Weight and related problems can be managed successfully, but only with intensive interventions.
The prevalence of overweight children increased dramatically from 1999 to 2004 (17% overall, higher in minority children), raising concerns about an increased risk for childhood metabolic syndrome. In this study, investigators randomized 209 overweight children (roughly two thirds Hispanic and African American; mean age, 12 years; mean body-mass index, 36; mean body fat, 46%) to an intensive weight-management program or a control group. The intervention group received intensive nutrition education and a structured exercise program (education plus 50 minutes of exercise twice weekly for 6 months, then twice monthly for 6 months more); the control group received standard diet and exercise counseling every 6 months.
Compared with the control group, the intervention group had significant improvements in several outcomes at 6 months of follow-up, and the improvements were maintained at 12 months. For example, at 6 months the intervention group had reductions of 2.6 kg in weight, 2.1 BMI units, 3.2 percentage points in body fat, and 7.5 mg/dL in total cholesterol level, compared with increases of 5.0 kg, 1.1 BMI units, 2.0 percentage points, and 1.5 mg/dL total cholesterol in the control group. Fasting insulin levels were also significantly lower in the intervention group. No significant difference was found between groups in blood pressure, HDL or LDL cholesterol, triglycerides, or fasting glucose. Interestingly, a second randomization, in which half the intervention group was assigned to a structured dieting program, was stopped because of a high dropout rate.
Comment: Although the positive results of this trial are encouraging, the costs of such labor-intensive interventions are substantial. More work is required to assess the effect of less intensive programs implemented in less controlled settings.
Published in Journal Watch General Medicine June 26, 2007
Savoye M et al. Effects of a weight management program on body composition and metabolic parameters in overweight children: A randomized controlled trial. JAMA 2007 Jun 27; 297:2697-704.