Effects of a combined intervention for treating severely obese prepubertal children

Obesity has become the most common modern pediatric chronic disease. Early prevention and treatment of childhood and adolescent obesity is mandated. Severe obesity [body mass index (BMI) percentile >98%] reduces the likelihood of the multidisciplinary childhood obesity program to succeed, suggesting, most probably, that a more intense program is needed to treat severely obese children.

To prospectively examine the effects of an intense, 3-month, combined dietary-behavioral-physical activity intervention on anthropometric measures, leisure time activity patterns, and fitness in prepubertal severely obese (BMI percentile >98%) children (n=22) compared to age, gender, and obesity matched controls (n=18).

At 3 months, there were significant differences (p<0.05) in changes in body weight (-0.5±2.4 vs. 1.7±1.9 kg), BMI (-0.9±1.2 vs. 0.4±1.0 kg/m2), BMI percentile (0.39±0.39% vs. -0.04±0.32%), sum skinfolds (-3.1±8.1 vs. 1.1±4.7 mm), total habitual physical activity (25.4±10.8 vs. 0.3±10.1 Mets), and fitness (142±72 vs. -8±88 s) in the intervention vs. control participants.

Our data demonstrate the beneficial, short-term effects of an intense combined dietary-behavioral-physical activity intervention on anthropometric measures, activity patterns, and fitness in severely obese children. However, despite the encouraging results, the modest effect on BMI percentiles emphasizes the difficulty of treating severely obese children using the conventional nutritional-behavioral-physical activity approach.