Objective To assess the effectiveness of parent-only vs family-based interventions for pediatric weight management in underserved rural settings. Design A 3-arm randomized controlled clinical trial. Setting All sessions were conducted at Cooperative Extension Service offices in underserved rural counties. Participants Ninety-three overweight or obese children (8–14 years old) and their parent(s). Intervention Families were randomized to (1) a behavioral family-based intervention, (2) a behavioral parent-only intervention, or (3) a wait-list control group. Outcome Measure The primary outcome measure was change in children’s standardized body mass index (BMI). Results Seventy-one children completed posttreatment (month 4) and follow-up (month 10) assessments. At the month 4 assessment, children in the parent-only intervention demonstrated a greater decrease in BMI z score (mean difference [MD], 0.127; 95% confidence interval [CI], 0.027 to 0.226) than children in the control condition. No significant difference was found between the family-based intervention and the control condition (MD, 0.065; 95% CI, −0.027 to 0.158). At month 10 follow-up, children in the parent-only and family-based intervention groups demonstrated greater decreases in BMI z score from before treatment compared with those in the control group (MD, 0.115; 95% CI, 0.003 to 0.220; and MD, 0.136; 95% CI, 0.018 to 0.254, respectively). No difference was found in weight status change between the parent-only and family-based interventions at either assessment. Conclusions A parent-only intervention may be a viable and effective alternative to family-based treatment of childhood overweight. Cooperative Extension Service offices have the potential to serve as effective venues for the dissemination of obesity-related health promotion programs.

OBJECTIVE -Magnesium deficiency has been associated with insulin resistance (IR) and increased risk for type 2 diabetes in adults. This study was designed to determine whether obese children exhibit serum or dietary magnesium deficiency and its potential association with IR.RESEARCH DESIGN AND METHODS -We studied 24 obese nondiabetic children (BMI Ն85th percentile) and 24 sex-and puberty-matched lean control subjects (BMI Ͻ85th percentile). We measured serum magnesium, indexes of insulin sensitivity, dietary magnesium intake (using a food frequency questionnaire), and body composition (by air displacement plethysmography).RESULTS -Serum magnesium was significantly lower in obese children (0.748 Ϯ 0.015 mmol/l, means Ϯ SE) compared with lean children (0.801 Ϯ 0.012 mmol/l) (P ϭ 0.009). Serum magnesium was inversely correlated with fasting insulin (r s ϭ Ϫ0.36 [95% CI Ϫ0.59 to Ϫ0.08]; P ϭ 0.011) and positively correlated with quantitative insulin sensitivity check index (QUICKI) (0.35 [0.06 -0.58]; P ϭ 0.015). Dietary magnesium intake was significantly lower in obese children (obese: 0.12 Ϯ 0.004 vs. lean: 0.14 Ϯ 0.004 mg/kcal; P ϭ 0.003). Dietary magnesium intake was inversely associated with fasting insulin (Ϫ0.43 [Ϫ0.64 to Ϫ0.16]; P ϭ 0.002) and directly correlated with ; P ϭ 0.002).CONCLUSIONS -The association between magnesium deficiency and IR is present during childhood. Serum magnesium deficiency in obese children may be secondary to decreased dietary magnesium intake. Magnesium supplementation or increased intake of magnesium-rich foods may be an important tool in the prevention of type 2 diabetes in obese children. Diabetes Care 28:1175-1181, 2005T he current epidemic of childhood obesity has been associated with an alarming rise in the prevalence of pediatric type 2 diabetes (1). Hyperinsulinemia and insulin resistance (IR) are the precursors of type 2 diabetes. Obesity and dietary macronutrients clearly play a role in the risk for type 2 diabetes, but the role of micronutrients in this process is not clear.Magnesium is an important cofactor for enzymes involved in carbohydrate metabolism. A strong relationship between magnesium and insulin action has been reported (2,3). In adults, low serum and intracellular magnesium concentrations are associated with IR, impaired glucose tolerance, and decreased insulin secretion (4 -6). Furthermore, large epidemiologic studies in adults indicate that lower dietary magnesium and lower serum magnesium are associated with increased risk for type 2 diabetes (7,8). However, the role of magnesium deficiency in the development of IR during childhood has not been clearly defined. The present study was designed to determine whether a relationship exists between magnesium homeostasis and IR in obese children and to evaluate potential mechanisms leading to magnesium deficiency in these children.RESEARCH DESIGN AND METHODS -We studied 24 obese children (BMI Ն85th percentile for age and sex) aged 8 -17 years with at least one risk factor for type 2 diabetes and 24 lean children...

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Project STORY is a 3-arm, randomized, planning and feasibility study assessing the effectiveness of two behavioral weight management interventions in an important and at-risk population, overweight children and their parents in medically underserved rural counties.Participants will include 90 parent-child dyads from rural counties in north central Florida. Families will be randomized to one of three conditions: (a) a Family-Based Behavioral Group Intervention, (b) a Parent-Only Behavioral Group Intervention, and (c) a waitlist control condition. Child and parent participants will be assessed at baseline (month 0), post-treatment (month 4) and follow-up (month 10). Assessment and intervention sessions will be held at Cooperative Extension offices within each local participating county. The primary outcome measure is change in child body mass index (BMI) z-score. Additional key outcome measures include child dietary intake, physical activity, self-esteem, body image, and parent BMI.The goals of the study are to (a) assess the feasibility of recruitment in rural settings, (b) develop and evaluate training protocol for group leaders, (c) determine strategies to increase adherence to monitoring and goal setting protocol, (d) evaluate strategies for participant retention, (e) assess the relative cost-effectiveness of the interventions, (f) assess the acceptability of the intervention to families and Cooperative Extension administrators and personnel, and (g) if successful, estimate the sample size needed for a full scale trial. This research has potential implications for medically underserved rural communities with limited resources and preventive health care services. If successful, a Parent-Only intervention program may provide a cost-effective and practical intervention for families in underserved rural communities.