Initial Results from a Real‐world Pediatric Specialty Weight Management Clinic in a Safety‐net Hospital

Background There is limited data available on anthropometric outcomes from specialty pediatric obesity clinics targeting underserved populations. There is increasing evidence that interventions in early childhood are critical. Objectives To identify changes in weight measures in a pediatric obesity specialty clinic (Nutrition and Fitness for Life program, NFL) at a safety‐net hospital (Boston Medical Center, BMC). To determine the prevalence of children with clinically relevant reductions in weight measures. Methods This is a prospective observational study using data from a clinical data warehouse. Patients evaluated in the NFL clinic are referred by clinicians from BMC and associated health centers. Data from 795 patients seen between 2003 and 2010 was extracted. The criteria for inclusion in the study was being age 2–18 years old and attending at least two office visits. Data was extracted for weight, height, age at first and last visit, sex, and insurance status. We present data on weight, BMI, and BMI z‐score change and the prevalence of children with more than 5% reduction in BMI and BMI z‐scores. Other weight measures are being examined. CDC references were used and descriptive analyses performed. Results Given the study inclusion criteria, the final sample consisted of 544 patients with a median (IQ) for age of 11.5 (9.1, 13.9) years, 45% were male, 63% were on public insurance, 57% were Black or African American, 29% Hispanic, 7% White, and 7% Other. The median (IQ) treatment period was 6(3; 14.5) months. Baseline BMI was 32.1(28.4; 37.7) kg/m 2 , percentile was 99.4(98.9; 99.7), and z‐score was 2.5(2.3–2.7) s.d. Overall, patients’ BMI increased by 1 (−1.6; 4.6) kg/m 2 and decreased by −0.8 (−4.1; 0.9) z‐score during the treatment period. Weight, BMI and BMI z‐score reductions of more than 5% varied significantly by age group. Discussion Despite socioeconomic challenges and the lack of exclusions, children were able to improve their weight measures. Overall the results in children less than six years old were encouraging. However, there is a lot of controversies on what weight loss indicator to use given the lack of references for severe obesity. There is a need for standardized measures of effectiveness in specialty obesity clinics that target underserved pediatric populations. Support or Funding Information Support from New Balance Foundation. Percent of children with more than 5% reduction in weight measure2–5.9 y(N=47) 6–11.9 y (n=247) 12–18.9 y (N=250)n(%) n(%) n(%) p‐value>5% wt Loss 2(4%) 1(0.4%) 22(9%) < 0.0001 >5% BMI Loss 6(13%) 13(5%) 29(12%) 0.0274 >5% BMI z‐score loss 29(62%) 43(17%) 36(14%) <0.0001