ABSTRACT
BACKGROUND: Childhood obesity is associated with adverse changes in cardiometabolic risk factors. A family-oriented group program stressing a health-promoting lifestyle has been more effective than routine counselling in the treatment of obesity in school children. The aim of the present study was to compare the impact of group program and routine councelling on body composition and metabolic profile, and to evaluate the associations of changes in adiposity with levels of cardiometabolic risk factors. METHODS: Seventy obese prepubertal children were randomized into family-oriented group program (15 sessions for parents and children) and routine counselling (2 appointments for children). Body mass index (BMI), body composition and different metabolic risk factors were assessed before and after the 6-month intervention. RESULTS: Waist/height decreased more in the children attending the group treatment, but there were no significant differences between treatment arms in the changes of metabolic risk factors. When the arms were analyzed as combined, serum triglycerides decreased significantly if BMI standard deviation score (BMI-SDS) decreased ≥ 0.5. Serum fasting insulin decreased if BMISDS decreased ≥ 0.25. CONCLUSIONS: Obesity-related metabolic risk factors reduced in prepubertal children if BMI-SDS decreased substantially. This result was not dependent on which intervention, family-oriented group program or routine counselling, was used.
Subject(s)
Body Composition , Family Therapy , Metabolome , Obesity/metabolism , Obesity/therapy , Body Mass Index , Child , Counseling/methods , Family Therapy/methods , Health Promotion/methods , Humans , Life Style , Obesity/diet therapy , Prognosis , Psychotherapy, Group/methods , Risk Assessment , Risk Factors , Risk Reduction Behavior , Social Class , Treatment OutcomeABSTRACT
BACKGROUND: Cost-effectiveness analyses facilitate the allocation of health care resources. The aim of the study was to compare the cost-effectiveness of group treatment, already known to be more effective, with routine counseling in obese children. METHOD: A prospective 6-month intervention assessed family-based group treatment (15 separate sessions for parents and children) and routine counseling (two appointments for children). Children's weights and heights were measured at baseline, at the end of the intervention and at follow up 6 months later, and the changes in weight for height and body mass index standard deviations scores (BMI-SDS) were calculated and used as main outcome measures. The mean costs and effects of the programs were analyzed to produce the incremental cost-effectiveness ratio, which is an estimate of the additional costs per 1% decrease in weight for height or 0.1 decrease in BMI-SDS. Cost-effectiveness analysis was performed from the perspective of the service provider. RESULTS: At the end of the intervention, group treatment costs were 1.4-fold (non-calculable 6 months later) when counted per 1% weight for height decrease, and 3.5-fold (2.8-fold 6 months later) when counted per 0.1 BMI-SDS decrease. Incremental cost-effectiveness ratio estimates were euro 53 when calculated for 1% weight for height decrease, and euro 266 (euro 275 6 months later) when calculated for 0.1 BMI-SDS decrease. CONCLUSIONS: Family-based group treatment is more costly compared with individual routine counseling. Salaries form most of the total costs.
