Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Pediatrics

Exploring the association between individual, family, and program characteristics and change in health outcomes 12 months after enrollment into the CANadian Pediatric Weight management Registry (CANPWR)

International Journal of Obesity volume 49, pages 109–117 (2025)Cite this article

Subjects

Abstract

Objectives

To examine individual, family, and program characteristics associated with changes in anthropometric and cardiometabolic health indicators in children with overweight or obesity after participating in multidisciplinary obesity management for 12 months.

Methods

Participants included children 2–17 years old with overweight or obesity enrolled in the CANadian Pediatric Weight Management Registry (CANPWR). Multiple linear regression analyses were conducted to investigate the associations between individual, family, and program characteristics and changes in anthropometry (WHO BMI z-score) and cardiometabolic health indicators (systolic and diastolic blood pressure; fasting and 2-h glucose post-oral glucose tolerance test (OGTT); high density lipoprotein- (HDL) and non-HDL cholesterol and fasting triglycerides).

Results

BMI z-score data were available from 1065/1286 (82.8%) at 6-months post-baseline and 893/1286 (69.4%) at 12-months post-baseline. At 6-months, BMI z-score decreased relative to baseline (mean difference (MD) [95% confidence interval (CI)] = −0.08 [−0.10 to −0.06]; p < 0.001). BMI z-score (MD [95% CI] = −0.08 [−0.13 to −0.04); p = 0.001) and fasting triglycerides (MD [95% CI] = −0.07 [−0.13 to −0.02); p = 0.011) decreased at 12 months from baseline. Older age at baseline (estimated β = 0.025; 95% CI [0.006, 0.042], p = 0.007) and female sex (estimated β = 0.241; 95% CI [0.108, 0.329], p < 0.001) were associated with a worsened Δ BMI z-score at 12 months, while total hours with mental health provider (estimated β = −0.015; 95% CI [−0.030, −0.001], p = 0.049) was associated with an improved Δ BMI z-score at 12 months. Hours with an exercise counselor (estimated β = 0.023; 95% CI [0.008, 0.039], p = 0.003) were associated with improved HDL, while hours with a registered dietitian (estimated β = −0.026; 95% CI [−0.051, −0.001], p = 0.044) were associated with improved non-HDL cholesterol.

Conclusions

Male sex and hours spent with a mental health provider, exercise counselor, and registered dietitian were related to significant improvements in several anthropometric and cardiometabolic health indicators at 12 months post-baseline.

Access through your institution
Buy or subscribe

This is a preview of subscription content, access via your institution

Access options

Access through your institution

Buy this article

  • Purchase on SpringerLink
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Significant independent predictors of Δ BMI z-score 12 months.
Fig. 2: Significant independent predictors of Δ BMI z-score (−0.5) 12 months.

Similar content being viewed by others

Data availability

The datasets generated during and/or analyzed during the current study are not publicly available due to the risk of individual participant privacy being compromised, but a deidentified dataset are available from the corresponding author on reasonable request.

References

  1. World Health Organization. Obesity and overweight. 2021. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight.

  2. Goran MI, Ball GDC, Cruz ML. Obesity and risk of type 2 diabetes and cardiovascular disease in children and adolescents. J Clin Endocrinol Metab. 2003;88:1417–27.

    Article  CAS  PubMed  Google Scholar 

  3. Jebeile H, Kelly AS, O'Malley G, Baur LA. Obesity in children and adolescents: epidemiology, causes, assessment, and management. Lancet Diabetes Endocrinol. 2022;10:351–65.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Romanelli R, Cecchi N, Carbone MG, Dinardo M, Gaudino G, Miraglia del Giudice E, et al. Pediatric obesity: prevention is better than care. Ital J Pediatr. 2020;46:1–7.

    Article  Google Scholar 

  5. Foster BA, Farragher J, Parker P, Sosa ET. Treatment interventions for early childhood obesity: a systematic review. Acad Pediatr. 2015;15:353–61.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Nordlund S, McPhee PG, Gabarin R, Deacon C, Mbuagbaw L, Morrison KM. Effect of obesity treatment interventions in preschool children aged 2–6 years: a systematic review and meta-analysis. BMJ Open. 2022;12:e053523.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Al‐Khudairy L, Loveman E, Colquitt JL, Mead E, Johnson RE, Fraser H, et al. Diet, physical activity and behavioural interventions for the treatment of overweight or obese adolescents aged 12 to 17 years. Cochrane Database Syst Rev. 2017;6:CD012691.

  8. Mead E, Brown T, Rees K, Azevedo LB, Whittaker V, Jones D, et al. Diet, physical activity and behavioural interventions for the treatment of overweight or obese children from the age of 6 to 11 years. Cochrane Database Syst Rev. 2017;6:CD012651.

  9. Smith JD, George SM, Prado G. Family-centered positive behavior support interventions in early childhood to prevent obesity. Child Dev. 2017;88:427–35.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Yackobovitch‐Gavan M, Wolf Linhard D, Nagelberg N, Poraz I, Shalitin S, Phillip M, et al. Intervention for childhood obesity based on parents only or parents and child compared with follow‐up alone. Pediatr Obes. 2018;13:647–55.

    Article  PubMed  Google Scholar 

  11. Rhee KE, Kessl S, Lindback S, Littman M, El-Kareh RE. Provider views on childhood obesity management in primary care settings: a mixed methods analysis. BMC Health Serv Res. 2018;18:1–10.

    Article  Google Scholar 

  12. McPhee PG, Zenlea I, Hamilton JK, Ho J, Ball GDC, Mian R, et al. Individual and family characteristics associated with health indicators at entry into multidisciplinary pediatric weight management: findings from the CANadian Pediatric Weight management Registry (CANPWR). Int J Obes. 2022;46:85–94.

    Article  CAS  Google Scholar 

  13. Morrison KM, Damanhoury S, Buchholz A, Chanoine J, Lambert M, Tremblay MS, et al. The CANadian Pediatric Weight management Registry (CANPWR): study protocol. BMC Pediatr. 2014;14:1–8.

    Article  Google Scholar 

  14. Onis MD, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ. 2007;85:660–7.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Morrison KM, Ball GDC, Ho J, Mackie P, Buckholz A, Chanoine J, et al. The CANadian Pediatric Weight management Registry (CANPWR): lessons learned from developing and initiating a national, multi-centre study embedded in pediatric clinical practice. BMC Pediatr. 2018;18:1–7.

    Article  Google Scholar 

  16. World Health Organization. WHO child growth standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: methods and development. World Health Organization; Geneva, Switzerland. 2006.

  17. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114:555–76.

  18. Jean-François Yale M, Breay Paty M, Peter A. Diabetes Canada Clinical Practice Guidelines Expert Committee. Can J Diabetes. 2018;42:S104–8.

    PubMed  Google Scholar 

  19. Dileepan K, Feldt MM. Type 2 diabetes mellitus in children and adolescents. Pediatr Rev. 2013;34:541–8.

    Article  PubMed  Google Scholar 

  20. Daniels SR, Greer FR, Committee on Nutrition. Lipid screening and cardiovascular health in childhood. Pediatrics. 2008;122:198–208.

  21. Zahn K, Ibrahim Q, Ball GDC, Buchholz A, Hamilton J, Ho J, et al. Variability in how Canadian pediatric weight management clinics deliver care: evidence from the Canadian pediatric weight management registry. Child Obes. 2021;17:420–6.

    Article  PubMed  Google Scholar 

  22. Reinehr T, Lass N, Toschke C, Rothermel J, Lanzinger S, Holl RW. Which amount of BMI-SDS reduction is necessary to improve cardiovascular risk factors in overweight children? J Clin Endocrinol Metab. 2016;101:3171–9.

    Article  CAS  PubMed  Google Scholar 

  23. Ford AL, Hunt LP, Cooper A, Shield JP. What reduction in BMI SDS is required in obese adolescents to improve body composition and cardiometabolic health? Arch Dis Child. 2009;95:256–61.

    Article  PubMed  Google Scholar 

  24. Kolsgaard MLP, Joner G, Brunborg C, Anderssen SA, Tonstad S, Andersen LF. Reduction in BMI z-score and improvement in cardiometabolic risk factors in obese children and adolescents. The Oslo Adiposity Intervention Study—a hospital/public health nurse combined treatment. BMC Pediatr. 2011;11:1–8.

    Article  Google Scholar 

  25. Shah B, Cost KT, Fuller A, Birken CS, Anderson LN. Sex and gender differences in childhood obesity: contributing to the research agenda. BMJ Nutr Prev Health. 2020;3:387.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Tanda R, Salsberry P. The impact of the 2007 expert committee recommendations on childhood obesity preventive care in primary care settings in the United States. J Pediatr Health Care. 2014;28:241–50.

    Article  PubMed  Google Scholar 

  27. Ross MM, Kolbash S, Cohen GM, Skelton JA. Multidisciplinary treatment of pediatric obesity: nutrition evaluation and management. Nutr Clin Pract. 2010;25:327–34.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Zenlea IS, Burton ET, Askins N, Pluhar EI, Rhodes ET. The burden of psychosocial stressors and urgent mental health problems in a pediatric weight management program. Clin Pediatr. 2015;54:1247–56.

    Article  Google Scholar 

  29. Griffiths LJ, Dezateux C, Hill A. Is obesity associated with emotional and behavioural problems in children? Findings from the Millennium Cohort Study. Int J Pediatr Obes. 2011;6:e423–32.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Halfon N, Larson K, Slusser W. Associations between obesity and comorbid mental health, developmental, and physical health conditions in a nationally representative sample of US children aged 10 to 17. Acad Pediatr. 2013;13:6–13.

    Article  PubMed  Google Scholar 

  31. Warschburger P, Kröller K. Loss to follow-up in a randomized controlled trial study for pediatric weight management (EPOC). BMC Pediatr. 2016;16:1–9.

    Article  Google Scholar 

  32. Whitlock EP, O’Connor EA, Williams SB, Beil TL, Lutz KW. Effectiveness of weight management interventions in children: a targeted systematic review for the USPSTF. Pediatrics. 2010;125:e396–418.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The CANPWR study was funded by the Canadian Institutes of Health Research, the Population Health Research Institute (PHRI), McMaster Children’s Hospital, and McMaster University. PGM was funded by a CIHR Fellowship FRN 164649. JKH was supported with unrestricted research funds by the University of Toronto Mead Johnson Chair in Child Nutrition. GDCB was supported by an Alberta Health Services Chair in Obesity Research. The CANPWR investigators would like to acknowledge the research teams at each clinic and at the central coordinating site (PHRI) for their exceptional support and all of the children and their families for participating in this study.

Author information

Authors and Affiliations

  1. Department of Pediatrics, McMaster University, Hamilton, ON, Canada

    Patrick G. McPhee & Katherine M. Morrison

  2. Centre for Metabolism, Obesity, and Diabetes Research, McMaster University, Hamilton, ON, Canada

    Patrick G. McPhee & Katherine M. Morrison

  3. Department of Pediatrics, Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, AB, Canada

    Geoff D. C. Ball

  4. Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada

    Annick Buchholz, Stasia Hadjiyannakis & Mark S. Tremblay

  5. Hospital for Sick Children, University of Toronto, Toronto, ON, Canada

    Jill K. Hamilton & Catherine Birken

  6. Department of Pediatrics, University of Calgary, Calgary, AB, Canada

    Josephine Ho

  7. Trillium Health Partners, Mississauga, ON, Canada

    Ian Zenlea

  8. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada

    Lehana Thabane

  9. Biostatistics Unit, St Joseph’s Healthcare Hamilton, Hamilton, ON, Canada

    Lehana Thabane

  10. Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa

    Lehana Thabane

  11. Population Health Research Institute, Hamilton, ON, Canada

    Katherine M. Morrison

  12. Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada

    Jean-Pierre Chanoine

  13. CHU Sainte-Justine Research Center, Montréal, QC, Canada

    Anne-Marie Laberge

  14. Department of Pediatrics, McGill University, Montreal, QC, Canada

    Laurent Legault

Authors
  1. Patrick G. McPhee
    View author publications

    Search author on:PubMed Google Scholar

  2. Geoff D. C. Ball
    View author publications

    Search author on:PubMed Google Scholar

  3. Annick Buchholz
    View author publications

    Search author on:PubMed Google Scholar

  4. Jill K. Hamilton
    View author publications

    Search author on:PubMed Google Scholar

  5. Josephine Ho
    View author publications

    Search author on:PubMed Google Scholar

  6. Ian Zenlea
    View author publications

    Search author on:PubMed Google Scholar

  7. Lehana Thabane
    View author publications

    Search author on:PubMed Google Scholar

  8. Katherine M. Morrison
    View author publications

    Search author on:PubMed Google Scholar

Consortia

CANPWR Consortium

  • Geoff D. C. Ball
  • , Catherine Birken
  • , Annick Buchholz
  • , Jean-Pierre Chanoine
  • , Stasia Hadjiyannakis
  • , Jill K. Hamilton
  • , Josephine Ho
  • , Anne-Marie Laberge
  • , Laurent Legault
  • , Katherine M. Morrison
  • , Lehana Thabane
  • , Mark S. Tremblay
  •  & Ian Zenlea

Contributions

PGM wrote the first draft of this manuscript supported by the writing group comprised of GDCB, AB, JKH, JH, IZ, LT, and KMM. GDCB, AB, JKH, JH, IZ, LT, and KMM contributed to the study design, study conduct, data collection and interpretation of findings. KMM also oversaw the acquisition of funding and study design. PGM conducted the analysis, and LT contributed to the analytical review. All authors, including those in the consortium listed below (CB, JPC, SH, AML, LL, MT), edited the manuscript and approved the final version.

Corresponding author

Correspondence to Katherine M. Morrison.

Ethics declarations

Competing interests

PGM, AB, JPC, AL, MST, JH and LT have no competing interests. IZ is an advisory board member for Novo Nordisk, Dexcom, and Abbot Diabetes Care. JKH is a site investigator for studies sponsored by Levo Therapeutics, Canada, Rhythm Pharmaceuticals and Eli Lilly, and an advisory board member for Novo Nordisk. GDCB and LL are advisory board members for Novo Nordisk. KMM is an advisory board member for Novo Nordisk and Akcea Therapeutics, Canada.

Ethics approval and consent to participate

The CANPWR study was approved by the following Research Ethics Boards: Hamilton Integrated Research Ethics Board, Conjoint Health Research Ethics Board (Calgary, Alberta), Research Ethics Board Trillium Health Partners, Health Research Ethics Board—Health Panel (Edmonton, Alberta), Children’s Hospital of Eastern Ontario Research Ethics Board, The Hospital for Sick Children Research Ethics Board, University of British Columbia Clinical Research Ethics Board, CHU Sainte-Justine Research Ethics Board, McGill University Health Centre Research Ethics Board—Pediatrics. All methods in the study were performed in accordance with the relevant guidelines and regulations of each Research Ethics Board. Written informed consent was obtained from the child’s parent or guardian, and participants provided assent.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

McPhee, P.G., Ball, G.D.C., Buchholz, A. et al. Exploring the association between individual, family, and program characteristics and change in health outcomes 12 months after enrollment into the CANadian Pediatric Weight management Registry (CANPWR). Int J Obes 49, 109–117 (2025). https://doi.org/10.1038/s41366-024-01631-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue date:

  • DOI: https://doi.org/10.1038/s41366-024-01631-2

Search

Advanced search

Quick links