# Exercise as it relates to Disease/Dietary- Behavioral- Physical Activity intervention for childhood obesity

This is an analysis of the journal article "Short- and Long-Term Beneficial Effects of a Combined Dietary–Behavioral–Physical Activity Intervention for the Treatment of Childhood Obesity" by Dan Nemet et al (2005). This was created for an assignment at the University of Canberra by U3144535.

## Background

1 in 4 Australian children aged 5–17 are either overweight or obese. This number has over doubled in the past 20 years, and is quickly rising. Obesity greatly effects children socially, mentally and physically but the greatest concern are the long term health effects that can follow them into adulthood. Not only do obese children have a 50% chance of being overweight as an adult, obesity in childhood has also been linked to insulin resistance, cardiovascular diseases, diabetes mellitus and other chronic diseases later in life. Obesity is a result of a large calorie intake, less physical activity and more sedentary time.
Overweight/ obesity is defined using a Body Mass Index scale (kg/m$^2$). Overweight is defined as a range from 25-29.9 and obese is 30+. BMI is a common way to depict someones body fat, however is also commonly seen as inaccurate as it does not take into muscle mass. For children, BMI is an easy, non-invasive way to measure their 'fatness'. To reduce an individuals BMI in aims to become healthier, they need to increase their energy expenditure through physical activity and decrease their calorie intake through a balanced diet.
As seen in the report below, for optimal results, combining a healthy eating pattern, regular physical activity and knowledge on healthy living and weight loss will enhance an individuals health and body composition.

## Where is this research from?

This study was conducted by physicians at the Child Health and Sports Centre and the Tel Aviv University (Israel) after being approved by the Meir General Hospital. American Academy of Pediatrics Publications then published the peer reviewed journal article. Regardless of this research being set in Israel, the results and implications can be translated to Australian children and even worldwide.

## What kind of research was this?

This study was a Randomized Control Trial (RCT) that investigated the effects of physical activity, nutrition and knowledge on obese children’s body composition and fitness levels. An RCT randomly allocates participants into either ‘intervention’ groups or ‘control groups’. There were two groups that subjects were assigned to.
1. Control group: No intervention.
2. Intervention group: This group went through a 3-month dietary-behavioural-physical activity intervention.
The aim of a Randomized Control Trial is to determine whether an intervention works or not by comparison of the different groups. The advantages of an RCT are to easily view the effectiveness of an intervention by comparing it to the control group. Also the confidence in the accuracy of this test due to the random assignment ensures each group is distributed evenly.

## What did this research involve?

The study involved 54 (self-referred) obese Israeli children and adolescents (6–16 years old). 30 of these participants were randomly assigned to participate in the 3-month dietary-behavioural-physical activity intervention and the other 24 were control subjects.
The 3 month intervention included the following:
* The intervention subjects and their parents attended 4 lectures across the 3 months, providing knowledge on childhood obesity, nutrition and exercise.
* The participants met with a dietitian 6 times and were asked to conduct a 24-hour dietary recall. In these meetings, they discussed explanations for childhood obesity, dietary habits, motivation and the subjects were given nutritional education as well as supplementary worksheets and flyers on nutritional issues.
* The subjects were given a balanced diet plan in a substantial caloric deficit.
* They also participated in 2x 1 hour training programs each week. These sessions were based around games focusing on endurance, coordination and flexibility. The subjects were also encouraged to add extra walking into their weekly routine and to limit sedentary activities.
Both control and intervention subjects were assessed on their anthropometric measurements, nutrition, habitual activity and fitness. These measurements were recorded at the beginning of the experiment, after the 3-month intervention and then 12 months after the program.

## What were the basic results?

Drastic improvements in anthropometric measurements (BMI, BMI percentile and body fat %) was found throughout the intervention participants, however the control group had increased. Improvements was also seen through the intervention groups habitual activity time, overall fitness, serum lipid levels and daily caloric intake.
As seen below in table 1, even 1 year after the combined dietary-behavioral-physical activity intervention, intervention subjects managed to continue losing weight. They also managed to continue increasing their daily habitual activity levels, decrease their screen time, improve on their endurance time and continue to eat at a healthy caloric intake. However, those in the control group had increased their BMI, BMI percentile and their body fat.
Table 1: Anthropometric data from the 1 year follow up.
| | Control group before | Control Group after | Intervention group before | Intervention group after |
| BMI, kg/m$^2$ | 28.0 ± 5.2 | 28.6 ± 5.8 | 27.7 ± 3.6 | 26.1 ± 4.7 |
| BMI percentile | 97.2 ± 0.7 | 96.1 ± 1.4 | 98.2 ± 0.3 | 92.3 ± 3.0 |
| Body fat % | 40.9 ± 9.5 | 44.4 ± 9.7 | 40.6 ± 6.7 | 38.3 ± 12.5 |

## What conclusions can we take from this?

Effective weight loss requires multidisciplinary interventions combining a structured diet plan, regular physical activity and the knowledge behind it all. Nutrition and physical activity might have positive short term effects on an individuals health, however for the long term improvements like ones seen in this study, including education on a healthy lifestyle is needed.
From this study we can also observe the importance of children participating in physical activity and living a healthy life with nutritious food from an early age. Ensuring kids are healthy and active will reduce their risk of developing chronic diseases later in life

## Practical advice

* Treating and preventing obesity at an early age is vital for long term health.
* Combine a balanced diet and regular physical activity for healthy weight loss.
* For anyone looking to lose weight, seeking advice from allied health professionals is encouraged

## Further information

For further information on childhood obesity and the effects of multidisciplinary interventions, please read the following links.
* Dietitian Association of Australia: http://daa.asn.au/for-the-public/smart-eating-for-you/nutrition-a-z/childhood-obesity/
* Raising Children Network: http://raisingchildren.net.au/articles/childhood_obesity.html
* Centers for Disease Control and Prevention: https://www.cdc.gov/healthyschools/obesity/facts.htm

## References

* 1 2 3 4 Nemet D, Barkan S, Epstein Y, Friedland O, Kowen G, Eliakim A. Short- and Long-Term Beneficial Effects of a Combined Dietary-Behavioral-Physical Activity Intervention for the Treatment of Childhood Obesity. PEDIATRICS. 2005;115(4):e443-e449.
* 1 2 3 Childhood Obesity | Dietitians Association of Australia [Internet]. Daa.asn.au. 2016 [cited 2 September 2016]. Available from: http://daa.asn.au/for-the-public/smart-eating-for-you/nutrition-a-z/childhood-obesity/
* ↑ 3. 4102.0 - Australian Social Trends, Sep 2009 [Internet]. Abs.gov.au. 2016 [cited 7 September 2016]. Available from: http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4102.0Main+Features20Sep+2009
* ↑ Overweight and obesity (AIHW) [Internet]. Aihw.gov.au. 2016 [cited 7 September 2016]. Available from: http://www.aihw.gov.au/overweight-and-obesity/
* ↑ Calculate Your BMI - Standard BMI Calculator [Internet]. Nhlbi.nih.gov. 2016 [cited 7 September 2016]. Available from: http://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm
* 1 2 3 4 West ASpring B. EBBP [Internet]. Ebbp.org. 2016 [cited 7 September 2016]. Available from: http://ebbp.org/course_outlines/randomized_controlled_trials/