Treatment to improve body composition in overweight and obese children

Background: Overweight and obesity are a rapidly growing problem because of its related health problems. Therefore it is important to find efficient and effective treatments for weight loss and improvement of body composition in overweight and obese children. The aim of the present study was to evaluate the effect of a multidisciplinary, family-based, cognitive-behavioural, group intervention named the ‘Dikke Vrienden Club’ (DVC), on body composition. The second aim was to evaluate the effect of an ad libitum high-protein diet on body composition in overweight and obese children. Methods: To evaluate the effect of the DVC on body composition in overweight and obese children, 126 children (age 10.6 ± 1.3 years, body mass index- standard deviation score (BMI-SDS) 2.62 ± 0.45) who participated in the DVC program were included in this prospective, longitudinal, observational study. Measurements of weight, height, WC and hip circumference (HC) were carried out at baseline, after 3 months of intensive treatment and after a follow up period of 12 months. To evaluate the effect of an ad libitum high-protein diet on body composition compared to a normal-protein diet in obese children, 3 children (age 9, 11 and 11 years, BMI-SDS 3.43, 1.87 and 1.89) participated in a crossover study design and were randomly assigned to start with an ad libitum normal- or high-protein diet (13% vs. 25% protein, respectively) of 4 weeks. At the start and at the end of the intervention period measurements of weight, height, WC and HC were carried out and a dual-energy X-ray absorptiometry scan was made. No statistical analyses could be performed because of the limited number of children that only completed the first intervention period. Results: In the DVC program there was a decrease of waist- and hip circumference standard deviation scores (WC-SDS and HC-SDS) of 0.17 ± 0.26 (p< 0.01) and 0.31 ± 0.37 (p< 0.01), respectively after the intensive period and of 0.36 ± 0.41 (p< 0.01) and 0.53 ± 0.62 (p< 0.01), respectively after the follow up period. Moreover, the BMI-SDS decreased with 0.22 ± 0.19 (p< 0.01) after the intensive period and 0.41 ± 0.39 (p< 0.01) after follow up. Furthermore, there was a significant correlation between ∆BMI-SDS and ∆WC-SDS of 0.623 (p< 0.01) and between ∆BMI-SDS and ∆HC-SDS of 0.767 (p< 0.01) after the follow up period. In the child who consumed the ad libitum high-protein diet there was in a decrease of BMI of 0.4 kg/m2 and of BMI-SDS of 0.03, a decrease of WC of 2.6 cm and a decrease of the total and abdominal fat mass with 1.2% and 0.5%, respectively. In the children who consumed the normal-protein diet the BMI increased with 0.4 kg/m2 or did not change, the WC increased with 3.3 and 2.2 cm and the total and abdominal FM increased with 1.2% and 2.2%, respectively. Conclusion: The children included in the DVC program achieved an improvement of the body composition after the intensive period of 3 months and after a follow up period of 12 months, because they had a reduction of body weight, WC and HC. An ad libitum high-protein diet might cause a higher decrease of BMI-SDS and more beneficial effects on body composition in obese children compared to a normal-protein diet. Nevertheless, further research on protein diets with a larger study population is necessary because of the limited number of subjects during the present study.