Effects of multidisciplinary interventions on weight loss
and health outcomes in children and adolescents with
, G. ten Velde
and A. C. E. Vreugdenhil
Centre for Overweight Adolescent and
Children’s Healthcare (COACH), Department of
Paediatrics, Maastricht University Medical
Centre, Maastricht, The Netherlands, and
School of Nutrition and Translational Research
in Metabolism (NUTRIM), Maastricht University,
Maastricht, The Netherlands
Received 16 November 2017; accepted 28
Address for correspondence: ACE
Vreugdenhil, Centre for Overweight Adolescent
and Children’s Healthcare (COACH),
Department of Paediatrics, Maastricht
University Medical Centre, P. Debyelaan 25,
6229 HX Maastricht, The Netherlands.
Morbid obesity is the fastest growing subcategory of childhood
obesity, associated with an increased health risk that persists into adulthood. There
is an urgent need to develop multifaceted interventions that target initial and long-
term lifestyle changes. This review investigates the effects of multidisciplinary
interventions on weight loss and health outcomes in children and adolescents with
morbid obesity. The influence of age, gender and family participation on health
outcomes and intensive treatment alternatives are explored.
The review includes 16 studies conducted between 1995 and 2017.
Studies examined youth with morbid obesity, 4–18 years old, undergoing multidis-
All studies found a reduction in body mass index (BMI or z-score) and if
measured, cardiovascular risk factors. Physical activity, nutrition education,
behavioural modification and family involvement are commonly included treat-
ment components and have improved weight loss and health-related outcomes.
However, initial weight loss was often not sustainable, despite the favourable
interventional effect on cardiometabolic risk markers. Weight loss was prolonged
in younger children and among the male sex.
There is not a ‘one-size-fits-all’ treatment approach, and matched
care to personal needs is preferable. The integration of a chronic care approach is
critical for the successful adaption of sustainable health behaviours.
Keywords: Cardiovascular diseases, childhood obesity, morbid obesity, obesity
Abbreviations: BMI, Body mass index; CVD, Cardiovascular disease; mHealth,
Mobile health; RYGB, Roux-en-Y gastric bypass; SG, Sleeve gastrectomy.
The childhood obesity epidemic is a critical public health
challenge facing the 21
century, incurring a significant
loss of quality of life and increased costs to society and
healthcare systems worldwide (1). Despite the stabiliza-
tion trend of childhood obesity prevalence in the United
States, a greater shift toward severe or morbid obesity
has emerged (1,2). Alarmingly, morbid obesity is the
fastest growing subcategory of childhood obesity,
affecting 4%–6% of youth in the United States (1,3). In
European countries such as the Netherlands, the preva-
lence of morbid obesity among children has also been
steadily increasing (4).
When compared to children with overweight or obesity,
individuals with morbid obesity possess a significant health
risk that is likely to project into adulthood, including the
potential for developing life-threatening chronic diseases,
© 2018 The Authors. Obesity Reviews published by John Wiley & Sons Ltd
on behalf of World Obesity Federation
Obesity Reviews 19, 931–946, July 2018
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any
medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.