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Energy Management for Personalized Weight Reduction (EMPOWER) Program: Three-Year Outcome Data
A P Vidmar1,2, C Fink2, B Torres2
1Center for Endocrinology, Diabetes and Metabolism, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, USA.
Insights
Pediatric obesity interventions show modest BMI improvements. Lower baseline BMI and no comorbidities predict better outcomes in youth, guiding future treatment strategies.
Area of Science:
- Pediatric Endocrinology
- Obesity Medicine
- Public Health
Background:
- Current pediatric obesity guidelines recommend clinic-based, family-centered, multidisciplinary interventions.
- These programs often yield only modest improvements in Body Mass Index (BMI) status.
- Factors predicting individual patient outcomes in pediatric obesity management remain understudied.
Purpose of the Study:
- To evaluate the outcomes of the EMPOWER clinic for pediatric obesity.
- To identify participant-specific characteristics that predict BMI status improvement.
Main Methods:
- Retrospective cohort study of youth completing at least 6 visits in the EMPOWER clinic.
- Paired t-tests analyzed changes in zBMI, modified BMIz, and %BMIp95 from baseline to the 6th visit.
- Multivariate mixed-effects models assessed the impact of baseline characteristics on BMI status changes.
Main Results:
- 92 participants (87% severe obesity, 66% Hispanic) were analyzed.
- Significant reductions observed in zBMI (-0.09 SD) and modified BMIz (-0.0003 SD) at the 6th visit.
- Lower baseline BMI status and absence of comorbidities predicted BMI status improvement; age, gender, ethnicity, family history, and insurance were not significant predictors.
Conclusions:
- Current pediatric obesity management guidelines result in modest BMI status reduction.
- Further research is needed to understand determinants of obesity-related health outcomes.
- This understanding can guide the development of more innovative and effective interventions for high-risk pediatric populations.
Background:
The current consensus guidelines for management of pediatric obesity recommend clinic-based, family-centered, multi-disciplinary interventions. It is well reported that these programs often only lead to modest improvements in BMI status. The individual factors that differentiate which patient's BMI status will improve vs. worsen remains understudied. A retrospective cohort study was conducted to evaluate the outcomes of EMPOWER clinic and identify the participant specific characteristics that predicted BMI status improvement in this population.
Methods:
Youth who completed at least 6 visits in EMPOWER were included. Paired t-test was utilized to evaluate the mean change in zBMI, modified BMIz and %BMIp95 from baseline to 6th visit, and multivariate mixed effect models were utilized to analyze effect of baseline characteristics on change in BMI status.
Results:
92 participants were included in the analysis, 87% with severe obesity and 66% Hispanic. At the 6th visit, there was a significant reduction in zBMI (-0.09 SD, p <0.001) and modified BMIz (-0.0003 SD, p = 0.04) with a small reduction in %BMIp95 (-1.15 %, p = 0.20). Lower BMI status (p < 0.001) and absence of a comorbidity (p < 0.05) at baseline were predictors of BMI status improvement whereas age, gender, ethnicity, family history of obesity and insurance status were not significant predictors.
Conclusions:
Given that implementation of the current guidelines for management of obesity in pediatrics only results in modest BMI status reduction, further investigation is required to understand how the determinants of obesity-related health outcomes can guide development of more innovative, effective interventions for this high risk population.
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