Don’t Skip Exercise in Lifestyle Interventions for Kids With Obesity

Exercise is a key component of a family-based lifestyle intervention program aimed at helping kids lose fat, according to a secondary analysis of a nonrandomized controlled trial.

Over the 22-week program, kids with overweight or obesity whose families participated in a lifestyle intervention program with supervised exercise training saw an 18.1% reduction in visceral adipose tissue (VAT) versus an 8.5% reduction for those in the basic lifestyle program (P=0.004), reported Cristina Cadenas-Sanchez, PhD, of the University of Granada in Spain, and colleagues.

Kids in the exercise program also saw significantly greater reductions in abdominal subcutaneous adipose tissue (-9.9% vs -3.0%, P=0.001) and intermuscular adipose tissue fat fractions (-6.0% vs -2.6%, P=0.02) compared with controls, they noted in JAMA Network Open.

Furthermore, the number of responders in terms of VAT area (73.5% vs 36.5%) and fat fraction reduction (81.6% vs 38.5%) was 40% higher in the exercise group versus the control group (P<0.001).

Reductions in VAT are likely the driving force responsible for 87.6% of the improvement seen in insulin resistance (β -0.102, 95% CI -0.230 to -0.002), highlighting “the importance of targeting childhood obesity therapies for this fat depot,” Cadenas-Sanchez and team wrote.

“Insulin resistance is a problem that might be reversed by substantial VAT loss, and the present work highlights that exercise-induced reduction in VAT might mediate a reduction in insulin resistance,” they explained. “This outcome should help protect against the development of type 2 diabetes.”

The only outcome that didn’t differ significantly between the two groups was pancreatic adipose tissue fat fraction.

Cadenas-Sanchez and colleagues said that current pediatric clinical practice guidelines from the Endocrine Society recommend these types of weight management interventions, but also underscore the need for full-family participation, noting that exercise should be incorporated as a key component of a comprehensive program involving diet, nutrition, and behavioral interventions.

For this secondary analysis, 116 children ages 8 to 12 (average age 10.6) with overweight or obesity from Vitoria-Gasteiz, Spain, were assigned to a 22-week family-based lifestyle program (n=57) or the same program plus an exercise intervention (n=59).

The program consisted of two 45-minute sessions per month, which promoted a healthy diet, physical activity, and proper sleep hygiene. It also incorporated a psychoeducation component that consisted of two 45-minute sessions per month, in which children were taught skills for emotional coping and well-being. The exercise program consisted of 90 minutes of supervised and monitored exercise training 3 times per week. Parents attended classes with their children.

Changes in fat mass and other metabolic parameters were collected via MRI, anthropometric and fitness assessments, and fasting blood samples.

At baseline, 57.8% of children presented with obesity. During the 22-week program, the mean attendance rate to the family-based lifestyle and psychoeducation program was 85% for children and 83% for parents, while the mean adherence to the supervised training in the exercise group was 72%.

Two exercise-related adverse events occurred, and included knee and ankle pain.