Intervention in overweight children improves body mass index (BMI) and physical activity

Abstract

Background: Childhood obesity is a growing epidemic in family medicine with few clinical treatment options. We implemented and evaluated a group office-visit intervention by family physicians for overweight children and their parents, emphasizing nutrition and physical activity within a resiliency psychosocial model.

Methods: The intervention lasted for 3 months, with half of the children crossing over to intervention after 6 months in the study. Participants included 35 children who met eligibility criteria of being in third through fifth grades and having a body mass index (BMI) above the 85th percentile. The 3-month, 12-session intervention, "Choices," included topics on nutrition, physical activity, and resiliency. The sessions were developed for delivery by a family physician and a nutritionist who received training in positive psychology and resilience skills. Main outcome measures were BMI z scores for age and sex and z scores for weight by age and sex, as well as qualitative interviews to understand individual and family processes.

Results: The intervention resulted in a significant effect on one primary outcome, BMI z score (-0.138 per 9 months [P = .017]) and a trend toward significance on the weight for age z score (-0.87 per 9 months [P = .09]). The net shift of activity from the low metabolic equivalents (METs) to the high METs had an intervention effect of 2.84 METs (P = .037). Families reported lasting changes in behaviors and attitudes.

Discussion: The innovative approach used in this study demonstrated modest efficacy in reducing BMI z score, changing physical activity levels, and possibly shifting family dynamics.

Figure 1

Consort Diagram

Figure 2

BMI and BMI Z -score In the upper panel, the light dashed line represents the predicted BMI increase if the children were to continue at the same CDC z-score (percentile). The lower panel shows the BMI age-specific z-score. In both panels, the heavy dashed line represents the intervention periods, and the darker dots are the three measurements points after the intervention for each group.

Figure 3

Weight and Weight for age Z-score In the upper panel, the dashed line represents the predicted weight increase if the children were to continue at the same CDC z-score (percentile). The lower panel shows the weight age-specific z-score. In both panels, the heavy dashed line represents the intervention periods, and the darker dots are the three measurement points after the intervention.