Impact of Psychosocial Risk on Outcomes among Families Seeking Treatment for Obesity
Thao-Ly T Phan1, Fang Fang Chen2, Alison Taggi Pinto3
1Department of Pediatrics, Nemours Children's Health System, Wilmington, DE; Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; Center for Healthcare Delivery Science, Nemours Children's Health System, Wilmington, DE.
Insights
Children with higher psychosocial risk face greater challenges in weight management programs, experiencing more dropouts and less successful weight outcomes. Early psychosocial screening is crucial for effective pediatric obesity treatment.
Area of Science:
- Pediatric Endocrinology
- Child Psychology
- Public Health
Background:
- Pediatric obesity is a significant public health concern.
- Weight management programs often face challenges with patient adherence and treatment efficacy.
- Psychosocial factors can influence health behaviors and treatment outcomes in children.
Purpose of the Study:
- To investigate the association between psychosocial risk and outcomes in pediatric weight management.
- To determine if elevated psychosocial risk predicts higher attrition rates.
- To assess the impact of psychosocial risk on weight management success, defined by body mass index (BMI) z-score changes.
Main Methods:
- A prospective cohort study involving 100 children (aged 4-12 years) in a weight management clinic.
- Parents completed the Psychosocial Assessment Tool to categorize risk levels.
- Logistic regression analyses were used to evaluate the odds of attrition and non-meaningful BMI z-score change over 6 months, adjusting for covariates.
Main Results:
- 59% of families had moderate or high psychosocial risk.
- Over 6 months, 53% of families were lost to follow-up (attrition), and 67% had no clinically meaningful decrease in BMI z-score.
- Children from moderate/high psychosocial risk families were 3.1 times more likely to be lost to follow-up and 2.9 times more likely to have non-meaningful BMI changes compared to low-risk families.
Conclusions:
- Elevated psychosocial risk is linked to increased attrition and poorer weight outcomes in pediatric weight management.
- Psychosocial screening should be integrated into standard pediatric weight management protocols.
- Addressing psychosocial factors may improve treatment adherence and effectiveness for children with obesity.
Objectives:
To test the hypothesis that children with elevated psychosocial risk would have increased attrition and worse weight outcomes in weight management treatment.
Study Design:
This was a prospective cohort study of 100 new patients, aged 4-12 years, in a weight management clinic. Parents completed the Psychosocial Assessment Tool. Logistic regression analyses were conducted to calculate the odds of attrition from the clinic and a nonmeaningful change in body mass index (BMI) z-score (ie, <0.1 unit decrease in BMI z-score) over a 6-month period based on psychosocial risk category, adjusting for child demographics and baseline weight category.
Results:
The majority of patients were male (59%), black (36%) or white (43%), and had severe obesity (55%), and 59% of families were categorized as having moderate or high psychosocial risk. Over the 6-month period, 53% of families were lost to follow-up, and 67% did not have a clinically meaningful decrease in BMI z-score. Compared with children of families with low psychosocial risk, children of families with moderate or high psychosocial risk were 3.1 times (95% CI, 1.3-7.2 times) more likely to be lost to follow-up and 2.9 times (95% CI, 1.1-7.9 times) more likely to have a non-clinically meaningful change in BMI z-score.
Conclusions:
Children presenting with increased psychosocial risk have higher attrition and poorer weight outcomes, supporting the need for psychosocial screening as a standard component of pediatric weight management treatment.
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