Prevention and treatment of childhood obesity

Childhood and adolescent obesity and long-term cognitive consequences during aging

The prevalence of childhood/adolescent obesity and insulin resistance has reached an epidemic level. Obesity's immediate clinical impacts have been extensively studied; however, current clinical evidence underscores the long-term implications. The current study explored the impacts of brief childhood/adolescent obesity and insulin resistance on cognitive function in later life. To mimic childhood/adolescent obesity and insulin resistance, we exposed 9-week-old C57BL/6J mice to a high-fat diet for 15 weeks, after which the mice exhibited diet-induced obesity and insulin resistance. We then put these mice back on a normal low-fat diet, after which the mice exhibited normal body weight and glucose tolerance. However, a spatial memory test in the forms of the Morris water maze (MWM) and contextual fear conditioning at 85 weeks of age showed that these mice had severe deficits in learning and long-term memory consolidation. Mechanistic investigations identified increased expression of histone deacetylases 5, accompanied by reduced expression of brain-derived neurotrophic factor, in the brains 61 weeks after the mice had been off the high-fat diet. Electrophysiology studies showed that hippocampal slices isolated from these mice are more susceptible to synaptic impairments compared with slices isolated from the control mice. We demonstrated that a 15-week occurrence of obesity and insulin resistance during childhood/adolescence induces irreversible epigenetic modifications in the brain that persist following restoration of normal metabolic homeostasis, leading to brain synaptic dysfunction during aging. Our study provides experimental evidence that limited early-life exposure to obesity and insulin resistance may have long-term deleterious consequences in the brain, contributing to the onset/progression of cognitive dysfunction during aging.

Kid's Choice Program improves weight management behaviors and weight status in school children

The present study examined the effectiveness of the Kid's Choice Program (KCP) for increasing children's weight management behaviors, and decreasing body mass index percentile (BMI%) for overweight and average-weight children. It also evaluated KCP characteristics relevant to long-term application in schools. Participants included 382 children assigned to two groups: a KCP group that received token rewards for three "Good Health Behaviors" including eating fruits or vegetables first at meals (FVFIRST), choosing low-fat and low-sugar healthy drinks (HDRINK), and showing 5000 exercise steps recorded on pedometers (EXERCISE), or a control group that received token rewards for three "Good Citizenship Behaviors." School lunch observations and pedometer records were completed for one month under baseline and three months under reward conditions. The school nurse calculated children's BMI% one year before baseline, at baseline, at the end of KCP application, and six months later. The KCP increased FVFIRST, HDRINK, and EXERCISE from baseline through reward conditions, with ANCOVAs demonstrating that these increases were associated with both the offer of reward and nearby peer models. Overweight (n=112) and average-weight (n=200) children showed drops in BMI% after the three-month KCP, but overweight children re-gained weight six months later, suggesting the need for more ongoing KCP application. HDRINK choice was the behavior most associated with BMI% drops for overweight children. Small teams of parent volunteers effectively delivered the KCP, and school staff endorsed parent volunteers as the best personnel to deliver the KCP, which costs approximately two U.S. dollars per child per month of application.

Weight control among obese adolescents: a pilot study

OBJECTIVE

The present study evaluated weight loss and compliance outcomes for overweight adolescents assigned to one of two dietary interventions differing in the type of snacks allowed.

METHODS

The study was a 12-week, controlled clinical trial, among otherwise healthy but overweight (body mass index >or=95th percentile) 11-year-old to 15-year-old girls who were randomly assigned to either a 1,500 kcal/day free-snack program or a 1,500 kcal/day restricted-snack program. All subjects were counseled to consume three servings of dairy products per day, and were provided with a 500 mg calcium supplement as well. Subjects in the free-snack group could choose any 150-calorie item as one of their two daily snacks, including regular soda if desired; however, subjects in the restricted-snack group were limited to diet soda.

RESULTS

Thirty-two adolescent girls completed the 12-week intervention. Both diets were equally effective in achieving a modest amount of weight loss, and were equally acceptable to the subjects. Significant decreases in weight, body mass index, anthropometric measures, total cholesterol and triglycerides were observed.

CONCLUSIONS

A 1,500 kcal/day diet allowing for a free snack of 150 calories was equally as effective as a more restricted snack policy in achieving a modest amount of weight loss among overweight 11-year-old to 15-year-old girls. In addition, results suggest that some soda may be included in a teen weight control diet, as long as caloric intake is maintained at recommended levels, and care is taken to achieve adequate intake of essential nutrients. Calcium intake among subjects was low at baseline, and, although it increased during the study (due to supplementation), further efforts to increase consumption of naturally calcium-rich and calcium-fortified foods and beverages are needed.

Children's adaptations to a fat-reduced diet: the Dietary Intervention Study in Children (DISC)

BACKGROUND

Prevention of cardiovascular disease through diet and lifestyle change is strongly advocated in adults and is initiated preferably during childhood. The Dietary Intervention Study in Children (DISC) was a multicenter, collaborative, randomized trial in 663 preadolescent children (363 boys and 301 girls) with elevated low-density lipoprotein cholesterol, designed to test the efficacy and safety of a dietary intervention to lower saturated-fat and cholesterol intake while also advocating a healthy eating pattern. DISC results have been published extensively. This ancillary study reports new data regarding changes in eating patterns among this cohort.

OBJECTIVE

We set out to compare children's self-selected eating patterns and approaches to achieving adherence to the DISC fat-reduced diet intervention with children in the usual-care group.

METHODS

An ancillary study was conducted to develop a detailed food-grouping system and report new analyses on dietary adherence to the recommended eating pattern. Every food in the nutrient database was ranked by its saturated-fat and cholesterol content and classified within its relevant food group as a "go" (less atherogenic) or "whoa" (more atherogenic) food.

RESULTS

At baseline, go foods contributed approximately 57% of total energy intake and 12.4% to 13.1% total fat energy intake in both groups. At 3 years, go foods contributed 67.4% and 13.7% of total and fat energy intake, respectively, in the intervention group versus 56.8% and 12.8% in the usual-care group. Differences between the 2 treatment groups were significant for changes in consumption of dairy foods, desserts, and fats/oils, with the intervention group reporting a 0.2- to 0.3-serving-per-day greater increase in go foods than the usual-care group. The intervention group also reported a 0.2- to 0.8-serving-per-day greater decrease in whoa foods than the usual-care group for breads/grains, dairy, fats/oils, meat/fish/poultry, snacks, and vegetables. Overall, snack foods, desserts, and pizza contributed approximately one third of total daily energy intake in both groups at 3 years.

CONCLUSIONS

Children in the intervention group reported consuming more servings per day of go grains, dairy, meats, and vegetable foods compared with children in the usual-care group, but intake of fruits and vegetables was low in both groups. Discovering that snacks, desserts, and pizza actively contribute so heavily to the diets of this age group, even among children who were part of this intervention, offers valuable insights regarding the need for more aggressive, innovative, and realistic approaches for additional dietary counseling.

Improving communication to tackle obesity in the UK

Obesity is a serious health issue. In the UK the prevalence of obesity has trebled in the last 20 years and today one in five adults is clinically obese. Research shows that obesity is a predictable response to an environment that favours the consumption of energy-dense foods and allows minimal physical activity. This finding implies that the efficacy of public health messages to individuals to inform their lifestyle choices will be enhanced by environmental changes that support and facilitate healthy options. The present paper focuses on the importance of communicating scientific knowledge to the stakeholders with a responsibility for tackling obesity and addresses some of the barriers that are encountered.