Exercise and Nutrition Outweigh Diet in Childhood Obesity

NEW HAVEN, Conn., June 26 -- Childhood obesity can be overcome by an intensive family-based program that includes supervised exercise and nutrition education, found researchers here. But dieting wasn't the answer.

At the end of a one-year program, overweight children in the so-called Bright Bodies program had lowered their body mass index, body fat, and insulin resistance compared with children in a control program, according to Mary Savoye, R.D., of Yale.

Their weight gain averaged 0.3 kg, compared with 7.7 kg in children in the control program who were simply given standard counseling about nutrition and the benefits of exercise at Yale's pediatric obesity clinic, the dietitian and colleagues reported in the June 27 issue of the Journal of the American Medical Association.

On the other hand, party of the study that included a planned diet had to be stopped because of a high drop-out rate, the researchers said.

Obesity in children "is a family problem. The child can't do it alone," Savoye said.

But if caregivers are involved and there is close contact between families and professional staff, she said, "we have shown that a family-based program that uses nutrition education, behavior modification, and supervised exercise can lower BMI, improve body composition and increase insulin sensitivity."

The researchers enrolled a random sample of 209 children seen at the clinic. They were between the ages of eight and 16 and their body mass index was above the 95^th percentile for their age.

The children were randomized in a two-to-one fashion either to take part in the Bright Bodies program or to get standard care at the obesity clinic.

Initially, children in the treatment arm were randomized again to get either a structured meal plan -- a diet, in essence -- or instruction in making better food choices, but the structured arm was stopped because of an 83% drop-out rate among the first 35 participants in the diet arm.

For the first six months, children and caregivers in the Bright Bodies program attended 50-minute exercise classes twice a week -- including games and sports -- along with a 40-minute session of nutrition information and behavior modification.

They were also encouraged to exercise on three other days at home.

Sessions were every other week for the final six months. Participants were weighed every one or two weeks for the first six moths and every two weeks for the rest of the program.

Outcome measures were weight, body mass index, body fat, and insulin resistance using the homeostasis model assessment.

The study found that after a year:

• Children in the control arm had gained an average of 7.7 kg (with a 95% confidence interval from 5.3 to 10), while those in the Bright Bodies arm gained 0.3 kg (with the confidence interval from minus 1.4 to 2.0).
• Body mass index rose on average 1.6 units in the control arm and fell 1.7 units in the Bright Bodies arm. The confidence intervals were 0.8 to 2.3 and minus 2.3 to minus 1.1, respectively.
• Body fat increased an average of 5.5 kilograms in the control children and fell 3.7 kilograms in the Bright Bodies children. The confidence intervals were 3.2 to 7.8 and minus 5.4 to minus 2.1, respectively.
• Insulin resistance increased 0.9 units in the control arm and fell 1.52 units in the Bright Bodies arm. The confidence intervals were minus 0.07 to 2.05 and minus 1.93 to minus 1.01, respectively.
• All of the differences between groups were significant at P