Objective: 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).
Methods: 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 KIDSSTEP[1] 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.
Results: Out of 3482 patients referred, only 36% started in MGPs, while 30% were treated for co-morbidities in an individual setting. The return rate for MGP data was 1162 (87.3%), 682 (87.5%) and 354 patients (50.8 %) at T0, T2 and T3, respectively. At baseline, the mean age was 12.2±2.5 years (46 % non-Swiss origin, 54% girls) while the onset of obesity was at 6 years. There were 78.6% of children with extreme obesity (BMI>P.99.5), 16.6% with obesity (97 < P.< 99.5) and 4.6% with overweight (P.90-P.97). After therapy, the BMI standard deviation score (BMI-SDS) was significantly reduced by -0.23 at T2 and -0.31 at T3, or in 70.5% and 70.2% of participants, respectively. Systolic blood pressure, physical capacities and fitness, family lifestyle and child’s eating disorders significantly improved over time. At T0, quality of life was poor and major co-morbidities such as orthopaedic (68%) or mental disorders (45%) were present. All improved during therapy. A better outcome at T2 was predicted by age below 12 years and normal scores for mental health, quality of life or eating disorders. The drop out at T1 was predicted by high BMI-SDS and non-Swiss parents.
Conclusion: 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. There is an urgent need to improve the programs financial support, the regional dissemination, the follow-up phase, and also the quality of care for obese children who cannot participate in group therapy.
[1] funded by the FOPH Grant / decree # 09.004211/204.0001/-629, Methods assessed: family origin and eating & activity habits, body mass index standard deviation score (BMI-SDS), waist circumference (WC), blood pressure (BP), physical capacity (Eurofit Test), quality of life (Kidsscreen 52), eating disorders (AD-EVA) and mental health problems (SDQ)
