Predictors of Weight Reduction in a Multidisciplinary Community Program for Children with Overweight and Obesity: A Study from Emilia-Romagna, Italy.

Background: The worldwide prevalence of obesity in children and adolescents quadrupled in the past decades, becoming a public health priority. Following the recommendation by the Italian Minister of Health, the Emilia-Romagna Region started a community-based program aimed at reducing pediatric overweight through children and family behavioral counseling on nutrition and physical activity. Methods: Children with excess weight, aged 2-17 years, and without severe diseases were visited five times by a multidisciplinary team, who provided dietary advice, exercise plans, and psychosocial support, according to Italian guidelines. The outcomes were the median pre-post change in Δ₃₀BMI (distance between children's BMI and age- and sex-specific obesity threshold values) and the proportion of children who moved to a lower weight class. Logistic regression was used to identify potential predictors of weight improvement. Results: Up to March 2025, 1331 participants completed the follow-up. In total, 17.5% of the children showed an improvement in weight class, and 32.5% had a reduction of more than one unit of Δ₃₀BMI. The program was significantly and substantially more effective among the children with obesity at baseline (overweight vs. obese children adjusted odds ratio-aOR-of weight class improvement: 0.28; p < 0.001), older than eight years (9-11 years vs. 2-8 years children aOR: 1.41; p < 0.05), who adhered to breakfast recommendations (aOR: 1.60; p < 0.01) and had no obese parents (≥1 vs. 0 obese parents aOR: 0.62; p < 0.05). Conclusions: The multidisciplinary model was associated with an overall positive impact on the weight status of the enrolled children. Given the varying response, however, in order to maximize cost-effectiveness, future programs could be reserved for children with obesity, older than eight years. Further randomized research is needed to investigate the efficacy of this intervention in different settings and on late clinical endpoints.