Abstract
This study aimed to develop a multidisciplinary lifestyle intervention program targeted at children and adolescents with moderate to severe obesity, and assess the additional effects of exercise intervention when compared to usual care. Overall, the 103 enrolled participants were ≥85th percentile of age and sex-specific body mass index (BMI). Participants were divided into groups that received 16 weeks of either usual care or exercise intervention. The BMI z-score of the overall completers decreased by about 0.05 after the 16-week intervention (p = 0.02). After the intervention, only the exercise group had a significantly lower BMI z-score than the baseline score by about 0.1 (p = 0.03), but no significant group by time interaction effects were observed. At the 16-week follow-up, significant group by time interaction effects were observed in percentage body fat (%BF) (β = −1.52, 95%CI = −2.58–−0.45), lean body mass (LM) (β = 1.20, 95%CI = 0.12–2.29), diastolic blood pressure (β = −5.24, 95%CI = −9.66–−0.83), high-sensitivity C-reactive protein (β = −1.67, 95%CI = −2.77–−1.01), and wall sit test score (β = 50.74, 95%CI = 32.30–69.18). We developed a moderate-intensity intervention program that can be sustained in the real-world setting and is practically applicable to both moderate and severe obesity. After interventions, the exercise group had lower %BF and cardiometabolic risk markers, and higher LM and leg muscle strength compared to the usual care group.
Highlights
Over the past few decades, the prevalence of obesity in children and adolescents has increased worldwide [1,2,3]
There were no significant differences in the proportion of severe obesity (31.0% versus 40.6%, p = 0.34) and the proportion of body mass index (BMI) ≥97th percentile for age and sex (81.7% versus 78.1%, p = 0.67) between usual care and exercise groups at baseline
At the 16-week follow-up, significant improvement over the intervention period was found in the exercise group compared with the usual care group with %BF, lean body mass (LM), diastolic blood pressure (DBP), CRP, and wall sit test score
Summary
Over the past few decades, the prevalence of obesity in children and adolescents has increased worldwide [1,2,3]. Children and adolescents with obesity are at high risk of transitioning to adult obesity [4]. Previous studies have found that obesity in childhood and adolescence increases the incidence of metabolic syndrome (MetS) and cardiovascular disease (CVD) such as hypertension. When compared to obese children, children with severe obesity are at greater risk of adult obesity, early atherosclerosis, HTN, T2DM, DL, MetS, obstructive sleep apnea syndrome, fatty liver disease, and premature death [8]. Obese children and adolescents have a threefold increased risk of MetS compared to moderately obese children and adolescents [10,11]. An increasing gradation of obesity was associated with a higher risk of HTN, while severe obesity has a nearly threefold increased risk compared to moderate obesity in children and adolescents [12]. The Bogalusa Heart Study demonstrated that 39% of children with moderate obesity had at least two cardiovascular risk factors, while 59% of children with severe obesity had at least two cardiovascular risk factors [13]
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