*3.2. The Excellent Responder Cohort*

The characteristics of the 252 patients who achieved a reduction in their BMI of over 1.5 SDS and/or of their weight of over 10% from baseline are shown in Table 3. There was a higher proportion of prepubertal children among good responders (χ2: 10.57; *p* < 0.01), whereas the relative percentages of the two main ethnicities was similar to those in the cohort at baseline.


**Table 3.** Clinical features of the excellent responder group at baseline.

*Abbreviations:* BMI-SDS: Standardized body mass index (Z-score).

The mean weight loss was 3.85 ± 5.92 kg, resulting in a mean BMI decrease of 1.59 ± 0.77 SDS. However, the mean body weight decrease needed to achieve the threshold set was higher in pubertal compared to prepubertal patients (−6.01 vs. −2.01 kg, respectively; *p* < 0.001). After weight loss patients experienced a significant increase in their HDL levels and a significant decrease in glucose, insulin, triglyceride, and LDL cholesterol, as well as in HOMA index (all *p* < 0.01, Table 4).


**Table 4.** Changes in BMI and metabolic parameters after weight loss compared to baseline.

*Abbreviations:* BMI-SDS: Standardized body mass index (Z-score); F: Female; HDL-c: High density lipoprotein cholesterol; HOMA: Homeostatic model assessment; LDL-c: Low density lipoprotein cholesterol; n: number of patients; N.S.: Not significant.

The mean time from baseline to weight loss achievement was 0.94 ± 0.86 years, with 35.3% of patients attaining this goal at 6 months and 74.2% before 12 months of follow-up. No differences in time to weight loss were observed according to sex or pubertal status.

The longer the time needed to attain BMI reduction, the lower the amount of raw weight loss achieved (r = −0.65; *p* < 0.001). However, no correlation between the magnitude of changes in metabolic parameters and the time spent to achieve weight loss was observed.

Prospective follow-up showed that the BMI reduction was preserved and even enhanced after 6 months upon weight loss attainment but increased from the first to the third year after weight loss and later remained stable in those patients achieving 5 years of follow-up (Figures 3 and 4).
