To determine if beneficial effects of a weight-management program could be sustained for up to 24 months in a randomized trial in an ethnically diverse obese population.
There were 209 obese children (BMI > 95th percentile), ages 8 to 16 of mixed ethnic backgrounds randomly assigned to the intensive lifestyle intervention or clinic control group. The control group received counseling every 6 months, and the intervention group received a family-based program, which included exercise, nutrition, and behavior modification. Lifestyle intervention sessions occurred twice weekly for the first 6 months, then twice monthly for the second 6 months; for the last 12 months there was no active intervention. There were 174 children who completed the 12 months of the randomized trial. Follow-up data were available for 76 of these children at 24 months. There were no statistical differences in dropout rates among ethnic groups or in any other aspects.
Treatment effect was sustained at 24 months in the intervention versus control group for BMI z score (−0.16 [95% confidence interval: −0.23 to −0.09]), BMI (−2.8 kg/m2 [95% confidence interval: −4.0–1.6 kg/m2]), percent body fat (−4.2% [95% confidence interval: −6.4% to −2.0%]), total body fat mass (−5.8 kg [95% confidence interval: −9.1 kg to −2.6 kg]), total cholesterol (−13.0 mg/dL [95% confidence interval: −21.7 mg/dL to −4.2 mg/dL]), low-density lipoprotein cholesterol (−10.4 mg/dL [95% confidence interval: −18.3 mg/dL to −2.4 mg/dL]), and homeostasis model assessment of insulin resistance (−2.05 [95% confidence interval: −2.48 to −1.75]).
This study, unprecedented because of the high degree of obesity and ethnically diverse backgrounds of children, reveals that benefits of an intensive lifestyle program can be sustained 12 months after completing the active intervention phase.
Step-Cal Meter, an easy method to educate children, young people and adults
Childhood obesity predisposes to insulin resistance and type 2 diabetes, hypertension, hyperlipidemia, liver and renal disease, and reproductive dysfunction. It also increases the risk of adult-onset obesity and cardiovascular diseases and has emerged as the number 1 health problem in the United States and another countries (1). Physicians and parents should encourage children to participate in vigorous physical activity throughout adolescence and young adulthood and to limit time spent watching television and videos and playing computer games. An energy -restricted and balanced diet, together with patient and parent education, behavioral changes and exercise, can limit weight gain in many pediatric patients who have mild or moderate obesity. The experts suggest that providers encourage healthy behaviors while using techniques to motivate patients and families, and interventions should be tailored to the individual child and family (2). A major educational barrier for both parents and children is the understanding of the simple equivalence between calorie intake and the exercise required to use this energy. Obesity prevention must clarify to caregivers and children the nutritional value associated with food and with the promotion of physical activity. Not all exercise demands the same energy expenditure. There are numerous tables showing the heat loss produced by the exercise performed. We believe this method is not very educational because it is difficult to learn and teach. The new proposal is based on the opposite reasoning. It pretends to teach the number of steps that should be walked up or down depending on the child’s calorie intake. Several studies (3-5) about the heart rate and oxygen uptake responses and the intensity and caloric cost of ascending and descending a public-access staircase, have showed that the caloric cost of stepping up and down a step were 0.11 and 0.05 kcal, respectively. The steps of the stairs have been standardized (6,7) With our method, it is possible to know the number of steps a child needs to walk up or down in order to burn the calories of the product he is about to eat. For educational purposes we have called it the Step-Cal Meter.
Nowadays, information on caloric values is available on the packaging and labelling of all foodstuffs. However, the public does not see on these labels the amount of effort it would take to burn those calories. Our simple tool transforms calories into steps, for educational purposes and the equivalence should be printed on all nutrition labels. For example, one McDonald’s Biscuit (Breads), which is 84 gm in weight and has 290 calories, is equivalent to walking up and down 1812 steps, a bit more than going up and down the Empire State Building, which has 1576 stairs up to the 86th floor.
References; 1.Moss BG, Yeaton WH. Young children's weight trajectories and associated risk factors: results from the Early Childhood Longitudinal Study-Birth Cohort. Am J Health Promot 2011; 25:190-8
2.Spear BA, Barlow SE, Ludwig DS, Saelens BE, Schetzina KE, Taveras EM. Recommendations for treatment of child and adolescent overweight and obesity. Pediatrics 2007; 120 (Suppl): S254-S288
3.Arvidsson D, Slinde F. Larsson S, Hulthe´n L. Energy cost in children assessed by multisensor activity monitors. Med. Sci Sports Exerc 2009: 41, 603–611 4.Ridley K, Ods TS. Assigning energy cost to activivies in children: A review and sythesis. Med Sci Sports Exerc 2009; 40:1439-1446
5.Teh KC, Aziz AR. Heart rate, oxygen uptake, and energy cost of ascending and descending the stairs. Med Sci Sports Exerc. 2002 Apr;34(4):695-9
6.Chiang C, Carter C. The Backstage Handbook: An Illustrated Almanac of Technical Information. Broadway Pr. 1994
Conflict of Interest:
Peer review or spin?
My comments are more for the peer reviewers than for the authors of the article which was well performed. The intervention was well studied, but ineffective; there was no significant difference between the intervention and control groups before, during or after the study. There was no good effect and no bad effect. My concern is the last line of the abstract which states that the program maintained "the effect" for 12 months after the end of the intervention, thereby implying there was an effect. This is spin and not science. I understand the frustration of funding and running this large program for 2 years, just to find no effect, obesity is a difficult problem, but we don't do ourselves any good spinning our failures instead of learning from them. The reviewers should have required it to be rephrased honestly or to have refused publication.
Conflict of Interest:
Number of children versus mean changes
The report by Savoye and colleagues suggests significant improvement from the intervention. However, mean changes in BMI z score or any group mean change is not very helpful in deciding the magnitude of the change associated with the intervention. What would be helpful is for the authors to report the number of children in the intervention and control groups whose BMI decreased by a clinically significant amount, e.g., fell below the 95th%. In other words what is the "risk reduction" that results from the intervention. This would allow the reader to determine a number needed to treat--how many children need to successfully complete the program for one of them to decrease his/her BMI to a healthy level? This would also be a good way to report all of the outcome variables. Most pediatricians want to know what the likelihood of improvement is for a particular obese child, not for a group.
Conflict of Interest: