ABSTRACT
OBJECTIVES: To investigate changes in health-related quality of life (HRQOL), body mass index (BMI), physical activity, and sedentary behavior at 24 months after an inpatient weight-loss program and to examine correlations between changes in HRQOL and BMI or physical activity. STUDY DESIGN: This prospective study included 707 overweight and obese individuals (mean age, 14 ± 2 years; 57% girls) participating in a 4- to 6-week inpatient weight-loss program, 381 of whom completed a 24-month follow-up. HRQOL, physical activity, sedentary behavior, and BMI were assessed at baseline, at discharge, and at 6, 12, and 24 months after starting therapy. Longitudinal analyses were conducted using repeated-measures mixed models, adjusted for age, sex, and baseline outcome and accounting for attrition over time. RESULTS: All variables improved over treatment and 6-month follow-up (P < .05). At 24 months, overall HRQOL indicated improvements relative to baseline (3 points on a scale of 0-100; 95% CI, 1.68-4.47; P < .001). Of the 6 HRQOL domains, the greatest improvement was observed for self-esteem (11 points; 95% CI, 8.40-13.14; P < .001). BMI was 0.5 kg/m(2) lower than at baseline (95% CI, -0.92 to -0.02; P = .04). Long-term changes in physical activity explained 30% of the variation in overall HRQOL (P = .01), and change in BMI was not associated with a change in HRQOL. CONCLUSIONS: This inpatient weight-loss program was associated with positive changes in HRQOL over the long term, with particular improvements in self-esteem. The results indicate the potential role of physical activity in improving HRQOL without a substantial change in body composition.
Subject(s)
Obesity/therapy , Quality of Life , Weight Reduction Programs/methods , Adolescent , Anthropometry , Body Composition , Body Mass Index , Child , Female , Follow-Up Studies , Humans , Inpatients , Linear Models , Male , Motor Activity , Obesity/psychology , Overweight/psychology , Overweight/therapy , Prospective Studies , Self Concept , Surveys and Questionnaires , Time Factors , Treatment OutcomeABSTRACT
OBJECTIVE: To compare the cardio-metabolic risk profile between moderately obese and severely obese children and adolescents. STUDY DESIGN: Cross-sectional study involving 463 obese 6- to 19-year-olds who were referred to an inpatient weight-loss program. Anthropometric data were assessed and fasting blood samples were analyzed for lipid and glucose metabolism, adipokines, and inflammatory markers. Moderately obese individuals (percentiles corresponding to body mass index ≥ 30 to 35 kg/m(2) at age 18 years) and severely obese individuals (percentiles corresponding to body mass index ≥ 35 kg/m(2) at age 18 years) were defined by sex and age-specific cut-offs according to the International Obesity Task Force. RESULTS: The prevalence of the metabolic syndrome was three times higher in severely obese individuals compared with those who are moderately obese. Mean values for proinsulin, insulin, homeostatic model assessment-insulin resistance, triglycerides, and interleukin-6 were 30%-50% higher in severe obesity compared with moderate obesity. Concentrations of leptin and high-sensitive C-reactive protein were about 1.5-fold higher, adiponectin levels were 12% lower, and resistin levels 10% higher in severely obese individuals compared with moderately obese (all P < .001). CONCLUSION: Severely obese individuals have a markedly more unfavorable cardio-metabolic risk profile than those who are moderately obese. The results of this study underscore the substantial effect of severe obesity on health and highlights that these children need to receive particular attention regarding obesity treatment.