Tertiary-level management of overweight and obese children and adolescents: Does intensive dietetic intervention have a positive impact on weight control?

Aim: Tertiary clinical management of paediatric obesity is complex and the best treatment model of care is unknown. We aimed to ascertain if a prescriptive nutritional intervention in a tertiary dietetic clinic resulted in a reduction in body mass index (BMI) z-score. Methods: Data (age, gender, anthropometry, clinic visits (number, timing)) were collected on all patients between June 2005-September 2009 and intention to treat analyses were carried out by using linear mixed models. Results: For attendees, significant reductions in BMIz-scores occurred in boys after the third clinic appointment (P = 0.04) and in girls after the fifth appointment (P = 0.046). Final mean BMIz-score reduction was 0.28 ± 0.09 for boys and 0.24 ± 0.12 for girls. A significant reduction in waist to height ratio (WHER) for girls (from mean 0.62 ± 0.06 to 0.54 ± 0.04) was achieved by the fifth visit (P < 0.001). Conclusions: Prescriptive nutritional intervention in a tertiary dietetic clinical setting resulted in a significant reduction in BMIz-scores in both boys and girls evident by the third and fifth clinical appointments (contacts), respectively. No correlation was found between intensity of appointments in terms of length of time between clinic visits, age or initial BMI of the patient and reduction in BMIz-score. These findings reinforce that multiple appointments are required to produce a beneficial effect.