Weight loss and growth velocity in obese children after very low calorie diet, exercise, and behavior modification

Sothern,; Udall, J. N.; Suskind, Robert M.; Vargas, Alfonso; Blecker, Uwe

doi:10.1080/713794562

Cited by 34 publications

(47 citation statements)

References 29 publications

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“…3,4 Combined intervention strategies have proved to lead to better and longer lasting results in children and in adolescents. 6,7,9,[20][21][22] However, body composition measurements are critical in obese subjects to assess the changes underlying weight loss. DEXA has been shown to be appropriate to measure LM, FM and percent fat in total and segmental regions.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, a weight loss program in obese children and adolescents must pay attention to ensure lasting growth and development. 9,22,[24][25][26][27] Obese children before late puberty are temporarily taller than they will eventually remain. 28 In our population, we could verify by plotting individual growth chart plots on French national reference charts, from birth onward, and by checking bone ages (not shown) that height growth followed the expected pattern.…”

Section: Discussionmentioning

confidence: 99%

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Effects of a multidisciplinary weight loss intervention on body composition in obese adolescents

et al. 2004

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OBJECTIVE:To investigate if a multidisciplinary weight loss program in adolescents suffering severe obesity allows adequate growth and development and avoid lean mass loss. DESIGN: A total of 55 adolescents (33 girls and 22 boys) suffering severe obesity were enrolled in an interdisciplinary weight reduction program lasting 6-12 months. Progressive submaximal physical activity was performed and national dietary allowances for adolescents with low levels of physical activity energy were provided. MEASUREMENTS: Total and segmental body composition was assessed by means of dual-energy X-ray absorptiometry. RESULTS: The mean height significantly increased (Po0.001). The mean body mass index (BMI) dropped in boys from 34.573.2 to 25.572.3 kg/m 2 and in girls from 38.474.1 to 28.474.1 kg/m 2 . Height increased according to the expected pattern (Po0.001). Total lean mass (LM) did not vary and was positively correlated to pubertal development in both sexes before and after weight loss. Steepest drop in fat mass (FM) was observed in the trunk (À63.2710.1% in boys and -51.5711.4% in girls). Decrease in BMI and FM was tightly correlated in both sexes. However, slopes significantly differed (Po0.0005) so that a decrease of 1 kg/m 2 in BMI corresponded to a decrease of 3.92 kg in FM in girls and of 5.44 kg in boys. In each sex, FM at baseline and duration of the treatment were the main determinants of the decrease in FM. CONCLUSION: During adolescence, despite a major weight loss, adequate growth and preservation of LM can be achieved. Weight loss kinetics markedly differs between boys and girls. Low-calorie diets are unnecessary to achieve a marked reduction of severe obesity during puberty. International Journal of Obesity (2004) 28, 290-299. doi:10.1038/sj.ijo.0802542Keywords: adolescents; diet; exercise; body composition IntroductionThe steep increase of obesity in children and adolescents is partly due to major changes in lifestyle in all industrialized countries. In France, the prevalence of obesity has doubled every 15 y since 1970 and reached 16% in 2000. 1 It has been extensively demonstrated that low physical activity levels are a cause and a consequence of overweight. 2 Obese children tend to remain obese in adulthood. 3 Many severe complications of adult obesity are embedded in childhood and adolescence. 4 So strategies are needed to prevent and to treat childhood obesity. 2,5 The treatment of obese children and adolescent should aim at decreasing fat mass (FM), avoiding loss of lean body mass, ensuring adequate growth and development and preventing cyclic weight regain. 2,6 Improving well-being is a second major aspect since psychological disturbances and social distress tend to be early features of obesity in the young. As such a multidisciplinary approach proves to be difficult to reach in the usual environment, in-patient units have been designed to help adolescents suffering the most severe forms of obesity. 7,8 Managing weight loss in obese adolescents actually requires paying special attention to potential...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effects of a multidisciplinary weight loss intervention on body composition in obese adolescents

et al. 2004

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“…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).…”

Section: Pharmacologic Treatmentmentioning

confidence: 99%

“…The ketogenic, very-low-calorie diet (VLCD), or protein-sparing modified fast, is a "low-insulin diet" that has previously been used in children (16). Recently, we have shown (17) that this diet induces rapid weight loss and improves sleep apnea while preserving lean body mass in nondiabetic obese children.…”

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confidence: 99%

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

et al. 2004

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OBJECTIVE -Pharmacologic agents currently approved for use in children with type 2 diabetes (metformin and insulin) are less than optimal for some patients. We evaluated the use of a ketogenic, very-low-calorie diet (VLCD) in the treatment of type 2 diabetes.RESEARCH DESIGN AND METHODS -We conducted a chart review of 20 children (mean age 14.5 Ϯ 0.4 years) who consumed a ketogenic VLCD in the treatment of type 2 diabetes. Several response variables (BMI, blood pressure, HbA 1c , blood glucose, and treatment regimens) were examined before, during, and up to 2 years after the diet and compared with a matched diabetic control group.RESULTS -Before starting the diet, 11 of 20 patients were treated with insulin and 6 with metformin. Mean daily blood glucose values fell from 8.9 Ϯ 1.1 to 5.5 Ϯ 0.38 mmol/l (P Ͻ 0.0001) in the first 3 days of the VLCD, allowing insulin and oral agents to be discontinued in all but one subject. BMI fell from 43.5 Ϯ 1.8 to 39.3 Ϯ 1.8 kg/m 2 (P Ͻ 0.0001) and HbA 1c dropped from 8.8 Ϯ 0.6 to 7.4 Ϯ 0.6% (P Ͻ 0.005) as the diet was continued for a mean of 60 Ϯ 8 days (range 4 -130 days), and none required resumption of antidiabetic medications. Sustained decreases in BMI and insulin requirements were observed in patients remaining on the VLCD for at least 6 weeks when compared with those of the control group.CONCLUSIONS -The ketogenic VLCD is an effective short-term, and possibly long-term, therapy for pediatric patients with type 2 diabetes. Blood glucose control and BMI improve, allowing the discontinuation of exogenous insulin and other antidiabetic agents. This diet, although strict, has potential as an alternative to pharmacologic therapies for this emerging subset of diabetic individuals. Diabetes Care 27:348 -353, 2004T he prevalence of obesity in adolescence has increased dramatically within the past two decades, with at least 12% of adolescents defined as overweight (BMI above the 95th percentile for age and sex) (1). The U.S. National Diabetes Commission and the Nurse's Health Study have both found a direct relationship between weight gain and the risk for diabetes (2,3). Excessive weight among adolescents threatens to become a major public health problem, as the emergence of type 2 diabetes in this age-group has risen exponentially (4). A number of groups have reported a profound increase in the incidence of type 2 diabetes among minority children in North America (5-9). Among African-American adolescents, this subset of diabetes is frequently associated with morbid obesity and hypertension (8,10). This condition is characterized by the absence of islet cell antibodies, normal to elevated fasting C-peptide levels, acanthosis nigricans, and a parental history of type 2 diabetes (11). At the time of presentation, many of the signs of type 1 diabetes (weight loss, polyuria, and polydipsia) may be lacking, while variable degrees of ketosis and even ketoacidosis are quite common (12). Obesity and puberty appear to combine with genetic predisposition to result in disease presentation (13...

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“…Portanto, um programa de perda de peso em crianças e adolescentes obesos deve assegurar a manutenção do crescimento e do desenvolvimento 23 . Apesar do equilíbrio energético negativo, nenhum efeito adverso sobre o crescimento da estatura foi verificado no presente estudo.…”

Section: Discussionunclassified

Effects of long-term multidisciplinary inpatient therapy on body composition of severely obese adolescents

Prado¹,

Siegfried²,

Dâmaso³

et al. 2009

J Pediatr (Rio J)

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Objective: To describe the effects of long-term multidisciplinary inpatient therapy on body composition of severely obese adolescents. Methods:A total of 728 extremely obese adolescents, including 249 boys (aged 15.25±1.56 years) and 479 girls (aged 15.34±1.59 years) received multidisciplinary therapy during a period of 3 to 9 months. The therapy consisted of reduced energy intake, dietetic education, physical exercises and psychological therapy. Body composition was assessed by bioelectrical impedance analysis, and physical capacity was assessed by the multistage cycle ergometer test. Type and duration of each activity were recorded using a daily controlled activity diary.Results: There was a significant decrease (p < 0.05) in body mass (27.84±12.49 kg for boys and 21.60±9.87 kg for girls), body mass index (9.19±3.88 kg/m 2 for boys and 7.72±3.98 kg/m 2 for girls) and fat mass. In addition, the percentage of fat free mass increased significantly (p < 0.05) in boys (from 58.8±6.41 to 69.98±7.43%) and in girls (from 51.86±4.96 to 60.04±5.65%). Conclusion:Long-term multidisciplinary approach allows significant reduction in severe obesity, preserving growth and percentage of fat free mass.J Pediatr (Rio J). 2009;85(3):243-248: Adolescent, body composition, body weight loss, exercise, nutrition, obesity. ResumoObjetivo: Descrever os efeitos da terapia multidisciplinar de longo prazo sobre a composição corporal de adolescentes obesos severos internados.Métodos: Um total de 728 adolescentes obesos extremos, incluindo 249 meninos (15,25±1,56 anos) e 479 meninas (15,34±1,59 anos), recebeu terapia multidisciplinar durante um período de 3 a 9 meses. A terapia consistiu de redução da ingestão energética, orientação dietética, exercícios físicos e terapia psicológica. A composição corporal foi analisada pela bioimpedância elétrica, e a aptidão física foi avaliada pelo teste em ciclo ergômetro multiestágios. O tipo e duração de cada atividade foram avaliados através de recordatório diário de atividade física.Resultados: Foi verificada redução significante (p < 0,05) na massa corporal (27,84±12,49 kg para meninos e 21,60±9,87 kg para meninas), índice de massa corporal (9,19±3,88 kg/m 2 para meninos e 7,72±3,98 kg/m 2 para meninas) e da gordura corporal. Além disso, a porcentagem de massa magra aumentou significantemente (p < 0,05) nos meninos (de 58,8±6,41 para 69,98±7,43%) e nas meninas (de 51,86±4,96 para 60,04±5,65%). Conclusão:A terapia multidisciplinar de longo prazo permite reduzir acentuadamente a obesidade severa, preservando o crescimento e a porcentagem de massa magra. J Pediatr (Rio J) IntroduçãoA obesidade infantil alcançou proporções de epidemia em todo o mundo apesar dos grandes esforços para promover a redução de peso. A prevalência tem aumentado a uma velocidade alarmante, afetando mais de 75% de crianças e adolescentes com sobrepeso ou obesos que vivem em países de baixa renda e em desenvolvimento, particularmente em áreas urbanas 1 . No Brasil, seis milhões de crianças e adolescentes têm sobrepeso o...

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Weight loss and growth velocity in obese children after very low calorie diet, exercise, and behavior modification

Abstract: We conclude that a multidisciplinary weight reduction program that combines a VLCD, followed by a balanced hypocaloric diet, with a moderate-intensity progressive exercise program and behavior modification is an effective means for weight reduction in obese children and adolescents.

Cited by 34 publications

References 29 publications

Effects of a multidisciplinary weight loss intervention on body composition in obese adolescents

Effects of a multidisciplinary weight loss intervention on body composition in obese adolescents

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

Effects of long-term multidisciplinary inpatient therapy on body composition of severely obese adolescents

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