2009 Southern Regional Meeting Abstracts

Purpose of Study: Pediatric obesity has reached epidemic proportions in America. Approximately 2 million children in Texas are overweight. The purpose of the study is to assess the effectiveness of the existing obesity follow along program offered by the two Texas Children’s Hospital mobile clinics, which provide medical care to uninsured, primarily Hispanic children in under-served areas of Houston.
Methods Used: The invited obese patient is scheduled to return monthly for 5 re-visits after the initial well exam (total of 6). Measurements are taken and the family/patient is interviewed regarding diet and activity. Praise is given for positive changes and advice is given regarding necessary changes. Fasting labs are offered to patients who have signs of insulin resistance or a family history of any co-morbidity of obesity. The style of intervention is directive counseling, and provision of lab evidence that the child’s obesity is having a negative effect on his/her health.
Summary of Results: During 2007-2008, 94 obese patients returned for at least one visit (V 2) after the initial exam (V 1). Mean age = 10.3 yrs (4.7-17.2 yrs). Mean BMI = 26.2 (17.4-47). 81% had BMI’s > 95% and 37% had BMI’s ≥ 99%. Mean BMI z score was 2.03 (1.13-3.13). 82% reported some family history of a co-morbidity of obesity. 66 % had signs of insulin resistance. Of the 48% who had labs, 82% had some abnormality. Only 55% returned for V3, 35% for V4, and only one patient came for all 6 visits as prescribed. Mean number of days between V1 and V2 = 34; between V1 & V3 = 76; between V1 and V4 = 120.
Using the paired samples t test, mean z scores were found to be significantly lower between V1 and V2 (P=.01); V1 and V3 (P=.002); and V1 and V4 (P=.002). Using the same test, mean BMI’s were only found to be significantly lower at V2 (P=.014).
Conclusions: Drop out from the program was high. Although the data do show statistically significant improvement in mean BMI and z scores, those “significant” BMI changes range from 0.14 to 0.3 points. The question is: are those changes clinically significant? The mobile clinic providers are seeking innovative, more effective ways to counsel obese children so they are empowered and motivated to make needed lifestyle changes.