Study finds successful treatment of childhood obesity lowers long-term health risks

Findings highlight the importance of treatment effectiveness in managing childhood obesity.

Study: Effect of Pediatric Obesity Treatment on Long-Term Health. Image Credit: Sergio Arjona/Shutterstock.com

In a recent study published in JAMA Pediatrics, researchers investigated the long-term effects of treatment for long-term pediatric obesity on multiple obesity-related health outcomes.

Their findings indicate that a positive response to obesity treatment, including remission, can significantly reduce the risk of outcomes such as hypertension, depression, and type 2 diabetes, as well as lower the probability of death during young adulthood.

Background

Childhood obesity is now a widespread issue globally, with projections showing that 18% of girls and 20% of boys between 5 and 19 will be obese by 2035. Obesity in children is linked to health problems like high blood pressure, insulin resistance, liver disease, and mental health issues like anxiety and depression. Additionally, children with obesity face higher risks of poor health during adulthood.

Treatments such as behavioral lifestyle changes, medications, and bariatric surgery have improved short- and long-term health indicators in affected children. In Sweden, evidence-based obesity treatments have focused on lifestyle modifications over the past 15 years.

Researchers have utilized the Swedish Childhood Obesity Treatment Register (BORIS), one of the world’s largest databases for treating childhood obesity, in multiple studies to explore the connection between obesity and its related health complications.

About the study

Researchers used a prospective cohort study design, BORIS data, and information from administrative and national health registers to investigate the long-term effects of pediatric obesity treatment.

Participants were adolescents and children (ages 6-17) with obesity who had received one or more years of treatment before turning 18.

The study compared these individuals with a matched group drawn from the general population in a 1:5 ratio based on sex, birth year, and location. Key exclusion criteria included individuals who had genetic syndromes, those who went through bariatric surgery, emigrated, or died before follow-up.

The primary exposure was treatment effectiveness, measured by changes in the standard deviation score (SDS) of body mass index (BMI) from the first to the last visit. Treatment responses were classified as poor, intermediate, good, or obesity remission.

Health outcomes assessed included hypertension, type 2 diabetes, dyslipidemia, anxiety or depression, bariatric surgery, and mortality. Data were linked to Swedish medical registers to track diagnoses, treatments, and outcomes.

Statistical analysis used Poisson regression to compare incidence rates of outcomes and Cox regression to assess the association between treatment response and these outcomes.

The study controlled for variables such as sex, age, degree of obesity, socioeconomic status, and migration background. Subgroup analyses focused on adolescents aged 12-17.

The study aimed to provide insights into how early treatment of obesity impacts long-term health, considering various sociodemographic and treatment-related factors.

Findings

The study included 6,713 individuals with a median age of 12.1 years at treatment initiation. Participants were categorized based on their treatment response: poor, intermediate, good, or obesity remission. They were compared to 32,402 individuals from the general population.

The results showed that individuals in the obesity remission and good response groups had lower rates of obesity-related health outcomes than those in the poor response group. For example, those in the obesity remission group had a significantly lower risk of developing type 2 diabetes, hypertension, and dyslipidemia.

Bariatric surgery rates were also lower in the good response and obesity remission groups. However, treatment response was not associated with a reduced risk of depression or anxiety.

Regarding mortality, individuals with a good response or obesity remission had a significantly lower risk of premature death compared to the poor response group.

No significant link was found between obesity treatment effectiveness and fractures.

Overall, better obesity treatment responses were associated with improved long-term health outcomes, including lower risks of type 2 diabetes, hypertension, dyslipidemia, and mortality.

Conclusions

This study found that successful treatment of pediatric obesity reduces the long-term risk of obesity-related health issues during young adulthood, including type 2 diabetes, dyslipidemia, and premature mortality.

The greatest reductions in risk were observed in individuals who achieved obesity remission, although even moderate improvements in obesity were beneficial. However, the study found no significant effect on the risk of anxiety or depression, suggesting these conditions require independent treatment.

The study also highlighted that early obesity treatment could normalize the risk of premature mortality, with individuals showing good treatment responses having mortality rates similar to the general population.

While bariatric surgery rates were lower in those with better treatment responses, surgery was still needed to some extent in all treatment groups, emphasizing the complexity of obesity management.

Despite potential weight regain, the study emphasized that substantial reduction in childhood obesity is critical for long-term health. Limitations included the potential underreporting of conditions treated with lifestyle modifications and biases in healthcare-seeking behavior.

Nonetheless, the study’s strengths, such as its large sample and national data, support the conclusion that effective treatment for pediatric obesity significantly reduces future health risks. However, it does not address long-term mental health outcomes.