Insulin resistance and parental obesity as predictors of unresponsiveness to standard therapeutic lifestyle change intervention
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Among predictors of weight loss, compensatory hyperinsulinaemia due to insulin resistance may impede or delay lipolysis and fatty acid oxidation in states of negative caloric intake and/or exercise-induced caloric expenditure, as a component of metabolic inflexibility. This retrospective chart review aimed to examine whether insulin resistance and parental obesity were predictors of improvement in weight status in obese children and adolescents undergoing therapeutic lifestyle change intervention. A total of 134 adolescents above the 95th percentile for body mass index (BMI) were studied. Weight management success was defined as BMI Z-score at final exam minus BMI Z-score at initial exam ≤0. In total, 99 were successful (group S) and 35 were not successful (NotS). At baseline, insulin resistance was significantly higher in the NotS group than in the S group as reflected by higher fasting insulin levels and higher HOMA-IR. After adjusting for confounding variables, an increase of 10 units of insulin resulted in 3.13-fold increased odds of failure whereas an increase in 1 unit of HOMA-IR resulted in 1.64-fold increased odds of failure. The same multivariate logistic regression analysis revealed that the existence of obesity-associated morbidity in both parents was associated with 12.6-fold increased odds of failure. In conclusion, failure to respond to standard therapeutic lifestyle change intervention was dependent on baseline insulin resistance and parental obesity-related comorbidity.
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