REGULAR ARTICLE Five-year outpatient programme that provided children with continuous behavioural obesity treatment enjoyed high success rate Pernilla Danielsson (pernilla.danielsson@ki.se) 1 , Anna Bohlin 2 , Ana Bendito 2 , Annie Svensson 2 , Sven Klaesson 2 1.Department of Clinical Science, Division of Pediatrics, Karolinska Institutet, Intervention and Technology (CLINTEC), Stockholm, Sweden 2.Department of Women’s and Children’s Health, S€ odert€ alje Hospital, S€ odert€ alje, Sweden Keywords Behavioural treatment, Childhood obesity, Long- term treatment, Outpatient paediatric clinic Correspondence Pernilla Danielsson, PhD, RN, Department of Pediatrics, Karolinska Institutet, B62, SE-141 86 Stockholm, Sweden. Tel: +46 8 58587423 | Fax: +46 8 58587200 | Email: pernilla.danielsson@ki.se Received 12 May 2015; revised 3 September 2015; accepted 5 February 2016. DOI:10.1111/apa.13360 ABSTRACT Aim: Results from long-time follow-up of obesity treatment in early childhood are lacking. We investigate long-term continuous behavioural childhood obesity treatment and factors of importance for treatment effect. Method: A five-year longitudinal retrospective controlled study of children aged five to 13 years in obesity treatment, divided into three groups depending on age at start of treatment. Outcome is presented as change in degree of obesity, body mass index standard deviation score (BMI SDS), change in weight status and decrease of ≥0.5 BMI SDS units, in relation to a age-matched obese comparison group. Results: In total, 220 children (46% females) were included. After five years of treatment, the decrease in BMI SDS was significant in all age groups with the largest effect in age group 4-6 years. Compared to the comparison group (n = 369), the decline in BMI SDS was greater (p = 0.001). After five years of treatment, 48% of the patients were cured from their obesity and 72% reached a decline of 0.5 BMI SDS units. Age at start of treatment was the only factor affecting treatment efficacy. Conclusion: The ability to reach a significant weight loss in a paediatric outpatient clinic is promising through a long-term behavioural obesity treatment. BACKGROUND Today, childhood obesity is a major public health problem which has reached epidemic proportions (1,2). Recent statistics show that the prevalence of childhood obesity has stabilised in several developed countries, but is still at historically high levels (2). In Sweden, the prevalence seems to have levelled off at 2–5% obesity 15–24% overweight, the different numbers depending on variations in age, living areas and the socioeconomic status of the families in different studies (3,4). The obese child suffers from a complex pattern of metabolic disorders, low quality of life and poor social integration (1). Metabolic disorders can already be seen in childhood and persist later in life (5,6). Thus, there is an urgent need for effective childhood obesity treatment. More effort has been made to find well-functioning forms of treatment for children with obesity (7–9). The most common forms of treatment focus on lifestyle interventions involving cognitive and beha- vioural techniques as well as solution focused and motiva- tional approaches in combination (8) to promote healthy eating habits and physical activity, as well as to reduce time spent in sedentary activities. The forms of behavioural lifestyle interventions vary from group-based, individual- and family-based and combinations of these formats (7). We have previously shown that the outcome of three years of behavioural therapy at a referral obesity centre was good in young children but very poor in adolescents (10,11). The effect of behavioural treatment is especially negligible for severely obese adolescents (10). A recent review by Reinehr concludes that lifestyle interventions are effective in obese children if parents are actively involved, that younger children more easily profit from the intervention, that group settings are more effective, and further, that reduction in sugar-sweetened drinks are the only proven effective diet Abbreviations BMI SDS, Body mass index standard deviation score; BVCF, Baseline value carried forward; EPD, Extrapolated data; FAS, Full analysis population; LOCF, Last observation carried forward; MI, Motivational interwieving. Key Notes  Results from long-time follow-up of obesity treatment in early childhood are lacking.  In this longitudinal controlled study, we investigated the effect of behavioural treatment in children aged five to 13 years in an outpatient paediatric clinic.  After five years of treatment, almost half of the patients were cured from their obesity and age at start of treatment was the only factor affecting the treatment efficacy. ©2016 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd 1 Acta Pædiatrica ISSN 0803-5253