Impact of Psychosocial Risk on Outcomes among Families Seeking Treatment for Obesity

J Pediatr. 2018 Jul:198:110-116. doi: 10.1016/j.jpeds.2018.02.071. Epub 2018 Apr 5.


Objectives: To test the hypothesis that children with elevated psychosocial risk would have increased attrition and worse weight outcomes in weight management treatment.

Study design: This was a prospective cohort study of 100 new patients, aged 4-12 years, in a weight management clinic. Parents completed the Psychosocial Assessment Tool. Logistic regression analyses were conducted to calculate the odds of attrition from the clinic and a nonmeaningful change in body mass index (BMI) z-score (ie, <0.1 unit decrease in BMI z-score) over a 6-month period based on psychosocial risk category, adjusting for child demographics and baseline weight category.

Results: The majority of patients were male (59%), black (36%) or white (43%), and had severe obesity (55%), and 59% of families were categorized as having moderate or high psychosocial risk. Over the 6-month period, 53% of families were lost to follow-up, and 67% did not have a clinically meaningful decrease in BMI z-score. Compared with children of families with low psychosocial risk, children of families with moderate or high psychosocial risk were 3.1 times (95% CI, 1.3-7.2 times) more likely to be lost to follow-up and 2.9 times (95% CI, 1.1-7.9 times) more likely to have a non-clinically meaningful change in BMI z-score.

Conclusions: Children presenting with increased psychosocial risk have higher attrition and poorer weight outcomes, supporting the need for psychosocial screening as a standard component of pediatric weight management treatment.

Keywords: attrition; behavior; weight.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Body Mass Index
  • Child
  • Child, Preschool
  • Family Relations*
  • Female
  • Humans
  • Logistic Models
  • Male
  • Pediatric Obesity / epidemiology
  • Pediatric Obesity / psychology
  • Pediatric Obesity / therapy*
  • Prospective Studies
  • Risk Factors
  • Socioeconomic Factors
  • Treatment Outcome