Recent advances in the treatment of childhood obesity

Abstract

The rapid increase in the prevalence of obesity in the last decade indicates a need for effective treatment programs. We conducted a short-term, repeated-measures, clinical-outcome trial in three groups of children and adolescents in two different locations. Two cohorts (n=34) were enrolled in a 36-wk multi-disciplinary weight-management program at the Children's Hospital of New Orleans. One cohort (n=16) was enrolled in a similar intervention at the General Clinical Research Center (GCRC) at the Medical Center of Louisiana for a 10-wk summer weight-loss program. Subjects were offered a protein-sparing modified fast (PSMF) diet (600-800 kcal/d; 2 g protein/kg body weight), followed by a balanced hypocaloric diet, and they participated in behavior-modification sessions and a moderate-intensity (45-55% volume of oxygen consumed at maximal effort [VO(2)max]), progressive exercise program. The following parameters were examined at baseline, 10 wk, and 36 wk (cohort 1 only): Weight, height, percentage of ideal body weight (%IBW), relative body fat (%fat), fat free body (FFB) mass, estimated VO(2)max mL/kg min(BW) [adjusted for body weight]), blood chemistries, lipid profiles (total cholesterol [TC], triglycerides [TG], low-density lipoprotein [LDL], high-density lipoprotein [HDL], and insulin-like growth factor-1 [IGF-1]). All three groups experienced significant decreases in weight, %IBW and %fat at 10 wk. The weight loss was maintained at 26 wk in cohorts 1 and 2, and at 36 wk in cohort 1. There were no significant decreases in height velocity during the study. In addition, measures of estimated VO(2)max mL/kg/min(BW) and IGF-1 parameters were significantly greater at 10 wk compared to baseline. Measures of TC, TG, and LDL were significantly lower at 10 wk, with no significant changes noted in HDL. We conclude that a multi-disciplinary weight-management program, including PSMF, behavior modification, and exercise, provides an effective method of treatment for obesity in children and adolescents. Long-term, randomized, and controlled clinical trials are needed to confirm the results of this preliminary, short-term observation.

Effects of resistance training on metabolic fitness in children and adolescents: a systematic review

“…The sample sizes for the studies (Tables 2 and 3) ranged from 15 to 82 with 67% of studies,(8/12studies), with sample sizes between 15 and 29. All but one of the studies (69) were conducted in male (57,58,61,63,68) or mixed (56,59,60,62,65,66) cohorts. Most studies recruited from school (57,62,63,66,68,69) or sports teams (57,61), with four studies from a hospital/medical clinic setting (56,59,65,68) and two where the recruitment location was not reported (58,60).…”

Efficacy and Safety of a High Protein, Low Carbohydrate Diet for Weight Loss in Severely Obese Adolescents

“…The literature is conflicting with respect to body composition changes in children on a so-called “protein sparing modified fast.” Studies that have relied on skinfold measurements have reported preservation of lean body mass with a high protein, very low calorie diet (30-32). In contrast to our protocol, several of these interventions had a structured exercise component, which may have affected the impact of weight loss on lean body mass (31, 32). Studies in adults have reported an additive effect of exercise and protein in the preservation of lean body mass during weight loss (21, 33).…”

Childhood Obesity for Pediatric Gastroenterologists

“…Comprehensive programs provided counseling on healthy diet, physical activity, and techniques for behavior change; moderate- to high-intensity programs engaged participants in more than 25 hours of contact. Weight loss in such programs is modest, especially in contrast to the dramatic change sought by patients, parents, and providers, but can be sustained (73). Ideally, pediatric gastroenterologists should refer obese patients, with their parents, to such programs when initial lifestyle modification counseling has not been successful, although lack of program availability and lack of insurance coverage for the programs are barriers.…”