Elsevier

Metabolism

Volume 63, Issue 3, March 2014, Pages 422-430
Metabolism

Clinical Science
The one year exercise and lifestyle intervention program KLAKS: Effects on anthropometric parameters, cardiometabolic risk factors and glycemic control in childhood obesity

https://doi.org/10.1016/j.metabol.2013.11.016Get rights and content

Abstract

Objective

Regular physical exercise within structured lifestyle programs may improve weight status and minimize metabolic risk factors in childhood obesity. The aim of this study was to evaluate the effect of the one-year combined physical exercise/lifestyle program KLAKS on anthropometric and metabolic parameters and glycemic control in childhood obesity.

Materials and Methods

142 overweight/obese (BMI > 90th percentile) candidates (7–18 years) were enrolled, 115 participants completed the program. Anthropometrics and biochemical parameters were obtained at beginning and completion. An oral glucose tolerance test (OGTT) was performed in a subgroup of participants. Course of glucose and insulin levels within OGTT was correlated with several parameters and is reported here for those who completed the program.

Results

The mean standard deviation scores (SDS) decreased significantly for BMI, waist circumference, waist-to-height ratio (WHtR) and percentage body fat (all p  0.01). Improved metabolic risk markers included mean glucose levels within an OGTT at follow-up compared to baseline (p < 0.0001) and HbA1c (p = 0.05) as well as indications of improvement for gamma-glutamyl-transferase and free fatty acids.

Conclusions

The one-year combined exercise/lifestyle program KLAKS significantly improves markers of obesity and glycemic control. Impaired cardiometabolic risk markers, even subclinical, are also favorably influenced by program participation.

Introduction

Childhood overweight and obesity are worldwide health problems [1]. Prevalence rates have reached very high levels during the past decades [2], although there seems to be a trend towards stabilization at a still alarmingly high level [3], [4]. Many obese children and adolescents already present with features of the metabolic syndrome, including disturbed glucose metabolism, dyslipidaemia, elevated transaminases, non-alcoholic fatty liver disease and others [5], [6], [7], [8], [9], [10]. Especially abdominal obesity, defined as increased waist circumference, is associated with increased risk for cardiometabolic comorbidities and the metabolic syndrome already in childhood [11], [12]. Thus, early and effective treatment of childhood obesity and prevention of comorbidities are essential, and regular physical activity and the avoidance of sedentary habits play an important role not only for the stabilization or reduction of body weight but also for the avoidance of associated cardiometabolic comorbidities and for psychosocial well-being [13]. A recent guideline on prevention of type 2 diabetes in adults provides clear recommendations: Even a modest change in lifestyle that includes adopting a healthy diet, increasing physical activity and maintaining a healthy body weight, may effectively prevent the risk for diabetes later in life, and these results have since been the basis for worldwide prevention programs [14].

Current pediatric guidelines recommend at least 60, or preferably 90 and more minutes of physical activity per day, however, this amount is reached only by a small number of children [13]. The optimal therapeutic intervention to reduce (abdominal) obesity and cardiometabolic risk factors in childhood obesity is largely unknown, and available studies that have investigated the impact of different exercise regimens or the “optimal” exercise modality are scarce to date [15]. The aim of the present study is to evaluate the effects of the one year combined exercise/lifestyle intervention (KLAKS program) on anthropometric parameters and body composition, glycemic control and cardiometabolic risk markers in childhood obesity.

Section snippets

Participants

Children and adolescents aged 7–18 years with overweight (BMI > 90th percentile) and accompanying comorbidities (impaired glucose tolerance, features of the metabolic syndrome or a family history (siblings or parents) for obesity/type 2 diabetes) or obesity (BMI > 97th percentile) according to German reference percentiles [16] were eligible for program participation. In addition, overweight siblings of obese participants were also invited to participate in the KLAKS program to facilitate lifestyle

Participants

142 participants started the intervention and provided complete anthropometric baseline measurements. Mean age at start of the program was 12.2 ± 0.2 years (72 boys; 51%). Complete anthropometric follow up data were available from 115 candidates. The flow of participants through each stage of the intervention, presented as diagram according to the CONSORT/TREND statement [29], is shown in Fig. 1. Mean age after completion of the program was 13.2 ± 0.2 years (58 boys; 50%), showing that the

Discussion

The aim of the present study was to evaluate the impact of a combined exercise/lifestyle intervention on anthropometric parameters and body composition, glycemic control and cardiometabolic risk markers in childhood obesity. The study was performed within the standardized and approved obesity therapy program KLAKS for obese children and adolescents.

We show that a standardized obesity therapy program for one year significantly reduces anthropometric parameters of body fat content and body fat

Conclusion and translational potential

In summary, we show that regular exericse within a structured lifestyle program for childhood obesity significantly improves marker of the body fat content and body fat distribution as well as metabolic risk markers for the metabolic syndrome. As (subclinical) impairments of glucose homeostatis are also significantly improved, the intervention may beneficial to prevent the development of impaired glucose tolerance or type 2 diabetes in obese children and adolescents. A recent European guideline

Author contribution

SB: study design and conduct of the study, data collection and analysis, data interpretation, manuscript writing

DP: analysis and interpretation of data, statistical expertise, manuscript writing

AW: study design, conduct of the study, revision of the manuscript

KW: study concept and design, revision of the manuscript

RG: data collection and analyses, revision of the manuscript

TK: conduct of analyses for biochemical parameters, interpretation of biochemical data, revision of manuscript

MW: physical

Funding

Part of the work was supported by the Federal Ministry of Education and Research, Germany (Integrated Research and Treatment Center IFB “Adiposity Diseases”, FKZ: 01E01001) as well as by grants from the Roland-Ernst-Stiftung für Gesundheitsförderung, the TANITA Healthy Weight Community Trust as well as the Saxonian Ministry for Social Affairs (to SB).

Conflict of interest

The authors have nothing to disclose.

Acknowledgments

We would like to thank all persons who are involved in the conduct of the KLAKS program. We are also very grateful to all children, adolescents and their parents who participated in this project.

References (38)

  • S. Wiegand et al.

    Gamma-glutamyl transferase is strongly associated with degree of overweight and sex

    J Pediatr Gastroenterol Nutr

    (2011)
  • S. Wiegand et al.

    Obese boys at increased risk for nonalcoholic liver disease: evaluation of 16,390 overweight or obese children and adolescents

    Int J Obes (Lond)

    (2010)
  • S. Blüher et al.

    Body Mass Index, waist circumference, and waist-to-height ratio as predictors of cardiometabolic risk in childhood obesity depending on pubertal development

    J Clin Endocrinol Metab

    (2013)
  • C. Graf et al.

    Therapy of juvenile obesity from the sports medicine/science viewpoint

    Fed Health Gaz Health Res Health

    (2011)
  • J. Lindström et al.

    Take action to prevent diabetes–the IMAGE toolkit for the prevention of type 2 diabetes in Europe

    Horm Metab Res

    (2010)
  • S. Lee et al.

    Effects of aerobic versus resistance exercise without caloric restriction on abdominal fat, intrahepatic lipid, and insulin sensitivity in obese adolescent boys: a randomized, controlled trial

    Diabetes

    (2012)
  • K. Kromeyer-Hauschild et al.

    Percentiles of body mass index in children and adolescents evaluated from different regional German cohorts

    Monatsschr Kinderheilkd

    (2001)
  • T. Reinehr et al.

    The German Working Group of Obesity in Childhood and Adolescence (AGA): improving the quality of care for overweight and obese children in Germany

    Obes Facts

    (2008)
  • F. Hauskeller et al.

    KLAKS Konzept Leipzig: bewegungsaktive Adipositasschulung für Kinder im Schulalter (Concept Leipzig: obesity therapy for school-aged children)

    Obesity

    (2009)
  • Cited by (0)

    View full text