Journal of Nutrition Education and Behavior
Research briefChildhood Obesity: Concept, Feasibility, and Interim Results of a Local Group-based, Long-term Treatment Program
Introduction
Pediatric obesity, a serious, global health issue, may cause metabolic abnormalities such as hyperlipidemia, hypertension, impaired glucose tolerance, or even type 2 diabetes early in childhood. Moreover, because obesity commonly persists into adulthood, affected children are at greater risk of developing a variety of metabolic and cardiovascular comorbidities along with increased mortality rates.1
The development of a successful therapeutic approach for obesity in children and adolescents remains a challenge. Basic treatment options include long-term changes in lifestyle, especially eating habits and exercise behavior. The CATCH study (Child and Adolescent Trial for Cardiovascular Health) in the United States is a multiethnic school- and family-based intervention program promoting healthful meals and physical activity. However, in addition to an ethnicity effect, a significant increase in body mass index (BMI) and prevalence of obesity was found in both the intervention and control groups.2 Therefore, more specific intervention programs for smaller, homogenous cohorts could be more successful in avoiding and treating risk factors for cardiovascular disease at younger ages.
Generally, long-term effects on body weight can be achieved only if the lifestyle is profoundly modified with respect to eating behavior and physical activity. In addition to treatment, prevention of obesity in childhood must be a key strategy. Family- and school-based primary prevention strategies, such as the Kiel Obesity Prevention Study (KOPS) in Germany, for example, have been shown to facilitate changes in lifestyle and body fat content.3 It is of interest to note that obesity prevention programs are considered more effective than the treatment of adiposity.1, 4
As has been described earlier for a large cohort of 4 610 young school children (age range 5.6-7.8 years, mean age 6.7 years) in the Erlangen district in Bavaria, Germany, the prevalence of overweight and obesity in children had increased within the 5-year interval from 1996 to 2001 from 6.3% to 9.5%.5 This increase in prevalence of overweight and obesity was significant for both sexes.
The authors have, therefore, introduced a pilot concept for obese children and adolescents, of multidisciplinary design, aiming to promote an active, health-oriented lifestyle in children, adolescents, and their families. This group-based project for early obesity treatment was carried out for 1 year, followed by open lessons in a local sports club.
The objective of the present study was, firstly, to examine the feasibility and acceptability of the long-term outpatient program for obese children and adolescents. Secondly, standardized BMI values at 0, 6, and 12 months were compared, along with interim outcome data in the active intervention group, with controls who had received only written therapeutic advice at 2 outpatient visits.
Section snippets
Design
Seventy-three obese children aged 7 to 15 years (mean 11.2 years) were recruited by pediatricians and local newspaper reports and randomized into 2 groups (Table). The participants of the active intervention group joined a 1-year program, composed of modules for physical activity, nutritional education, and coping strategies, given in 2 sessions per week. There were also monthly parental meetings and medical supervision including laboratory tests at 0, 6, and 12 months. The controls received
Results
After 1 year, there was a significant reduction of BMI z score in the active group by −0.34, from +2.24 to +1.90 (P < .05), and of mean BMI (−1.5 kg/m2, P < .05) (Table). Although BMI of participants of the active group was significantly lower than BMI of controls from the beginning (P < .05), baseline values for BMI z score did not differ significantly (P = .07). Assessment of body composition by bioelectric impedance analysis (BIA) showed that fat mass at baseline did not differ significantly
Lessons Learned
Local long-term therapeutic programs for young obese patients are an important tool in establishing a more active and health-oriented lifestyle, and to reduce the individual and public burden of obesity in childhood.14 In growing children, stabilization of body weight slowly reduces BMI z score, and a value of less than 2.0, as in this project, is presumed to noticeably reduce comorbidity.1 The authors focused primarily on BMI z score in this study because BIA-derived measurements of body
Discussion
Treatment for adiposity is usually intensive and requires multidisciplinary efforts. Local community-based projects, such as the one depicted here, promote good attendance with the lowest dropout rate. They should offer lessons in strengthening self-esteem, optimizing eating habits, and increasing physical activity as major lifestyle factors affecting body weight. It has been described by other groups, also, that community-based exercise programs may be a tool to establish an active lifestyle,
Acknowledgments
This project was funded by the Bavarian State Ministry of Environment, Public Health, and Consumer Protection and the health insurance company Siemens Betriebskrankenkasse, Germany. The authors are grateful to all the patients for their participation and to our colleagues in Erlangen, Germany for their valuable contributions. We also thank Patricia Schmid for excellent technical assistance and stimulating discussion.
References (20)
- et al.
Using food calendars to self-monitor: Got 5?nutrition for kids program
J Nutr Educ Behav
(2003) - et al.
How to put the Food Guide Pyramid into practice
J Am Diet Assoc
(1994) - et al.
Dietary variety increases as a function of time and influences diet quality in children
J Nutr Educ Behav
(2004) - et al.
Childhood obesity: public-health crisis, common sense cure
Lancet
(2002) - et al.
Childhood obesity
J Clin Endocrinol Metab
(2005) - et al.
Prevalence of marked overweight and obesity in a multiethnic pediatric population: findings from the Child and Adolescent Trial for Cardiovascular Health (CATCH) study
J Am Diet Assoc
(2000) - et al.
School-based interventions to prevent overweight and obesity in prepubertal children: process and 4-year outcome evaluation of the Kiel Obesity Prevention Study (KOPS)
Acta Paediatr Suppl
(2007) - et al.
The prevention of overweight and obesity in children and adolescents: a review of interventions and programs
Obes Rev
(2006) - et al.
Early factors influencing body weight and prevalence of overweight in 4610 children prior to school entry in the Erlangen district/Northern Bavaria
Gesundheitswesen
(2005) Obesity: preventing and managing the global epidemicReport of a WHO consultation
World Health Organ Tech Rep Ser
(2000)
Cited by (44)
The Effectiveness of Nutrition Specialists on Pediatric Weight Management Outcomes in Multicomponent Pediatric Weight Management Interventions: A Systematic Review and Exploratory Meta-Analysis
2019, Journal of the Academy of Nutrition and DieteticsCitation Excerpt :The interventions included a wide variety of treatment configurations. Multicomponent approaches included modules delivered by nutrition, behavior, physical activity, and medical specialists.39,42,48,51,54-88 Nutrition-focused interventions employed various diet manipulations along with eating behavior modification.89-96
Pediatric Weight Management Evidence-Based Practice Guidelines: Components and Contexts of Interventions
2018, Journal of the Academy of Nutrition and DieteticsLifestyle weight management programmes for children: A systematic review using Qualitative Comparative Analysis to identify critical pathways to effectiveness
2018, Preventive MedicineCitation Excerpt :In total, 1098 references were screened for the views synthesis and 1617 references were screened for the trials synthesis (for details of the flow of studies included in the review, see Figs. 2a and 2b). Eleven studies, presented in 19 papers, were included in the views synthesis (Lewis et al., 2014; Lucas et al., 2014; Newson et al., 2013; Owen et al., 2009; Pittson, 2013; Robertson, 2009; Staniford et al., 2011; Stewart, 2008; Trigwell et al., 2011; Visram et al., 2013; Watson, 2012) and 30 intervention evaluations, reported in 24 trials, were identified for the evaluation synthesis (Resnicow et al., 2015; Janicke et al., 2008a; Broccoli et al., 2016; Backlund et al., 2011; Taylor et al., 2015; Kalavainen et al., 2011; Lochrie et al., 2013;Bocca et al., 2012; Bryant et al., 2011; Coppins et al., 2011; Estabrooks et al., 2009; Gerards et al., 2015; Golley et al., 2011b; Hughes et al., 2008; McCallum et al., 2006; Raynor et al., 2012; Stark et al., 2014; Stark et al., 2011; Taveras et al., 2015; Taveras et al., 2011; van Grieken et al., 2014; Wake et al., 2009; Wake et al., 2013; Weigel et al., 2008). Eight views studies captured perspectives from children, ten captured parents' perspectives, and four captured providers' views (see Table 2).
Outcomes of group-based treatment program with parental involvement for the management of childhood and adolescent obesity
2014, Patient Education and CounselingCitation Excerpt :Being male and attending the group sessions regularly were associated with successful weight management in this study. Several studies have shown the efficacy of group treatments over routine individual counseling [23–25]. A randomized controlled trial of 73 obese German children aged 7–15 years showed that a group-based treatment program held twice weekly for 12 months was more effective in managing childhood obesity than the transfer of written therapeutic advice to individuals at the outpatient clinic [25].
Evaluation of multidisciplinary weight loss shared medical appointments
2020, Journal of the American Pharmacists AssociationCitation Excerpt :In addition, it could have been beneficial to have physical therapy involvement to evaluate patient’s ability to participate in physical activity and provide guidance to individualized activities that patients could perform. Previous publications on SMAs and group visits involved only 1 or 2 providers: a physician, dietician, psychologist, or therapist.5-14 In addition, most commercial diet programs do not have pharmacist or physician involvement, although there are some programs available with medical monitoring.
This project was funded by the Bavarian State Ministry of Environment, Public Health, and Consumer Protection and the health insurance company SBK, Germany.