个体、以社区为基础的肥胖儿童及其家庭治疗方法：聚焦解决方法。
An individual, community-based treatment for obese children and their families: the solution-focused approach.
机构信息
Department of Pediatrics, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
出版信息
Obes Facts. 2013;6(5):424-32. doi: 10.1159/000355909. Epub 2013 Oct 8.
BACKGROUND
This study evaluates an individual, community-based treatment for obese children and their families. In this program, a treatment team applied solution-focused techniques to develop a custom-made treatment plan in collaboration with the participants. The treatment plan consisted of community-based lifestyle activities.
METHODS
559 obese children with an average BMI z-score of 2.76 ± 0.54 took part in the 12-month study, and 372 children with an average BMI z-score of 2.75 ± 0.52 took part in the 24-month study. At the start of the study, ethnicity and special school needs were recorded. Before, after 12 months, and after 24 months of the treatment, body weight and height were measured. The effect of the treatment on body weight was evaluated using BMI z-scores.
RESULTS
291 children (52%) completed 12 months of treatment, whereas 22 children (4%) were dismissed earlier due to a good response. After 12 months, the children showed a significant decrease in BMI z-score by 0.16 (95% confidence interval (CI) 0.11-0.20; p < 0.005). After 24 months, 103 children (28%) were participating in the program, with a significant decrease in BMI z-score of 0.15 (95% CI 0.07-0.22; p < 0.005). 50 children (13%) were dismissed before the end of the second year due to significant weight loss (standard deviation z-score reduction -0.38; 95% CI 0.30-0.46; p < 0.005; with an average treatment duration of 12.9 ± 6.4 months). There was a negative correlation of age and reduction in BMI z-score: children younger than 6 years showed a decrease in BMI z-score of 0.45 (95% CI 0.26-0.65) and 0.31 (95% CI 0.11-0.53) after 12 and after 24 months, respectively.
CONCLUSIONS
Children showed a significant decrease in BMI z-score after the treatment. We found a negative correlation of age and weight loss. Special attention to patients with a high risk of drop-out might further improve these results. We advise a referral to obesity treatment as early as possible since a 'wait and see' policy might have adverse results in obese children.
背景
本研究评估了一种针对肥胖儿童及其家庭的个体化、社区为基础的治疗方法。在该方案中，治疗团队应用以问题为导向的方法，与参与者共同制定定制化的治疗计划。治疗计划包括以社区为基础的生活方式活动。
方法
559 名肥胖儿童参与了为期 12 个月的研究，平均 BMI z 分数为 2.76 ± 0.54；372 名肥胖儿童参与了为期 24 个月的研究，平均 BMI z 分数为 2.75 ± 0.52。在研究开始时，记录了种族和特殊学校需求。在治疗开始、治疗 12 个月后和治疗 24 个月后，测量体重和身高。使用 BMI z 分数评估治疗对体重的影响。
结果
291 名儿童（52%）完成了 12 个月的治疗，而 22 名儿童（4%）因反应良好而提前退出。治疗 12 个月后，儿童的 BMI z 分数显著下降 0.16（95%置信区间 0.11-0.20；p<0.005）。治疗 24 个月后，103 名儿童（28%）继续参与该方案，BMI z 分数显著下降 0.15（95%置信区间 0.07-0.22；p<0.005）。50 名儿童（13%）在第二年结束前因体重显著减轻而退出（标准偏差 z 分数降低-0.38；95%置信区间 0.30-0.46；p<0.005；平均治疗持续时间为 12.9 ± 6.4 个月）。年龄与 BMI z 分数降低呈负相关：6 岁以下儿童治疗 12 个月和 24 个月后 BMI z 分数分别下降 0.45（95%置信区间 0.26-0.65）和 0.31（95%置信区间 0.11-0.53）。
结论
治疗后儿童 BMI z 分数显著下降。我们发现年龄与体重减轻呈负相关。特别关注高脱落风险的患者可能会进一步改善这些结果。我们建议尽早转介到肥胖治疗，因为“观望”政策可能会对肥胖儿童产生不良结果。
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