Evaluation of Multiprofessional Group Programs for Paediatric Obesity Therapy
Condition: Overweight
MeSH terms: Overweight
Study type: Observational

Summary: 
      The aim of this pilot project is to disseminate multiprofessional group programs (*MGP*) for
      therapy of the estimated 119'140 overweight/obese children in Switzerland. Family-based
      behavioral MGPs have been implemented from 2009 to 2013 to determine changes of health and
      family behaviours, after the intensive phase (*T1*), at 1 and 2 years after start (*T2*,
      *T3*). MGP costs are reimbursed in Switzerland: 1) if 116 sessions are provided by experts in
      physical activity, nutrition and psychology; 2) if parents are included and if their
      adherence is higher than 85%. In the nationwide "Evaluation of Multiprofessional Group
      Programs for Paediatric Obesity Therapy" (*KIDSSTEP*) study, multiple psychosocial and
      physical parameters were assessed at T0, T2 and T3 . Out of 33 certified centers, 25 were
      active and only 19 were re-certified in 2013/2014. Obese children suffer from major
      co-morbidities and therefore, only one third of referred patients can be treated in MGPs and
      their beneficial effects on obesity as well as physical and mental health outcomes are
      sustained over 2 years.
    

Detailed description: 
      In Switzerland, the number of overweight children <18 years is estimated to 80'000 and
      related cardiovascular, osteoarticular and other complications are already present in
      approximately in 50% of these youth. Controlled studies demonstrated that multiprofessional
      treatment programs can reduce adiposity and improve health risk factors. To pre-empt the
      deterioration of obesity and co-morbidities in adult life, the Swiss Department of the
      Interior (EDI) approved in 2007 the reimbursement of treatment of overweight children by
      health insurances , if conducted in certified multi-professional family-based group programs.
      All programs have to participate in a scientific evaluation study supported by the Federal
      Office of Public Health (FOPH) in order to determine nationwide outcomes in clinical
      practice. The goal of this study is to evaluate individual changes of physical activity,
      nutrition, behaviours, quality of life, co-morbidities and adiposity during therapy and to
      identify predictors of positive or negative changes.

      During 5 years, the investigators will recruit about 200 children and adolescents aged 6 to
      18 years every year. Patients must have a Body Mass Index (BMI), fat mass or waist
      circumference above the 97th percentile, or a BMI above the 90th percentile plus a
      co-morbidity. Together with their parents they will be enrolled in an intensive group therapy
      program for 6 to 12 months, with 12 months of follow up. To date, in 25 certified centres,
      physicians, nutrition and physical activity specialists as well as psychologists can provide
      a multiprofessional standardized care, the costs of participation being reimbursed after
      regular presence. At start, after 1 year and 2 years, standardized instruments validated in
      Swiss or European children will be used to document changes during therapy. Questionnaires
      will assess motivation, weight of parents, personal and family history, quality of life,
      child and family lifestyle, parenting skills, eating or psychological disorders, and
      satisfaction. Other investigations will include medical examination, blood tests, and
      European Fitness (*Eurofit*)-test for physical fitness and capacities. Anonymised data will
      be recorded centrally in an electronic database, after controlling for completeness and
      plausibility. Informed consent and positive votes of local ethical committees will be
      obtained. Reports on cross-sectional and longitudinal descriptive statistics and benchmarking
      will be provided once yearly. A comprehensive multivariate analysis of complex associations
      between predictors and health-related outcomes will be completed. Statistical analyses will
      be performed by specialists in each field and will be supervised by public health scientists.
      To guarantee meaningful analyses, the last patients will be included in December 2013.
    

Intervention name(s): multiprofessional group therapy
Intervention type(s): Behavioral
Intervention description(s): Behavioural therapy of lifestyle including activity, family and eating habits
Observational model: Case-Only
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Overweight children < 18 years of age
      
Keywords: Child; adolescent; co-morbidity; psychology; motivation; physical activity; eating disorders; quality of life; therapy; predictors