Family-based weight management program cuts diabetes risk, improves BMI in overweight children

Children who participated in a family-based weight management program designed for inner-city minority children had better outcomes regarding weight gain, body fat, body mass index (BMI) and insulin sensitivity compared to children who received traditional weight counseling in a clinic, according to a study in the June 27 issue of JAMA: The Journal of the American Medical Association, a theme issue on chronic diseases of children.

Mary Savoye, R.D., CD.-N., C.D.E., of Yale University, New Haven, Conn., presented the findings of the study at a JAMA media briefing in New York.

The percentage of children and adolescents in the U.S. who are overweight has increased significantly in recent years, up to 17 percent in 2004, and with an even higher prevalence among African American and Hispanic youth (18 percent - 26 percent). The epidemic of childhood obesity has been accompanied by an increase of type 2 diabetes among adolescents, and is more common in African American and Hispanic youth.Since an overweight child has a high probability of becoming an overweight adult, the grave concerns for the long-term health of obese children are well justified, the authors write. Few studies have reported successful weight control interventions in children and adolescents.

This one-year randomized clinical trial, conducted May 2002 - September 2005, evaluated the effectiveness of a weight management program, Bright Bodies, in comparison to routine care provided at a pediatric obesity clinic. This weight management program is a family-based, intensive lifestyle intervention that has been specially tailored for the needs of inner-city minority children. The primary aim of the study was to compare changes in BMI, body composition, insulin sensitivity, blood pressure, and lipid profiles.

The study included 209 overweight children (BMI greater than the 95th percentile for age and sex), ages 8 to 16 years of mixed ethnic groups. A total of 135 participants (60 percent) completed six months of the study, 119 (53 percent) completed 12 months. Participants were randomly assigned to either a control or weight management group. The control group (n = 69) received traditional clinical weight management counseling every six months, and the weight management group (n = 105) received an intensive family-based program including exercise, nutrition education and behavior modification. Intervention occurred bi-weekly the first six months and bi-monthly thereafter to mimic a maintenance phase of the program.

The researchers found that while average body weight was essentially unchanged from baseline after 12 months in the weight management group (+.67 lbs.), BMI change was -1.7. In contrast, the control group gained 16.94 pounds and increased their BMI by 1.6 units. Percent and total body fat were reduced in the weight management group, and increased in the control group. The difference between the two groups in changes in BMI (-3.3), body weight (-16.3 lbs.), body fat (-20.3 lbs.), and percent body fat (-6.0 percent) after 12 months were significantly different. Total cholesterol improved in the weight management group, but not in the control group.

The difference between the two groups in insulin sensitivity, a parameter that measures the risk of the development of type 2 diabetes, was also significantly different at 12 months. The weight management group had an increase in insulin sensitivity, which is associated with a decreased risk of the development of type 2 diabetes.

As illustrated by the outcomes in the control group in this study, simple education about health risks of obesity and routine counseling regarding diet and exercise are insufficient to prevent the seemingly inexorable increases in BMI, body weight, and body fat observed in traditionally treated overweight children, the authors write.In contrast to conventional wisdom regarding the futility of changing the lifestyle of overweight children, 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 success of the Bright Bodies program undoubtedly relates, in part, to the frequent contacts between families and the professional staff. While the program was very successful in treating overweight children, the expense incurred in operating such a program is substantial. Future work for our group includes cost-benefit analyses, as this would be helpful for pediatric clinicians or health management organizations that are considering offering similar services to overweight children and adolescents.

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