Little is known about the influence of pediatric obesity treatment on the risk of longer-term medical events. A Swedish study carried out on 6,700 obese children aged 6 to 17 (median 12 years) who followed treatment for at least one year, shows that a good response to the latter is associated with a reduction in morbidity and mortality, particularly with a drop in the incidence of cardiometabolic disorders.
More specifically, the occurrence of type 2 diabetes (T2D), dyslipidemia and hypertension in adulthood is reduced when childhood obesity is effectively managed. The results, published in the Jama Pediatricsreport a graded risk reduction based on response to treatment. Anxiety and depression are not affected.
An effect on hypertension only in case of remission
The researchers distinguished four categories of treatment response: poor (1,224 children), intermediate (2,910), good (1,070) and obesity remission (1,506) and compared poor treatment response to the other three. .
A good response significantly reduces the risk of developing T2D, dyslipidemia or having bariatric surgery in adulthood (adjusted hazard ratio aHR = 0.42; 0.31 and 0.42 respectively). The finding is similar for remission with a marked reduction in risk for these three prognoses as well as a lower risk of hypertension: aHR = 0.16 for T2D; aHR = 0.22 for dyslipidemia; aHR = 0.14 for bariatric surgery and aHR = 0.40 in hypertension. The mortality rate is divided by eight in the case of remission or a good response to treatment (aHR = 0.8).
-Independent treatments for obesity and depression
For depression and anxiety, the difference between treatment response groups is not significant, which demonstrates the absence of a link between therapeutic effectiveness and psychiatric risk. For the authors, this suggests that, even if obesity coexists with anxiety and depression, therapies must be independent and dedicated to each disorder.
In an editorial associated with the study, Professors Leonard H. Epstein (University at Buffalo, Jacobs School of Medicine and Biomedical Sciences), Myles S. Faith (University at Buffalo – Graduate School of Education) et Denise E. Wilfley (Washington University School of Medicine), commentent : “The data indicate that age and degree of obesity have an influence on the achievement of therapeutic objectives. The percentage of children aged 6 to 12 years old achieving a good response or remission is 48.1% compared to 29.1% for those aged 12 to 17 years old.. The authors argue in favor of treatment as early as possible, during preadolescence, rather “what to wait to see if growth regulates their weight”.
And to salute the usefulness of this article whose data will allow “to improve the effectiveness of clinical approaches and to point out their limits”. However, specialists deplore the lack of information on the type of therapeutic interventions carried out and their intensity, making comparison with recommendations from other countries difficult.
