OBJECTIVES: Outcomes of childhood obesity interventions are rarely reported beyond 1 year. We hypothesized that the impact on the BMI z-score from a child-centered physical-activity program in combination with a parent-centered dietary-modification program would be greater than either program conducted alone at 24 months' after baseline. PARTICIPANTS AND METHODS: A total of 165 overweight prepubertal children (68 boys, aged 5.5 to 9.9 years, mean BMI z-score 2.8) were randomly assigned to either a child-centered physical-activity program, a parent-centered dietary-modification program, or both conducted together in an assessor-blinded 6-month intervention. RESULTS: Using linear mixed models, all groups reduced their mean (95% confidence interval) BMI z-score at 24 months from baseline (p < 0.001) (the activity and diet group -0.24 (-0.35 to -0.13); the diet-only group -0.35 (-0.48 to -0.22); activity-only group -0.19 (-0.30 to -0.07)). There was a significant group-by-time interaction (p = 0.04) with the activity+diet and the diet-only groups showing a greater reduction than the activity-only group. For waist z-score and waist-to-height ratio, there was a significant time effect (p < 0.0001) at 24 months but no between-group differences (p > 0.05). Some metabolic outcomes improved at 24 months, although there were no between-group differences (p > 0.05). CONCLUSIONS: A reduction in BMI z-score was sustained at 24 months by treatment with either program combination. The greatest effects were achieved through inclusion of a parent-centered diet program, indicating the importance of targeting parents within treatment and the possibility of targeting them exclusively in treating obese prepubertal children.
Reproduced with permission from Pediatrics. Copyright by the American Academy of Pediatrics.

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