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ELECTRONIC ARTICLE:
Dan Nemet, Sivan Barkan, Yoram Epstein, Orit Friedland, Galit Kowen, and Alon Eliakim
Short- and Long-Term Beneficial Effects of a Combined Dietary–Behavioral–Physical Activity Intervention for the Treatment of Childhood Obesity
Pediatrics 2005; 115: e443-e449 [Abstract] [Full text] [PDF]
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[Read P3R] Intervention Program for Childhood Obesity and Suggestions for Improvement
Richard N. Arboleda, Srikanth R. Ambati MD, Barry Greenberg PhD, Marco Danon MD   (20 August 2007)

Intervention Program for Childhood Obesity and Suggestions for Improvement 20 August 2007
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Richard N. Arboleda,
MD, MPH
Miami Children's Hospital,
Srikanth R. Ambati MD, Barry Greenberg PhD, Marco Danon MD

Send letter to journal:
Re: Intervention Program for Childhood Obesity and Suggestions for Improvement

richard.arboleda{at}mch.com Richard N. Arboleda, et al.

To the Editor—

Several studies involving physical activity, dietary or combined strategies have failed to show significant favorable effects in body mass index (BMI) or body fat percentage after the intervention was over.(1) However various studies have shown that multidisciplinary interventions during childhood led to changes in dietary habits, nutrition knowledge, increased fitness and physical activity levels.(2) The short and long term benefits of a combined dietary-behavioral-physical activity intervention program reported by Dan Nemet et al,(3) were promising. However, we observed some limitations in this study.

1. The sample size was small when compared to other studies that had similar interventions. The authors mentioned that they arrived at this number based on 90% power. However they did not mention the percentage of weight loss or decrease in BMI that was considered ‘significant’ (the ‘effect’ size) to get the minimum number of subjects.

2. Only 66% of the subjects in the intervention could be followed-up at 12 months. With no additional information provided about the characteristics of those who did not complete the study, we are left wondering whether those who were least successful under the treatment were the most likely to have dropped. That would leave only the successful completers in the final analysis, hence skewing the results.

3. Did not account for the variability in daily diet. The 2-day record might not be accurate if it includes special days like holidays, festivals, parties or sickness.

4. It seems they took the same group of subjects for analysis at the beginning of the study to compare with the parameters at 3 months as noted in Tables 1, 2 and 3. However, the characteristics of the subjects at beginning in Table 4 are different from the characteristics mentioned in Table 1. The authors did not specify if they excluded the drop-out parameters in Table 4. The screen time (before) for the control group in Table 2 should be 4.6±4.2, similar to Table 1.

5. Potential interviewer bias could be there because the researchers knew about the subjects in both groups.

6. The results of the study could not be extrapolated for other populations.

7. The authors compared 3 month intervention with 12 month intervention done earlier in Fig 2. It is not clear whether the control group for the 12 month intervention is a combination of studies or one of these studies.

At the completion of 3 months, there were significant within-group differences for weight, BMI and body fat percentage in the intervention group (Fig 1). However, when measured at 12 months, these differences were not existent (Table 5). The differences between the control and intervention groups persisted at 12 months. As indicated by the authors, a much longer follow-up is needed to know if the benefits exist. Further, biochemical testing (e.g., LDL levels) as noted by Sothern et al (4) is extremely important to see if there is any difference between the control and intervention group during a multidisciplinary approach. Therefore we suggest a larger sample study, “intention to treat” to account for drop outs, and a more diverse group to allow for comparisons to other populations.

References

1. Summerbell CD, Waters E, Edmunds LD, Kelly S, Brown T, Campbell KJ. Interventions for preventing obesity in children. Cochrane Database Syst Rev 2005(3):CD001871.

2. Sharma M. International school-based interventions for preventing obesity in children. Obes Rev 2007; 8(2):155-67.

3. Nemet D, Barkan S, Epstein Y, Friedland O, Kowen G, Eliakim A. Short- and long-term beneficial effects of a combined dietary-behavioral- physical activity intervention for the treatment of childhood obesity. Pediatrics 2005; 115(4):e443-9.

4. Sothern MS, Despinasse B, Brown R, Suskind RM, Udall JN Jr, Blecker U. Lipid profiles of obese children and adolescents before and after significant weight loss: differences according to sex. Southern Medical Journal. 93(3):278-82, 2000 Mar.

Conflict of Interest:

None declared