Primary Care Can Succeed in Treating Childhood Obesity, Study Finds

Treating childhood obesity is essential to avoiding long-term health consequences—and primary care physicians can do just as well as specialists, according to a new study from Sweden.

The small study, which appeared in Acta Paediatrica, followed 64 children from 8 to 13 years of age, who received treatment for obesity in primary or outpatient care clinics near their homes after being referred by their school health service.

The program included both the children themselves and a legal guardian for a year, and it offered advice on diet, physical activity, and sleep. Results being reported cover the children’s weight after an additional 3 years without treatment.

Childhood obesity is a global epidemic—the World Health Organization found that the number of overweight or obese children and infants 5 years or younger rose from 32 million in 1990 to 41 million worldwide in 2016. Lack of healthy food and the marketing of sugary beverages around the world are blamed for the problem, and experts have called on countries to impose taxes on sugar-sweetened beverages to halt the rise of obesity.

In this study, researchers were able to keep track of 56 children over 4 years, and 3 in 10 were in a lower weight category than before the intervention. This means those who were severely obese were now obese, those who were obese were now overweight, and those who were overweight now had a normal weight.

While that might not seem impressive, “they’re at about the same levels as those achieved by the major research clinics,” said senior author Staffan Marild, associate professor of pediatrics, Sahgrenska Academy, University of Gothenburg, in a statement. Although there was no control group, the researchers compared the children with 34 others who were of normal weight when the study began, and 5 had become overweight in the 4-year period.

Using primary care is easier than using specialist care—and in the United States, likely more affordable, although there is a shortage of primary care physicians. One challenge in fighting childhood obesity worldwide is the increasing disparity of the condition. A separate study published this month found that socioeconomic inequities and obesity both increased between 2006 and 2012 in Liverpool, described by researchers as Great Britain’s “most deprived” city.

Yet failing to intervene can mean serious consequences. Another study published this month based on data from the National Longitudinal Study of Adolescent Health found that obesity was directly linked to academic outcomes in young adulthood; other factors linked to academic performance included immigrant status and having obese friends.

Early intervention appears to be key, based on results from a Massachusetts-based intervention with obese minority children published in September. Results from this ongoing intervention for young children (aged 2-4 years) whose mothers were enrolled in the Supplemental Nutrition Assistance Program found that non-Hispanic black children who received the intervention had greater reductions in body mass index than did other children.

Training physicians to treat obesity is the first step, because not all physicians are comfortable discussing obesity with their patients. Novo Nordisk announced in July it would work with the Obesity Society to fund an obesity fellows program to fill the gaps in physician education. At the time, Novo Nordisk’s Todd Hobbs, MD, said the fellows program would “add credibility to a disease state that is so often associated with stigma and bias.”

Reference

Forsell C, Gronowitz E, Larsson Y, et al. Four-year outcome of randomly assigned lifestyle treatments in primary care of children with obesity [published online September 14, 2018]. Acta Paediatr. 2018. doi: 10.1111/apa.14583.