Orit Friedland

Short- and Long-Term Beneficial Effects of a Combined Dietary-Behavioral-Physical Activity Intervention for the Treatment of Childhood Obesity

Background. Obesity has become the most common pediatric chronic disease in the modern era. Early prevention and treatment of childhood and adolescent obesity is mandated. Surprisingly, however, only a minor fraction of obese children participate in weight reduction interventions, and the longer-term effects of these weight-reduction interventions among children have not been elucidated. Objective. To examine prospectively the short- and long-term effects of a 3-month, combined dietary-behavioral-physical activity intervention on anthropometric measures, body composition, dietary and leisure-time habits, fitness, and lipid profiles among obese children. Methods. In this randomized prospective study, 24 obese subjects completed the 3-month intervention and were compared with 22 obese, age- and gender-matched, control subjects. Results. At 3 months, there were significant differences in changes in body weight (−2.8 ± 2.3 kg vs 1.2 ± 2.2 kg), BMI (−1.7 ± 1.1 kg/m2 vs −0.2 ± 1.0 kg/m2), body fat percentage (from skinfold tests; −3.3 ± 2.6% vs 1.4 ± 4.7%), serum total cholesterol level (−24.6 ± 15.1 mg/dL vs 0.8 ± 18.7 mg/dL), low-density lipoprotein cholesterol level (−23.3 ± 15.2 mg/dL vs −3.7 ± 17.3 mg/dL), and fitness (215 ± 107 seconds vs 50 ± 116 seconds) in the intervention group versus the control group. After a 1-year follow-up period, there were significant differences between the intervention group (n = 20) and the control group (n = 20) in body weight (0.6 ± 6.0 kg vs 5.3 ± 2.7 kg), BMI (−1.7 ± 2.3 kg/m2 vs 0.6 ± 0.9 kg/m2), and body fat percentage. There was a significant increase in leisure-time physical activity among the intervention participants, compared with a decrease among the control subjects. Conclusions. Our data demonstrate the short- and longer-term beneficial effects of a combined dietary-behavioral-physical activity intervention among obese children. These results highlight the importance of multidisciplinary programs for the treatment of childhood obesity and emphasize their encouraging long-term effects.

The effect of a combined intervention on body mass index and fitness in obese children and adolescents – a clinical experience

Abstract. We assessed the effect of a weight management programme on body weight, body mass index (BMI), and fitness in obese children and adolescents. The study was designed as a longitudinal, non-randomised, clinical experience of a 3 and 6 month combined dietary-behavioural-exercise intervention. A total of 177 obese children (age 6–16 years) participated in the 3 month programme, of whom 65 completed the 6 month intervention. A group of 25 age- and maturity-matched obese children who did not participate in the structured programme served as controls. Body weight, BMI, and fitness were evaluated at baseline, and after the 3 and 6 months intervention. Body weight and BMI were significantly reduced (P<0.05), and endurance time significantly increased (P<0.0005) following the 3 months intervention. Obese children who continued the programme for 6 months maintained the decrease in BMI and further improved endurance time. In contrast, obese children who did not participate in the structured programme gained weight, increased their BMI, and improved fitness less significantly. Gender, pubertal status, and the degree of obesity had no influence on BMI changes. Children without parental overweight had significantly greater decreases in BMI compared to children of obese parents. Conclusion: a combined, structured multidisciplinary intervention for childhood obesity results in decreased body weight, decreased body mass index and improved fitness.

Obesity and lipid profiles in children and adolescents

Childhood obesity is associated with unfavorable lipid profile, suggesting that obese children should be screened for hypercholesterolemia. However, the prevalence of hypercholesterolemia in childhood obesity, and the effect of the degree of obesity on lipid profile, are unknown. Eighty-nine obese children and adolescents (BMI >85%, mean age 10.4 +/- 2.5 years) and 53 non-obese control children matched for age, gender and pubertal stage participated in the study. Early morning blood samples for serum lipids were collected in all children after a 12-h fast. Mean serum cholesterol and triglycerides (TG) levels were significantly higher (p <0.05) among the obese children (cholesterol: 175.2 +/- 31.4 vs 143.3 +/- 24.3 mg/dl; TG: 122.8 +/- 69.7 vs 94.3 +/- 37.8 mg/dl in obese and control children, respectively). Among the obese children, 52% had elevated serum cholesterol levels (>170 mg/dl) compared to 16% in the controls. The degree of obesity (BMI 85-95% vs BMI >95%) had no effect on serum lipids. Unfavorable lipid levels were relatively common among obese children, suggesting that obesity should be considered a risk factor for hypercholesterolemia, and that screening obese children for hypercholesterolemia should be considered.

Parental Obesity and Higher Pre-intervention BMI Reduce the Likelihood of a Multidisciplinary Childhood Obesity Program to Succeed - A Clinical Observation

OBJECTIVE To assess the effects and identify factors associated with success of a combined, structured multidisciplinary weight management program in obese children and adolescents. METHODS Seventy-seven obese children (age 6-16 years) participated in a 12-month combined dietary-behavioral-exercise intervention. Thirty-seven (age and maturity comparable) obese children who did not participate in the structured program served as controls. Body weight, BMI, and BMI percentiles were measured at baseline, after 6 months, and at the end of the intervention. RESULTS The combined intervention was associated with a significant decrease in BMI (from 25.9+/-0.4 to 24.5+/-0.4 kg/m2, p <0.0005) and BMI percentile (from 97.3+/-0.2% to 92.6+/-0.9%, p <0.0005). In contrast, obese children who did not participate in the structured program gained weight (from 51.4+/-3.6 to 57.7+/-3.7 kg, p <0.0005), increased their BMI (from 25.2+/-1.0 to 26.6+/-0.9 kg/m2, p <0.0005), and had a non-significant increase in BMI percentiles (from 94.9+/-0.8% to 95.4+/-0.9%, NS). Children with higher BMI percentiles and parental overweight tended to respond less favorably to the combined multidisciplinary program (p <0.01). CONCLUSIONS A prolonged (12 mo), combined, structured multidisciplinary intervention for childhood obesity resulted in a significant decrease in BMI and BMI percentiles. Higher pre-intervention BMI percentiles and parental obesity were associated with less favorable responses to the combined intervention.

Spontaneous Activity in Premature Infants Affects Bone Strength

OBJECTIVE: Determination of bone strength of lower extremities in very low birth weight (VLBW) premature infants with central nervous system pathology resulting in reduced unilateral spontaneous leg movements.STUDY DESIGN: Quantitative ultrasound (QUS) measurements of speed of sound (SOS) of the tibiae of both legs in three VLBW premature infants with brain insult and unilateral reduced spontaneous activity. Results were compared to QUS measurements of both legs in healthy premature infants. Measurements were performed by the same investigator who was blinded to the clinical course of the participants.RESULTS: Reduced spontaneous activity of one leg due to brain pathology resulted in decreased tibial SOS in the affected side. There was no difference in bone SOS between the legs of the healthy controls.CONCLUSION: Spontaneous movements (mainly antigravity flexion and extension) are important for bone structure and mineralization in VLBW premature infants. QUS may become an important diagnostic modality for the evaluation, treatment, and follow-up of bone strength and osteopenia in this unique population.

Bone turnover markers and bone strength during the first weeks of life in very low birth weight premature infants.

Abstract Objective: To determine the association between changes in bone turnover markers and bone strength of very low birth weight infants during the first eight postnatal weeks. Study design: Twelve very low birth weight premature infants [mean gestational age: 28.4+-0.6 weeks, mean birth weight: 1131+-62 grams] participated in the study. Bone strength was evaluated weekly by quantitative ultrasound measurements of tibial bone speed of sound (SOS, Sunlight Omnisense™). Bone specific alkaline phosphatase (BSAP), a marker of bone formation, and carboxy terminal cross-links telopeptide of type-I collagen (ICTP), a marker of bone resorption, were collected at the ages of one, four and eight weeks. Results: BSAP increased significantly (from 119.9+-16.2 U/L to 132.1+-11.9 U/L and 152.1+-15.7 U/L at one, four and eight weeks of life, respectively, p<0.05). ICTP decreased significantly during the study period (from 122.3+-8.7 ng/ml to 96.0+-4.8 ng/ml and 92.3+-5.4 ng/ml at one, four and eight weeks of life, respectively; p<0.05). There was a significant decrease in bone SOS (from 2886+-29 m/sec to 2792+-30 m/sec and 2753+-30 m/sec at birth, four weeks and eight weeks of life, respectively; p<0.02). There was no correlation between the levels of bone markers and bone SOS. Conclusion: In VLBW premature infants, there is a significant decrease in bone strength concomitant with biochemical evidence for new bone formation (increase in BSAP and a decrease in ICTP) during the first eight postnatal weeks. Changes in the biochemical markers could not predict the changes in bone strength.

“Growing pains” in children are not associated with changes in vascular perfusion patterns in painful regions

The most common cause of recurring childhood musculoskeletal pain is termed “growing pains” (GP). The etiology and pathogenesis are unknown. There is an increased prevalence of migraine headaches in families with children with GP. This fact, and the sudden onset and severity of GP episodes, has led to speculation that GP may have a vascular component. Therefore, we investigated whether GP are associated with vascular perfusion changes, measured by technetium-99 methylene diphosphate (MDP) bone scintigraphy. Eleven patients with GP who underwent technetium-99 MDP bone scans were compared to 12 children who underwent bone scans for other indications. The uptake in the blood pool phase, static images, and blood pool phase/static image ratio were measured in the right mid-tibia region (painful among patients with GP) and right mid-femur (non-painful). Student’s t-test was used to compare these measurements at painful and painless regions among GP children, and to compare children with or without GP. There were no significant differences between children with GP and without GP in the blood pool, static images, and blood pool/static images in all localities. There were also no significant differences among patients with GP between painful regions and non-painful regions. We conclude that GP are not associated with vascular perfusion changes in painful regions as opposed to migraine headaches.

Living with Children with Growing Pains: How Does It Affect the Parents?

Objective: To assess quality of life [QOL] and psychological status of parents of children with growing pains. Methods: Thirty-three mothers and 28 fathers of 37 children with growing pains and 20 mothers and 19 fathers of 21 matched healthy normal control [HNC] children completed the Flanagan QOL Scale questionnaire and two validated anxiety and depression questionnaires. An analysis of variance and a students t-test were used to compare the groups. Results: The QOL and anxiety scores were similar in both groups. Depression levels were significantly higher among mothers of children with growing pains. Conclusions: Quality of life does not appear to be affected. However, maternal depression was mildly increased.