家庭治療可能對嚴重兒童肥胖患者有效
作者：Laurie Barclay, MD
出處：WebMD醫學新聞
October 13, 2009 — 根據一項於10月號小兒醫學期刊發表的研究結果，家庭為主的治療可能對於嚴重兒童肥胖患者有效。
來自賓州匹茲堡大學醫學院Melissa A. Kalarchian博士與其同事們寫到，體重管理計畫與學齡兒童中度減重及健康好處有關，但是很少有研究針對嚴重肥胖的兒童進行。我們評估以家庭為主，嚴重兒童肥胖的行為體重控制效果。
總共有192個年齡介於8至12歲的肥胖兒童家庭被隨機分派接受介入或一般常規性照護，且在試驗前、6、12與18個月後接受評估。平均年齡為10.2±1.2歲，而年齡與性別的平均身體質量指數（BMI）百分位數為99.18 ± 0.72。
過重百分比（性別與年齡超過BMI中位數的百分比）是試驗的主要終點，其他的預後評量包括血壓變化、身體組成、腰圍、以及與健康相關的生活品質，同時也評估計畫出席率與其他影響兒童過重百分比的因素。
相較於日常照護，介入顯著地與6個月時兒童過重百分比顯著降低有關。根據意向分析，介入在6個月時與兒童過重百分比降低7.58%有關，日常照護則是0.66%。然而，這些組與組之間的差異在12與18個月時並未達到統計上顯著差異。在6與12個月時，醫療預後有微小但顯著的改善。
介入講習出席率至少75%的兒童，在18個月的時間之內，過重比例持續下降。其他與介入組6個月時兒童過重百分比顯著下降較多有關的因素，包括試驗前過重百分比較低、出席率較高、收入較高、以及雙親BMI下降較多。
研究作者們寫到，介入與肥胖短期顯著下降，以及醫學參數的改善有關，且賦予出席75%以上講習之兒童長期的體重改變好處。雖然還需要未來的研究來瞭解出席率與體重控制的關係，目前這些發現代表促進與提高計畫順從性潛在重要性的策略。
這項研究的限制包括無法將結果歸因為家庭為主介入的特定部分；缺乏應用到西班牙裔，或是其他沒有參加大學為主研究計劃的應用性；最後是意向分析中的遺失數據。
研究作者們的結論是，在6個月時，以家庭為主的體重行為控制計畫與嚴重肥胖的學齡兒童過重百分比顯著降低、以及醫療危險因子改善有關。雖然過重比例改變地有限，考慮到肥胖的嚴重性，介入的顯著健康好處代表進一步最佳化家庭為基礎介入計畫預後的努力是有必要的。
國家衛生研究院、匹茲堡大學肥胖與營養研究中心、匹茲堡兒童醫院綜合臨床研究中心、以及匹茲堡臨床與轉譯科學機構贊助這項研究。研究作者們表示已無相關資金上的往來。
Family-Based Treatment May Be Effective in Severe Pediatric Obesity
By Laurie Barclay, MD
Medscape Medical News
October 13, 2009 — Family-based treatment may be effective in severe pediatric obesity, according to the results of a study reported in the October issue of Pediatrics.
"Weight management programs are associated with moderate weight losses and health benefits for school-aged children, but few studies have focused on severely obese children," write Melissa A. Kalarchian, PhD, from the University of Pittsburgh School of Medicine in Pennsylvania, and colleagues. "We evaluated the efficacy of family-based, behavioral weight control in the management of severe pediatric obesity."
Families of 192 severely obese children aged 8.0 to 12.0 years were randomly assigned to the intervention or to usual care, and evaluations were performed at baseline and at 6, 12, and 18 months. Mean age was 10.2 ± 1.2 years, and average body mass index (BMI) percentile for age and sex was 99.18 ± 0.72.
Percent overweight (percent over the median BMI for age and sex) was the main study endpoint, and other outcome measures were changes in blood pressure, body composition, waist circumference, and health-related quality of life. Session attendance and other factors associated with changes in child percent overweight were also assessed.
Compared with usual care, the intervention was associated with significant decreases in child percent overweight at 6 months. The intervention was associated with a 7.58% decrease in child percent overweight at 6 months vs a 0.66% decrease with usual care, based on intent-to-treat analyses. However, these between-group differences were not significant at 12 or 18 months. At 6 and 12 months, there were small but significant improvements in medical outcomes.
Children who attended at least 75% of the intervention sessions maintained their decreases in percent overweight through 18 months. Other factors associated with significantly greater reductions in child percent overweight at 6 months among intervention participants were lower baseline percent overweight, better attendance, higher income, and greater reduction in parental BMI.
"Intervention was associated with significant short-term reductions in obesity and improvements in medical parameters and conferred longer-term weight change benefits for children who attended ? 75% of sessions," the study authors write. "Although future work is needed to understand the relationship between attendance and weight control, the present findings suggest the potential importance of strategies to promote and to facilitate program adherence."
Limitations of this study include inability to attribute outcomes to the specific components of the family-based intervention; lack of generalizability to Hispanics or to those not participating in university-based, research programs; and missing data in intent-to-treat analyses.
"A 6-month, family-based, behavioral weight management program was associated with significant decreases in percent overweight and improvements in medical risk factors in severely obese, school-aged children," the study authors conclude. "Although the changes in percent overweight were modest, given the severity of obesity, the significant health benefits of the intervention suggest that further efforts to optimize the outcomes of family-based intervention programs are warranted."
The National Institutes of Health, the University of Pittsburgh Obesity and Nutrition Research Center, Children's Hospital of Pittsburgh General Clinical Research Center, and the University of Pittsburgh Clinical and Translational Science Institute supported this study. The study authors have disclosed no relevant financial relationships.
Pediatrics. 2009;124:1060-1068.
