1024 Interventions for managing childhood and adolescent obesity

With so much attention currently focused on issues such as foetal determinants of adult disease, poor eating habits and low activity levels of children and adolescents, and a worldwide epidemic of the metabolic syndrome, one expects a range of preventive strategies to avoid or eliminate the problem of early obesity. Parents are the targets of various programmes, particularly for infants and children, but with the older child and adolescent one has to engage with and involve the subjects themselves. Recent articles include an analysis of implementation of health policy mandating physical activity in schools. In 2005 Texas passed Senate Bill 42 (SB42) which required public middle school students to participate in 30 minutes of structured physical activity each day. Follow up in 112 schools, with a particular focus on 17 Texas-Mexico border schools, with feedback from school staff and students themselves, showed that physical education instruction took place at least 4 times per week. The duration of physical activity exceeded the SB42 minimum of 135 minutes per week and also the Healthy People 2010 objective of 50% time in moderate to vigorous activity during physical education class. Another strategy has been to focus on after-school activity, and in a meta-analysis of 13 articles looking at after-school interventions there were positive effect sizes for physical activity (0.44[95% CI 0.28-0.60]), physical fitness (0.16[CI 0.01-0.30]), body composition (0.07[CI 0.03-0.12]) and blood lipids (0.20[CI 0.06-0.33]). The blood lipid effect in particular is impressive. A third approach that has recently been reported is to issue accelerometers which are worn and measure activity, and encourage downloading of data and interfacing with the internet. In that study from Holland, 87 adolescents were provided with a 3-month minimal physical activity intervention. Measurements were carried out at baseline, 3 months and 8 months. Sixty-five percent of the participants reported wearing the monitor frequently and 56% of the users uploaded scores to the internet ‘coach’ at least once. At 3 months girls showed an increase in moderate-intensity physical activity (411 mins/wk) and at 8 months boys showed a significant reduction in sedentary time (-1801 min/wk). While the result for the girls is plausible, the 30 hour reduction in sedentary time for the boys seems optimistic. However, the bottom line is that one must not only engage in one way or another in order to bring about change, but also measure the impact of such engagement.

Read more:
Prev Med 2010; 51: 31-36
Am J Prev Med 2009; 36: 527-37
J Adolesc Health 2009; 45; Suppl 1; S82-90