss were directly correlated with the frequency of sessions attended. A follow-up study is needed to assess long-term (1 y and 5 y) effects of weight management program in this population.

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