Top

BMC Public Health

Published in:

Open Access 01-12-2018 | Research article

The effectiveness of a stage-based lifestyle modification intervention for obese children

Authors: Nor Baizura Md. Yusop, Zalilah Mohd Shariff, Ting Tzer Hwu, Ruzita Abd. Talib, Nicola Spurrier

Published in: BMC Public Health | Issue 1/2018

Abstract

Background

Interventions that encompass behavioural modifications of dietary intake and physical activity are essential for the management of obesity in children. This study assessed the effectiveness of a stage-based lifestyle modification intervention for obese children.

Methods

A total of 50 obese children (7–11 years old) were randomized to the intervention group (IG, n = 25) or the control group (CG, n = 25). Data were collected at baseline, at follow-up (every month) and at six months after the end of the intervention. IG received stage-based lifestyle modification intervention based on the Nutrition Practice Guideline for the Management of Childhood Obesity, while CG received standard treatment. Changes in body composition, physical activity and dietary intake were examined in both the intervention and control groups.

Results

Both groups had significant increases in weight (IG: 1.5 ± 0.5 kg; CG: 3.9 ± 0.6 kg) (p < 0.01) and waist circumference (IG: 0.1 ± 0.5 cm; CG: 2.2 ± 0.7 cm) (p < 0.05), but the increases were significantly higher in CG than IG. Body Mass Index (BMI)-for-age z scores decreased significantly in IG (− 0.2 ± 0.0, p < 0.01) but not in CG. The physical activity of the IG significantly increased (0.44 ± 0.13) compared with that of CG (− 0.28 ± 0.18), and the difference in mean change between groups was statistically significant (p < 0.05). Dietary intake was not significantly different between the two groups. However, calorie and carbohydrate intake decreased significantly in both groups.

Conclusions

A stage-based intervention that modified dietary and physical activity behaviour may be effective in weight management for obese children.

Trial registration

NCT03429699 retrospectively registered 9 February 2018.

WHO. World Health Statistic 2014. [cited 2015 January 8]. Available from URL http://www.who.int/gho/publications/world_health_statistics/2014/en/.

Ezzati MA, et al. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. Lancet. 2017;6736(17):1–16.

Institute for Public Health. National Health and Morbidity Survey 2015 (NHMS 2015). In: Volume II: non-communicable diseases, risk factors and other health problems. Kuala Lumpur, IPH, Ministry of Health Malaysia. p. 2015.

Poh BK, Ng BK, Siti Haslinda MD, et al. Nutritional status and dietary intakes of children aged 6 months to 12 years: findings of the nutrition survey of Malaysian children (SEANUTS Malaysia). Br J Nutr. 2013;110(Suppl):S21–35. https://doi.org/10.1017/S0007114513002092.CrossRefPubMed

Wee BS, Poh BK, Bulgiba A, Ismail MN, Ruzita AT, Hills AP. Risk of metabolic syndrome among children living in metropolitan Kuala Lumpur: a case control study. BMC Public Health. 2011;11(1):333. https://doi.org/10.1186/1471-2458-11-333.CrossRefPubMedPubMedCentral

Kelsey MM, Zaepfel A, Bjornstad P, Nadeau KJ. Age-related consequences of childhood obesity. Gerontology. 2014;60(3):222–8. https://doi.org/10.1159/000356023.CrossRefPubMed

Oude Luttikhuis H, Baur L, Jansen H, Shrewsbury VA, O'Malley C, Stolk RP, Summerbell CD. Interventions for treating obesity in children. Cochrane Database Syst Rev. 2009:21(1). https://doi.org/10.1002/14651858.

Trinh A, Campbell M, Ukoumunne OC, Gerner B, Wake M. Physical activity and 3-year BMI change in overweight and obese children. Pediatrics. 2013;131(2):e470–7.CrossRefPubMed

Prochaska J, Diclemente CC. Toward a Comprehensive Model of Change. In: Miller WR, Heather N. (ed) Treating Addictive Behaviors. Applied Clinical Psychology, vol 13. Boston: Springer; 1986.

10.

Maxwell CJ, Onysko J, Bancej CM, Nichol M, Rakowski W. The distribution and predictive validity of the stages of change for mammography adoption among Canadian women. Prev Med (Baltim). 2006;43(3):171–7. https://doi.org/10.1016/j.ypmed.2006.04.018.CrossRef

11.

Wee CC, Davis RB, Phillips RS. Stage of readiness to control weight and adopt weight control behaviors in primary care. J Gen Intern Med. 2005;20(5):410–5. https://doi.org/10.1111/j.1525-1497.2005.0074.x.CrossRefPubMedPubMedCentral

12.

Garrett NA, Alesci NL, Schultz MM, Foldes SS, Magnan SJ, Manley MW. The relationship of stage of change for smoking cessation to stage of change for fruit and vegetable consumption and physical activity in a health plan population. Am J Health Promot. 2004;19(2):118–27.

13.

Jury A, Flett R. Stages of change for fruit and vegetable intake among New Zealand men: readiness to eat five servings a day and impact of contextual factors. Int J Mens Health. 2010;9(3):184–200. https://doi.org/10.3149/jmh.0903.184.CrossRef

14.

Mason HN, Crabtree V, Caudill P, Topp R. Childhood obesity: a transtheoretical case management approach. J Pediatr Nurs. 2008;23(5):337–44. https://doi.org/10.1016/j.pedn.2008.01.080.CrossRefPubMed

15.

Frenn M, Malin S, Bansal NK. Stage-based interventions for low-fat diet with middle school students. J Pediatr Nurs. 2003;18(1):36–45. https://doi.org/10.1053/jpdn.2003.6.CrossRefPubMed

16.

Nazaimoon W. My Body is Fit and Fabulous at School. [cited 2015 Feb 20]. Available from URL https://clinicaltrials.gov/ct2/show/NCT02212873.

17.

Sharifah WW, Nur HH, Ruzita AT, Roslee R, Reilly JJ. The Malaysian childhood obesity treatment trial (MASCOT). Malays J Nutr. 2011;17(2):229–36. Available at: http://nutriweb.org.my/publications/mjn0017_2/RuzitaSharifah282RV-8.pdf.

18.

De Onis M, Garza C, Onyango AW, Borghi E. Comparison of the WHO child growth standards and the CDC 2000 growth charts. J Nutr. 2007;137(1):144–8.CrossRefPubMed

19.

Piantadosi S. Block Stratified Randomization: Windows Version 6.0. West Hollywood: Cedars-Sinai Medical Center, 2010.

20.

Hughes AR, Stewart L, Chapple J, McColl JH, Donaldson MDC, Kelnar CJH, Zabihollah M, Ahmed F, Reilly JJ. Randomized, controlled trial of a best-practice individualized behavioral program for treatment of childhood overweight: Scottish childhood overweight treatment trial (SCOTT). Pediatrics. 2008;121:3:539–46.CrossRef

21.

Burrows T, Warren JM, Baur L a, Collins CE. Impact of a child obesity intervention on dietary intake and behaviors. Int J Obes 2008;32(10):1481–1488. https://doi.org/10.1038/ijo.2008.96.

22.

Nor Baizura MY, Zalilah MS, Ting TH, Ruzita AT, Nicola S. Dietetic practices in the management of childhood obesity in Malaysia. Mal J Nutr. 2014;20(2):255–69.

23.

Slaughter MH, Lohman TG, Boileau RA, et al. Skinfold equations for estimation of body fatness in children and youth. Hum Biol an Int Rec Res. 1988;60(5):709–23.

24.

Baharudin A, Zainuddin AA, M A M, et al. Factors associated with physical inactivity among school-going adolescents: data from the Malaysian school-based nutrition survey 2012. Asia Pac J Public Health. 2014;26(5 Suppl):27S–35S. https://doi.org/10.1177/1010539514543682.CrossRefPubMed

25.

Suzana S, Rafidah G, Noor Aini MY, Nik Shahnita S, Zahara AM, AMH S. Atlas of food exchanges & portion sizes: MDC Publishers Printers Sdn.Bhd. Malaysia: Malaysia Book Publishers Association; 2002.

26.

Whitlock EA, O’Connor EP, Williams SB, Beil TL, Lutz KW. Effectiveness of weight management programs in children and adolescents. Evid Rep Technol Assess. 2008;170:1–308. (full rep) Available at: https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0025446/.

27.

Sun MX, Huang XQ, Yan Y, Li BW, Zhong WJ, Chen JF, Zhang YM, Wang ZZ, Wang L, Shi XC, Li J, Xie MH. One-hour after-school exercise ameliorates central adiposity and lipids in overweight Chinese adolescents: a randomized controlled trial. Chin Med J. 2011;124(3):323–29.

28.

Lee YS, Kek BLK, Poh LKS, Saw SM, Loke KY. Association of raised liver transaminases with physical inactivity, increased waist-hip ratio, and other metabolic morbidities in severely obese children. J Pediatr Gastroenterol Nutr. 2008;47(2):172–8. https://doi.org/10.1097/MPG.0b013e318162a0e5.CrossRefPubMed

29.

Spolidoro JV, Pitrez Filho ML, Vargas LT, et al. Waist circumference in children and adolescents correlate with metabolic syndrome and fat deposits in young adults. Clin Nutr. 2013;32(1):93–7. https://doi.org/10.1016/j.clnu.2012.05.020.CrossRefPubMed

30.

Lee S, Bacha F, Gungor N, S A A. Waist circumference is an independent predictor of insulin resistance in black and white youths. J Pediatr. 2006;148(2):188–94. https://doi.org/10.1016/j.jpeds.2005.10.001.CrossRefPubMed

31.

Siren R, Eriksson JG, Vanhanen H. Waist circumference a good indicator of future risk for type 2 diabetes and cardiovascular disease. BMC Public Health. 2012;12(1):631. https://doi.org/10.1186/1471-2458-12-631.CrossRefPubMedPubMedCentral

32.

Lazaar N, Aucouturier J, Ratel S, Rance M, Meyer M, Duché P. Effect of physical activity intervention on body composition in young children: influence of body mass index status and gender. Acta Paediatr. 2007;96(9):1315–20. https://doi.org/10.1111/j.1651-2227.2007.00426.x.CrossRefPubMedPubMedCentral

33.

Fletcher G, Balady G, Blair S, et al. Statement on exercise: benefits and recommendations for physical activity programs for all Americans. Circulation. 1996;94:857–62. https://doi.org/10.1161/01.CIR.94.4.857.CrossRefPubMed

34.

Gortmaker SL, Lee RM, Mozaffarian RS, et al. Effect of an after-school intervention on increases in children’s physical activity. Med Sci Sports Exerc. 2012;44(3):450–7. https://doi.org/10.1249/MSS.0b013e3182300128.CrossRefPubMed

35.

Sealy YM, Farmer GL. Parents’ stage of change for diet and physical activity: influence on childhood obesity. Soc Work Health Care. 2011;50(4):274–91. https://doi.org/10.1080/00981389.2010.529384.CrossRefPubMed

36.

Woods C, Mutrie N, Scott M. Physical activity intervention: a transtheoretical model-based intervention designed to help sedentary young adults become active. Health Educ Res. 2002;17(4):451–60. https://doi.org/10.1093/her/17.4.451.CrossRefPubMed

37.

Alberga AS, Prud’homme D, Sigal RJ, et al. Effects of aerobic training, resistance training, or both on cardiorespiratory and musculoskeletal fitness in adolescents with obesity: the HEARTY trial. Appl Physiol Nutr Metab. 2016;41(3):255–65. https://doi.org/10.1139/apnm-2015-0413.CrossRefPubMed

38.

McManus AM, Chu EYW, Yu CCW, Hu Y. How children move: activity pattern characteristics in lean and obese chinese children. J Obes. 2011;2011:679328. https://doi.org/10.1155/2011/679328.CrossRefPubMed

39.

Ham OK, Sung KM, Lee BG, Choi HW, Im E-O. Transtheoretical model based exercise counseling combined with music skipping rope exercise on childhood obesity. Asian Nurs Res (Korean Soc Nurs Sci). 2016;1:–7. https://doi.org/10.1016/j.anr.2016.03.003.

40.

Austin GL, Ogden LG, Hill JO. Trends in carbohydrate, fat, and protein intakes and association with energy intake in normal-weight, overweight, and obese individuals: 1971-2006. Am J Clin Nutr. 2011;93(4):836–43. https://doi.org/10.3945/ajcn.110.000141.CrossRefPubMed

41.

Burrows T, Collins CE, Garg ML. Omega-3 index, obesity and insulin resistance in children. Int J Pediatr Obes. 2011;6(2–2):e532–9. https://doi.org/10.3109/17477166.2010.549489.CrossRefPubMed

42.

Waling M, Larsson C. Improved dietary intake among overweight and obese children followed from 8 to 12 years of age in a randomised controlled trial. J Nutr Sci. 2012;1:e16. https://doi.org/10.1017/jns.2012.17.CrossRefPubMedPubMedCentral

43.

Vernarelli JA, Mitchell DC, Hartman TJ, Rolls BJ. Dietary energy density is associated with body weight status and vegetable intake in U.S. children. J Nutr. 2011; https://doi.org/10.3945/jn.111.146092.nomic.

44.

National Coordinating Committee on Food and Nutrition (NCFFN). Recommended nutrient intakes for Malaysia. Malaysia: Ministry of Health; 2005.

45.

Mohd Shariff Z, Lin KG, Sariman S, et al. The relationship between household income and dietary intakes of 1-10 year old urban Malaysian. Nutr Res Pract. 2015;9(3):278–87. https://doi.org/10.4162/nrp.2015.9.3.278.CrossRefPubMedPubMedCentral

46.

Sharif Ishak SI, Shohaimi S, Kandiah M. Assessing the children’s views on foods and consumption of selected food groups: outcome from focus group approach. Nutr Res Pract. 2013;7(2):132–8.CrossRefPubMedPubMedCentral

47.

Bourke M, Whittaker PJ, Verma A. Are dietary interventions effective at increasing fruit and vegetable consumption among overweight children? A systematic review. J Epidemiol Community Health. 2014;68(5):485–90. https://doi.org/10.1136/jech-2013-203238.CrossRefPubMed

48.

Gibson RS. Principles of nutritional assessment. 2nd ed. Oxford: University Press, Inc.; 2005.

49.

Kyle UG, Earthman CP, Pichard C, Coss-Bu JA. Body composition during growth in children: limitations and perspectives of bioelectrical impedance analysis. Eur J Clin Nutr. 2015;69(12):1298–305.CrossRefPubMed

Title: The effectiveness of a stage-based lifestyle modification intervention for obese children
Authors: Nor Baizura Md. Yusop
Zalilah Mohd Shariff
Ting Tzer Hwu
Ruzita Abd. Talib
Nicola Spurrier
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: BMC Public Health / Issue 1/2018
Electronic ISSN: 1471-2458
DOI: https://doi.org/10.1186/s12889-018-5206-2

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

The effectiveness of a stage-based lifestyle modification intervention for obese children

Abstract

Background

Methods

Results

Conclusions

Trial registration

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Trial registration

Please log in to get access to this content

Other articles of this Issue 1/2018

Physical activity, energy expenditure and sedentary parameters in overfeeding studies - a systematic review

Body and mind: retention in antiretroviral treatment care is improved by mental health training of care providers in Ethiopia

Impact of passenger engagement through road safety bus stickers in public service vehicles on road traffic crashes in Zambia: a randomized controlled trial

Receptiveness and preferences of health-related smartphone applications among Vietnamese youth and young adults

Current epidemiology of diabetic retinopathy in patients with type 1 diabetes: a national multicenter study in Brazil

A qualitative evaluation of hospital versus community-based management of patients on injectable treatments for tuberculosis