BALTIMORE — An intensive multidisciplinary weight-loss program can help obese adolescents lose weight and reduce lipid levels, a small study has shown.
By combining clinical care, nutrition, behavioral counseling, and exercise guidance, 28 teens in the program significantly reduced their body mass index by an average of 3 kg/m
The Michigan Pediatric Outpatient Weight Evaluation and Reduction (MPOWER) program helps obese adolescents aged 12–17 years identify causes of their weight gain as a strategy for reducing their weight. During the first visit, patients receive a complete medical evaluation including lab tests aimed at identifying possible causes for, and complications from, their weight gain. Patients with complications from their obesity may be referred to other University of Michigan subspecialty clinics.
A registered dietitian provides personalized dietary assessments and nutrition education. The program's family-focused treatment of obesity includes dietitian home visits to assess barriers to weight loss and help families improve the likelihood of success.
The program includes regular visits with pediatric therapists who specialize in weight loss. They work with families to help motivate behavioral changes and build confidence in new lifestyle habits. Each patient receives fitness evaluations and regular physical activity instruction from a physiologist. Exercise classes are tailored to adolescents, and a well-equipped exercise facility is accessible. Patients are taught new kinetic skills to help them become more active in their home environment.
The retrospective study included obese adolescents enrolled in the MPOWER program between April 2007 and July 2008 with a BMI greater than or equal to the 95th percentile for age and sex. Patients were excluded if they were taking cholesterol-lowering medications or obesogenic medications (such as steroids), or had a moderately severe mental illness.
They were weighed weekly, and their height was measured at weeks 1, 12, and 23. Lipids were measured at weeks 1 and 23. The researchers calculated mean changes in weight and BMI using measurements taken at weeks 1 and 23. Differences in fasting lipid levels at weeks 1 and 23 were calculated.
Twenty-eight patients completed 6 months in the program and their initial and final laboratory levels were available. Mean age was 15 years; 69% were female. Almost half (44%) received Medicaid. Most patients were white (64%) and 28% were black.
Final mean fasting levels of total cholesterol, LDL, and triglycerides were significantly lower than were the initial mean levels. The mean reduction in fasting total cholesterol was 7 mg/dL, with a final average level of 156.6 mg/dL. Fourteen patients had borderline or elevated initial total cholesterol levels (greater than 170 mg/dL). Eleven of these patients reduced their total cholesterol over 6 months. Eight had final levels in the normal range.
Mean reduction in fasting LDL was 2.7 mg/ dL, with a final average level of 98 mg/dL. Eleven patients had borderline or elevated initial LDL (greater than 110 mg/dL). Nine of them reduced their LDL. Six had final levels in the normal range.
The mean reduction in fasting triglycerides was 24.2 mg/dL, with a final mean level of 97.6 mg/dL. Eight patients had elevated initial triglyceride levels (greater than 150 mg/dL). Seven of these patients reduced their triglycerides levels to the normal range. Two teens with strong family histories of dyslipidemia had lipid levels that did not decrease with weight loss. Three teens who initially had normal lipid levels had elevated final levels, but all three lost weight during the program.
The study was funded by the University of Michigan Pediatric Comprehensive Weight Management Center.