Minority kids may need longer support to keep weight off

Aug. 7, 2013, MedPage Today

By Cole Petrochko

A lifestyle modification program for obese minority and inner city teens effectively helped them manage body mass index and nutrition, but the benefits wore off after the program’s conclusion, researchers found.

During nine months of the behavior- and nutrition-modifying intervention, participants saw significant reductions in rates of BMI increase (0.13 versus 0.04,P<0.01), BMI percentile (0.0002 versus -0.0001, P<0.01), the percentage of overweight participants (0.001 versus -0.001, P<0.01), and in BMI z-score (0.003 versus -0.003, P<0.01), according to Jessica Rieder, M.D., of the Children’s Hospital at Montefiore in New York City, and colleagues.

Participants also had significant increases in the amount of fruits and vegetables consumed, as well as in participation in vigorous physical activities, they wrote online in the journal Childhood Obesity.

However, after the program was finished, BMI increased significantly (P=0.002) during follow-up, the authors pointed out, adding that program participation and retention were low, in part because of limitations set by school obligations, family emergencies, and transportation issues.

“We found improvements can be made, but without continued healthy lifestyle support and participant and family engagement, weight regain is likely,” said Rieder in an accompanying statement.

Her group noted that some 18 percent of adolescents ages 12 to 19 are obese, with ethnic minority and low socioeconomic status teens at a 35 percent increased risk of obesity versus white and higher socioeconomic status teens, and a 40 percent increased risk for severe obesity.

Many weight management interventions targeting this age group have been conducted in well-controlled clinic or school-based research settings, but few target busy, understaffed health clinics, large health systems, or poorer, minority, and severely obese adolescents, nor is there data to support that interventions in higher socioeconomic environments would be effective in that population.

The study enrolled 349 obese teens with a mean age of 15 to participate in a multicomponent, community based weight management program known as the Bronx Nutrition and Fitness Initiative for Teens (B’N Fit), which was a nine-month program made up of nutrition, sedentary behavior reduction, and parental involvement components.

At baseline, researchers gathered a complete comprehensive medical history and physical examination of participants, a psychosocial evaluation, and assessed how ready participants were to adopt a healthy lifestyle. Dietitians examined participant nutrition and physical activity to establish goals for the teen. Additionally, patients were treated for comorbid conditions if indicated.

Among participants with a BMI greater than the 95th percentile for their age, it was recommended that they lose weight until BMI was lower than the 85th percentile with no more than an average two pounds of weight lost weekly.

During the 12-week induction period, participants were taught food guide contents, label reading, discrepancies between current behaviors and goals, team building, awareness of sugar content in drinks, and self-assessment and goal setting. Instruction also was given on awareness of fast food nutritional content and alternative foods, portion evaluation, healthy shopping habits in supermarkets, and cognitive behavioral treatment, followed by a reassessment of what was learned over the prior 11 weeks during the final week.

Generally, participants were taught to limit sugary drink consumption, to eat more fruits and vegetables, to limit television and other screen time to two hours a day, to eat breakfast every day, to limit eating out and at fast food restaurants, to eat meals with the family, to eat appropriate serving sizes, to engage in moderate to vigorous physical activity for at least 60 minutes a day, and to avoid consuming energy-dense foods.

The induction period was followed by six months of maintenance. The program was also coordinated with community-based youth leaders who were tasked with creating a youth-focused environment and managing the program structure. The leaders also had to motivate the teens, role play with them, and help them develop decision making and critical thinking skills.

The study population was mostly female (54 percent) and mostly black (52 percent), with a large number of Hispanic participants (44 percent). Mean BMI was 39.2 kg/m2 and most participants were at the pre-contemplation or contemplation stage of behavioral readiness (68 percent) and were considered severely obese (67 percent) at baseline. The most common comorbidities were asthma (39 percent), hypertension (9 percent), and diabetes (8 percent).

Some 79 percent of participants consumed one or more sugary drinks a day, half ate no fruits and 57 percent at no vegetables daily, and fewer than 5 percent consumed four or more servings of fruits or vegetables in a day. Fewer than 20 percent spent six or more hours engaged in moderate or vigorous physical activity in the two weeks prior to the study, and 90 percent spent two or more hours a day in front of a television and/or computer screen. Thirty-one percent spent six or more hours in front of a screen.

After 12 months of follow-up, the authors “found significant, but modest clinical improvements in the rate of change in all anthropometric measures,” which included a slowing of BMI increase, decreases in BMI and BMI z-score, and a trend for decrease in BMI percentile (-0.003 of a percentile monthly, P=0.06). There was a significant correlation between reductions in these scores with the number of physical activity sessions attended.

In addition to low participation, other barriers to the program were reluctance on the part of the kids to undergo a BMI screening and issues with contacting parents to enroll their children.

Limitations to the study included a mostly heterogeneous study sample and low attendance.

Nonetheless, “our study validates the notion that managing weight is a lifetime effort that requires support from myriad healthcare professionals in partnership with patients, families, schools, and our communities to ensure that all aspects of the person’s health and well-being are addressed,” Rieder said. “Our next step is to leverage these findings and empower the youth and their families, with hospital and community support, to strengthen and invest in the program and themselves so that they are more engaged and able to achieve long-lasting healthy lifestyle behaviors.”

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