Lifestyle intervention failed to sustain the reduction in BMI in children with obesity

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17.09.2021

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Children with a high BMI who participated in a high-intensity lifestyle intervention program in New Zealand had a lower BMI standard deviation score after 1 year, but the decrease did not persist after 5 years, according to study data.

In a randomized controlled trial, children in New Zealand aged 5 to 16 years with a BMI in 98 activity, nutrition, and psychology sessions or a minimal-intensity control group with assessments and advice were given at home. In output data, the high-intensity intervention group had a reduction in BMI standard deviation score of 0.12 and the control group had a reduction of 0.1 after 12 months. However, in follow-up data 5 years after the end of the study, the BMI standard deviation scores increased for both the intervention and control groups.

Obesity boy 2020
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“Both the high-intensity intervention group and the low-intensity control group returned to their baseline BMI standard deviation regardless of age, ethnicity, or socio-economic status.” Yvonne C. Anderson, PhD, FRACP, MBChB, BSc, a senior lecturer in the Department of Pediatrics, Child and Adolescent Health at the University of Auckland, New Zealand, and colleagues in a study published in obesity. “The lack of ethnicity and socioeconomic disadvantage in the primary endpoint was encouraging, despite negative overall results. Early intervention seems to be beneficial, which has been supported by previous international evidence. “

Researchers conducted 5-year follow-up assessments with study participants in their home or other preferred location. The assessment included measuring heart rate, blood pressure, waist height ratio, and identifying weight-related comorbidities. Physical activity was measured by questionnaire and wearing the accelerometer for 5 days. Cardiovascular fitness was assessed as walking or running 550 meters. The pediatric quality of life questionnaire was used to assess health-related changes in quality of life.

The values ​​of the BMI standard deviation are reset to the initial value

The 5-year follow-up data included 28 participants from the study control group and 41 from the intervention group. The demographics between the two groups were similar, although the control group contained more girls than the intervention group (79% vs. 49%; P. = 0.012). The BMI standard deviation score did not differ between the groups at follow-up, with both scores returning to baseline after 5 years. Overall, 41% of participants retained a lower BMI standard deviation value compared to baseline after 5 years.

The intervention group had an average decrease in sweet drink intake but an increase in reported screen time and fasting insulin at 5 years. According to the study, both groups had an increase in water intake and an improvement in health-related quality of life.

In the total cohort, girls had an increase in BMI standard deviation score of 0.21 after 5 years, while boys had a decrease in BMI standard deviation score of 0.14 (P. = 0.013). Participants younger than 10 years at baseline also had a decrease in BMI standard deviation score of 0.15, while those aged 10 years or older had an increase of 0.21 (P. = 0.008).

In the subgroup analysis, participants in the high-intensity intervention group who attended at least 70% of the sessions maintained a reduction in BMI standard deviation score for at least 2 years after the study. After 5 years, however, the trajectories of both high and low participation participants converged with no significant difference between the two groups.

The benefits of lifestyle intervention are still evident

Despite the results, the researchers found that the intervention brought several long-term benefits.

“First, while changes in the primary endpoint were not sustained over the long term, there is evidence of broader long-term benefit from engaging participants in a non-judgmental, non-stigmatizing approach to healthy lifestyle changes,” the researchers write. “Previously, it was argued that failure to lower BMI should not be equated with failure to change healthy lifestyles. Second, increased engagement can be achieved when services are accessible and appropriate to the most obese people. Third, assessment and management of weight-related comorbidities can be accomplished through community-based programs with home assessments that prevent hospital appointments and result in an efficient, participant-centric care model. “

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