Feasibility of a Clinic‐Based Hypocaloric Dietary Intervention Implemented in a School Setting for Obese Children

Abstract

Feasibility of a clinic-based hypocaloric dietary intervention implemented in a school setting for obese children. Obes Res. 1996;4:419-429. The objective of this study was to examine whether a protein-sparing modified fast diet and a hypocaloric balanced diet are effective in a clinic-based dietary intervention implemented in a school setting highrisk weight loss program for superobese (2 140% of their ideal body weight for height [IBW]) children. A group of children from two suburban public schools in New Orleans, Louisiana were randomized to either dietary-intervention group and control group. Children were followed for 6 months. In the dietary-intervention-group, 12 of 44 superobese children [ages 8.8 to 13.4 years, weight 144% to 212% of IBW] volunteered to participate. In the control group, 7 of 19 superobese children [ages 9.4 to 12.9 years, weight 140% to 195% of IBW] volunteered to participate. During the first 9 weeks, 12 superobese children were placed on a 2520 to 3360 J (600 to 800 Cal) protein-sparing modified fast diet. Subsequently, the diets of all children were increased in a 3-month period 420 J (100 Cal) every 2 weeks until a 5040 J (1200 Cal) per day balanced diet was attained. In both groups, height and weight were obtained at baseline, 10 weeks, and 6 months; and biochemical measurements were performed at baseline and 6 months.At 6 months the 12 superobese children on protein-sparing modified fast diet had a significant Six children were not superobese at 6 months. At 6 months eight of 12 children were active participants and 11 of 12 children were followed. Decrease in blood pressure, as well as, downward trends in serum lipids were observed at 6 months. No clinical complications were observed. A t 6 months, the 7 control superobese children, when compared with baseline had gained weight (2.8 & 3.1 kg, ANOVA p c 0.008); but had no significant change in percentage IBW (-0.3 f 5.9%, ANOVA p = 0.61); and had no changes in growth velocity Z-score (0.1 k 1.3, ANOVA p = 0.83). These children did not have any change in blood pressure and an upward trend in serum lipids were observed at 6 months.Protein-sparing modified fast diet and a hypocaloric balanced diet appear to be effective in a group of superobese-school-age children in a medically supervised clinic-based program implemented in a school setting over a 6-month period. The efforts of committed clinic staffs, school officials, peers, and family involvement were crucial to the success of this intervention program in promoting and maintaining weight loss over a 6-month period. Further research with a specific comparison of the hypocaloric diets with longer follow-up periods in the school setting is necessary. In the meantime, these diets should be used only with close medical supervision.

Treatment of Type 2 Diabetes in Childhood Using a Very-Low-Calorie Diet

“…Weight loss, the most outwardly apparent benefit of the VLCD, is a good example. Our subjects lost an average of 11.4 kg during the diet (5.8 kg/month), which is comparable with that in nondiabetic adolescents (17,22,29) and, in fact, exceeds that of m o s t s t u d i e s i n d i a b e t i c a d u l t s (19,28,30 -32). These results were achieved in a predominantly outpatient setting and without the benefit of a behavioral therapy component.…”

“…RESULTS -The diet was followed for a mean of 60 Ϯ 8 days (range 4 -130 days). All subjects stopped the diet voluntarily, and none experienced nausea, vomiting, dehydration, or other side effects, such as orthostatic dizziness, muscle cramps, fatigue, or halitosis, previously reported in pediatric studies (22).…”

“…The ketogenic VLCD is a "low-insulin diet" that has been shown to safely induce rapid weight loss while preserving lean body mass in nondiabetic obese children (16,17,22). The VLCD causes similar weight loss in obese adults with type 2 diabetes while improving endogenous insulin secretion and lowering HbA 1c (28).…”

Changes in serum interleukin-6 concentrations in obese children and adolescents during a weight reduction program

“…25 However, it has been shown that physical training in obese children not only reduced percentage body fat, but also showed positive effects on the sympathetic=parasympathetic balance. 14 Thus, the decrease of blood pressure and heart rate during the weight reduction program, which has also been observed by other investigators, 27,28 suggests a more favorable balance between the sympathetic and parasympathetic system, probably resulting in concomitant reduced production of IL-6.…”

School-based approaches for preventing and treating obesity

“…11,13,14,17,19 One study 10 provided a special school meal program for the overweight children of the study. One study 13 used a protein-sparing modi®ed fast and a hypocaloric balanced diet, in a medically supervised school clinic-based program for superobese children. The programs were conducted either after school or during school hours or a combination of both.…”