The increasing number of U.S. children who are overweight is alarming, as the graph below shows. That being overweight contributes significantly to the development of diabetes and cardiovascular disease has been well established, and health care providers are seeking ways to help people manage their weight to prevent-or at least forestall-the development of overweight- and obesity-related diseases.
"Obesity in children is especially problematic," said Mary Savoye, director of the Bright Bodies Weight Management Program for Children at Yale University's School of Medicine in New Haven, Connecticut. "Now we see obese 16-year-olds with type 2 diabetes, whereas before it was mostly a disease of 40-year-olds. That means many more years of living with a disease that has many complications and creates a tremendous cost burden."
At a briefing held by the Journal of the American Medical Association to highlight its June 27 issue on chronic diseases of children, Savoye presented findings from a study she and her colleagues published in that issue. It compared children ages eight to 16 who participated in the Bright Bodies program, developed by Yale for overweight inner-city children, to a control group that received diet and exercise counseling every six months during visits to the pediatric obesity clinic.
Children enrolled in the Bright Bodies program and at least one parent or caregiver participated in an intensive exercise, nutrition, and behavior-modification program that met twice weekly for six months and then twice monthly for six more months. At each meeting, children exercised for 50 minutes under the supervision of an exercise physiologist. They also met with a registered dietician and a social worker for nutrition and behavior-modification instruction. Weight, body mass index (BMI), blood lipid, and insulin resistance measurements were taken at baseline and then at six and 12 months. Of the 209 participants recruited, 119 (53%) completed the study.
In the Bright Bodies group, improvements seen at six months and sustained at 12 months included reduced BMI, body fat, total cholesterol, and insulin resistance. Weight was essentially unchanged in this group. In contrast, control group participants had increased BMI, weight, body fat, total cholesterol, and insulin resistance. The weight gain in controls at 12 months was almost 17 pounds. Savoye noted that "the difference in the treatment effect between the two groups at 12 months amounts to almost 20 pounds of body fat."
However, the program is costly: about $800 per child annually. And essential to the program's success is having a parent or caregiver involved. "The high dropout rate is largely due to transportation [difficulties]," Savoye said. "Parents are the key in getting children to the program location and supporting their efforts."
Maureen Shawn Kennedy, MA, RN, news director