ESPE Yearbook of Paediatric Endocrinology

Brief Summary: For both clinicians and patients, it is of great interest to have easily-applicable predictors to forecast weight reductions achievable by lifestyle intervention (LI). This study identified 3 distinct clusters of responses to paediatric outpatient LI. Up to 2 years after LI initiation, responses ranged from ‘pronounced BMIz loss’ (in 19% of patients; median delta-BMIz: -0.61 (IQR: -0.76 to -0.49) to ‘moderate BMIz loss’ (in 45%; -0.23 (-0.33 to -0.14)) and ‘no BMIz loss’ (or even an BMIz increase) (in 36%). Greater LI response was predicted by younger age (5 to ≤11 years), lower baseline BMIz, greater initial BMIz reduction (at least 5%), and longer LI duration (≥12 months). By contrast, living in socioeconomically deprived areas and having a family history of obesity predicted limited response to LI.

This study highlights again the need for early, and sustained, personalized intervention among pediatric individuals living with overweight and obesity. In high-risk subjects with likely limited benefit from LI, early treatment escalation using approved weight-reduction drugs or bariatric surgery in addition to LI might be considered to support weight loss. However, large heterogeneity to semaglutide treatment in addition to LI among adolescents (>12 years) has been reported and warrants better understanding of the underlying mechanisms [1]. Additional studies on the economic benefits of timely, patient-tailored intervention and prevention programs might help to convince health care insurances and policy makers in the future. LI programs are often characterized by high drop-out rates. Thereby, the current study may be biased due to the inclusion criteria of multiple follow-up visits, so only families with good adherence to LI might have been included. This in turn may explain the high success rate; >60% of individuals achieved BMIz reduction ≥0.2 within 2 years. As the study is from Germany, its generalizability to other ethnic groups or countries with different healthcare systems is unclear.

Reference: 1. Weghuber, D.; Barett T.; Barrientos-Pérez, M.; Gies, I.; Hesse D.; Jeppesen, O.K.; Kelly, A.S.; Mastrandrea, L.D.; Sørrig, R.; Arslanian, S.; Once-Weekly Semaglutide in Adolescents with Obesity. N Engl J Med 2022, 387 (24), 2245-2257. doi:10.1056/NEJMoa2208601.