Long-term changes in psychosocial well-being in children with obesity deciding not to participate in a lifestyle intervention

Abstract Purpose To investigate whether children with obesity who decide not to participate in a lifestyle intervention experience a more negative long-term development in psychosocial well-being. Methods This observational study included 403 children aged 5–10 years with obesity. Children who decided not to participate ( n = 71) were compared to those not invited (not-invited group, n = 225) and those attending the lifestyle intervention (intervention group, n = 107). Psychosocial well-being was assessed with a mean follow-up of 24.5 ± 4.5 months using the self-reported Danish National Well-being Questionnaire. Data from national registries and mandatory health examinations were included. Within-group changes were analyzed using McNemar’s test, and group differences with multivariable logistic regression. Results Adjusted analyses showed no significant differences in well-being changes between groups. However, children who decided-not-to-participate reported an overall decrease in psychosocial well-being with significantly increased school-related loneliness and reduced classroom concentration and helpfulness over time. Similarly, the not-invited group reported reduced school-related classroom concentration, helpfulness, and enjoyment but improved loneliness and bullying over time. Conclusions Deciding not to participate in a lifestyle intervention for childhood obesity was associated with a more negative development in psychosocial well-being over time; however, causality needs to be determined. Clinical trial registration : ClinicalTrials.gov identifier: NCT06705231. Level of evidence: Level III, longitudinal cohort study.