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Nutrition in acute and chronic diseases

Parent and child characteristics associated with treatment non-response to a short- versus long-term lifestyle intervention in pediatric obesity



This study aimed to identify the factors associated with short- or long-term non-response to an obesity intervention in children and adolescents.


In this observational study, a total of 242 children and adolescents (sex- and age-specific body mass index (BMI) ≥ 85th percentile) were divided into three groups according to the BMI z-score change after 6 (n = 163) and 24 months (n = 110) of participating in an obesity intervention: responders, low responders, and non-responders if the BMI z-score decrease was ≥0.25, 0 to 0.25, and if it increased, respectively.


Short-term non-response was associated with higher maternal psychosocial stress (OR = 2.34, 95% CI [1.07–5.11]) and adolescence (>11 years; OR = 2.40, 95% CI [1.10–5.22]). The odds of long-term non-response were reduced by an increased vegetable consumption of more than five dishes per week (OR = 0.21, 95% CI [0.07–0.69]) and an hour of increased sleep duration during weekends (OR = 0.14, 95% CI [0.04–0.53]).


Short-term non-response was associated with child and maternal characteristics, whereas long-term non-response was associated with actual lifestyle changes such as sleep duration and vegetable consumption. Children with obesity may benefit from an hour of weekend catch-up sleep in lowering the risk of long-term treatment non-response. An individualized approach should be considered for children of older age and mothers with a higher level of stress, as they may not benefit from a conventional short-term lifestyle intervention.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.


  1. Juonala M, Magnussen CG, Berenson GS, Venn A, Burns TL, Sabin MA, et al. Childhood adiposity, adult adiposity, and cardiovascular risk factors. N. Engl J Med. 2011;365:1876–85.

    Article  CAS  PubMed  Google Scholar 

  2. Weihrauch-Blüher S, Schwarz P, Klusmann JH. Childhood obesity: increased risk for cardiometabolic disease and cancer in adulthood. Metab: Clin Exp. 2019;92:147–52.

    Article  Google Scholar 

  3. Grulich-Henn J, Lichtenstein S, Hörster F, Hoffmann GF, Nawroth PP, Hamann A. Moderate weight reduction in an outpatient obesity intervention program significantly reduces insulin resistance and risk factors for cardiovascular disease in severely obese adolescents. Int J Endocrinol. vol. 2011; Article ID 541021:1–6.

  4. Grossman DC, Bibbins-Domingo K, Curry SJ, Barry MJ, Davidson KW, Doubeni CA, et al. Screening for obesity in children and adolescents us preventive services task force recommendation statement. JAMA - J Am Med Assoc. 2017;317:2417–26.

    Article  Google Scholar 

  5. Ells LJ, Rees K, Brown T, Mead E, Al-Khudairy L, Azevedo L, et al. Interventions for treating children and adolescents with overweight and obesity: an overview of Cochrane reviews. Int J Obes. 2018;42:1823–33.

    Article  Google Scholar 

  6. Knop C, Singer V, Uysal Y, Schaefer A, Wolters B, Reinehr T. Extremely obese children respond better than extremely obese adolescents to lifestyle interventions. Pediatr Obes. 2015;10:7–14.

    Article  CAS  PubMed  Google Scholar 

  7. Gow ML, Baur LA, Ho M, Chisholm K, Noakes M, Cowell CT, et al. Can early weight loss, eating behaviors and socioeconomic factors predict successful weight loss at 12- and 24-months in adolescents with obesity and insulin resistance participating in a randomised controlled trial? Int J Behav Nutr Phys Act. 2016;13:1.

    Article  Google Scholar 

  8. Danielsson P, Svensson V, Kowalski J, Nyberg G, Ekblom Ö, Marcus C. Importance of age for 3-year continuous behavioral obesity treatment success and dropout rate. Obes Facts. 2012;5:34–44.

    Article  PubMed  Google Scholar 

  9. Danielsson P, Bohlin A, Bendito A, Svensson A, Klaesson S. Five-year outpatient programme that provided children with continuous behavioural obesity treatment enjoyed high success rate. Acta Paediatrica, Int J Paediatrics. 2016;105:1181–90.

    Article  Google Scholar 

  10. Freemark M. Pharmacotherapy of childhood obesity. Diabetes Care. 2007;30:395–402.

    Article  CAS  PubMed  Google Scholar 

  11. Sabin MA, Ford A, Hunt L, Jamal R, Crowne EC, Shield JP. Which factors are associated with a successful outcome in a weight management programme for obese children? J Evaluation Clin Pract. 2007;13:364–8.

    Article  Google Scholar 

  12. Nielsen TRH, Fonvig CE, Dahl M, Mollerup PM, Lausten-Thomsen U, Pedersen O, et al. Childhood obesity treatment; effects on BMI SDS, body composition, and fasting plasma lipid concentrations. PLoS ONE. 2018;13:1–18.

    Google Scholar 

  13. Lee SY, Kim J, Oh S, Kim YM, Woo S, Jang HB, et al. A 24-week intervention based on nutrition care process improves diet quality, body mass index, and motivation in children and adolescents with obesity. Nutr Res. 2020;84:53–62.

    Article  CAS  PubMed  Google Scholar 

  14. Seo YG, Lim H, Kim Y, Ju YS, Choi YJ, Lee HJ, et al. Effects of circuit training or a nutritional intervention on body mass index and other cardiometabolic outcomes in children and adolescents with overweight or obesity. PLoS ONE. 2021;16:1–21.

  15. Moon JS, Lee SY, Nam CM, Choi JM, Choe BK, Seo JW, et al. 2007 Korean National Growth Charts: review of developmental process and an outlook. Korean J Pediatr. 2008;51:1.

  16. Jang S. Stress. The Korean Society for Preventive Medicine. Seoul, Korea: Kyechukmunhwasa. 2000:92–94.

  17. Goldberg D, Williams P. General health questionnaire (GHQ). Swindon, Wiltshire, UK: nferNelson. 2000.

  18. Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychological Meas. 1977;1:385–401.

    Article  Google Scholar 

  19. Chon KK, Rhee MK. Preliminary development of Korean version of CES-D. Korean J Clin Psychol. 1992;11:65–76.

    Google Scholar 

  20. Smucker MR, Craighead WE, Craighead LW, Green BJ. Normative and reliability data for the children’s depression inventory. J Abnorm Child Psychol. 1986;14:25–39.

    Article  CAS  PubMed  Google Scholar 

  21. Cho SC, Lee YS. Development of the Korean form of the Kovacs’ Children’s Depression Inventory. J Korean Neuropsychiatr Assoc. 1990;29:943–56.

    Google Scholar 

  22. Lee J, Lee C, Min J, Kang DW, Kim JY, Yang HI, et al. Development of the Korean Global Physical Activity Questionnaire: reliability and validity study. Glob Health Promotion. 2019;0:175797591985430.

    Google Scholar 

  23. Pott W, Albayrak Ö, Hebebrand J, Pauli-Pott U. Treating childhood obesity: family background variables and the child’s success in a weight-control intervention. Int J Eat Disord. 2009;42:284–9.

    Article  PubMed  Google Scholar 

  24. Moens E, Braet C, Van Winckel Myriam M. An 8-year follow-up of treated obese children: Children’s, process and parental predictors of successful outcome. Behav Res Ther. 2010;48:626–33.

    Article  PubMed  Google Scholar 

  25. Goldschmidt AB, Best JR, Stein RI, Saelens BE, Epstein LH, Wilfley DE. Predictors of child weight loss and maintenance among family-based treatment completers. J Consulting Clin Psychol. 2014;82:1140–50.

    Article  Google Scholar 

  26. Golan M, Crow S. Targeting parents exclusively in the treatment of childhood obesity: Long-term results. Obes Res. 2004;12:357–61.

    Article  PubMed  Google Scholar 

  27. Moens E, Braet C, Bosmans G, Rosseel Y. Unfavourable family characteristics and their associations with childhood obesity: a cross-sectional study. Eur Eat Disord Rev. 2009;17:315–23.

    Article  PubMed  Google Scholar 

  28. Nielsen TRH, Fonvig CE, Dahl M, Mollerup PM, Lausten-Thomsen U, Pedersen O, et al. Childhood obesity treatment; effects on BMI SDS, body composition, and fasting plasma lipid concentrations. PLoS ONE. 2018;13:1–18.

    Google Scholar 

  29. Wallace TC, Bailey RL, Blumberg JB, Burton-Freeman B, Chen CYO, Crowe-White KM, et al. Fruits, vegetables, and health: a comprehensive narrative, umbrella review of the science and recommendations for enhanced public policy to improve intake. Crit Rev Food Sci Nutr. 2020;60:2174–211.

    Article  CAS  PubMed  Google Scholar 

  30. Jang H, Lim H, Park K, Park S, Lee H. Changes in plasma choline and the betaine-to-choline ratio in response to 6-month lifestyle intervention are associated with the changes of lipid profiles and intestinal microbiota: The icaan study. Nutrients. 2021;13:1–13.

    Google Scholar 

  31. Li L, Zhang S, Huang Y, Chen K. Sleep duration and obesity in children: a systematic review and meta-analysis of prospective cohort studies. J Paediatrics Child Health. 2017;53:378–85.

    Article  Google Scholar 

  32. Tambalis KD, Panagiotakos DB, Psarra G, Sidossis LS. Insufficient sleep duration is associated with dietary habits, screen time, and obesity in children. J Clin Sleep Med. 2018;14:1689–96.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Rhie S, Chae KY. Effects of school time on sleep duration and sleepiness in adolescents. PLoS ONE. 2018;13:1–9.

    Article  Google Scholar 

  34. Lee BH, Kang SG, Choi JW, Lee YJ. The association between self-reported sleep duration and body mass index among korean adolescents. J Korean Med Sci. 2016;31:1996–2001.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Skelton JA, Beech BM. Attrition in paediatric weight management: a review of the literature and new directions. Obes Rev. 2011;12:273–81.

    Article  Google Scholar 

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This research was funded by the Korea Disease Control and Prevention Agency [grant number: 2016ER6405]. This work was supported by the Korea Disease Control and Prevention Agency [grant number: 2016ER6405].

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Authors and Affiliations



KHP and SW conceptualized the study, performed formal analysis and created the original draft. KHP, SW, YMK, and HJL participated in designing the research protocol and conducting the investigation. KHP, SW, HJS, and JKS contributed to data interpretation and critical revision of the manuscript. All authors have approved the final manuscript.

Corresponding author

Correspondence to Kyung Hee Park.

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The authors declare no competing interests.

Ethics approval and consent to participate

The study was conducted in accordance with the ethical guidelines regarding human participants that were approved by the Institutional Review Board of Hallym University Sacred Heart Hospital (no. 2016-I135). All participants and their primary caretakers provided written informed consent. Informed consent was obtained from all subjects involved in the study.

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Woo, S., Song, H.J., Song, JK. et al. Parent and child characteristics associated with treatment non-response to a short- versus long-term lifestyle intervention in pediatric obesity. Eur J Clin Nutr (2022).

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