Chapter- II

REVIEW OF RELATED LITERATURE

The review of literature is an instrument in the selection for topic,
formation of hypothesis and deductive reasoning leading to the problem. It
helps to get a clear idea and support the finding with regard to the problem
under study. Study of related literature implies locating reading and evaluating
reports of research as well as reports of casual observation and opinion that
are related to the individuals planned research reports. A study of relevant
literature is an essential step to get a clean idea of what has been done with
regard to the problem under study. Such a review brings about a deep and
clear respective of overall field.
Wang, et al., (2009)1 conducted a study on Differences of height and
body mass index of youths in urban vs. rural areas in Hunan province of
China the background of the study was the economic reforms in China were
implemented approximately 30 years ago. Since then, people's nutrition, living
conditions and overall health have continually improved, but there has been
an imbalance between the progresses in urban vs. rural areas. Height and
body mass index (BMI) are regarded as two important indicators of nutritional
status and overall health. The aim of this study was to investigate differences
in height and BMI between Chinese youths of rural vs. urban areas and
further, to determine whether these differences have changed over time
(1990s vs. 2000s). The Subject and methods of the study was the 24 194
urban youths and 7130 rural youths were recruited in Hunan province of
China. In each gender group, the subjects were divided into eight subsets
according to age, geographic area residence, and decade when the youths
were measured. Independent t-tests were used to test the differences of
height and BMI between the studied groups. The Results of the study was
both male and female youths from urban areas were significantly taller than
youths from rural areas in both the 1990s and 2000s (all p<0.001), with the
exception of the 1990s female 1518 years subset (p=0.21). The height of
youths was significantly greater in the 2000s compared to the corresponding
gender and geographic subset in the 1990s (p<0.001), except for the female
1Xiang li Wang et.al.,(2009) Differences of Height and Body Mass Index of Youths in Urban
vs. Rural Areas in Hunan Province of China, Vol. 36, No. 6 , December 2009, pp 750-755.

14

1518 years subset from rural areas (p=0.10). Similar results were obtained
for BMI. The Conclusion of the study was that there are significant differences
in height and BMI between youths rose in urban vs. rural areas and positive
growth trends of height and BMI over time (1990s vs. 2000s) in youths in
Hunan Province of China.

Nareshkumar, (2012)2 conducted a study on Effect of Body Mass

Index on physical fitness of human being. Physical fitness is the basis of
dynamic and creative intellectual activity. The intelligence and skill can only
function at the peak of their capacity when the body is healthy and strong; the
study was taken with the objective to analyze the effect of BMI on physical
fitness of college going students. With the assistance and help of the experts
in the field of physical fitness and BMI factors package was evolved. To obtain
physical fitness components score and BMI, AAHPERED Youth fitness test
components like, flexed-leg sit ups to measure abdominal strength and
endurance, fixed-arms hang to measure arm hang and shoulder strength,
shuttle run to measure speed and agility, 50-yards dash to measure speed,
standing broad jump to measure legs explosive power and height and weight
to measure BMI were organized. Physical activity at 11 years had no no effect
on the BMI trajectories, in females, More active females at 16 years gained
BMI more slowly than others, by 0.007kg/m2/year per activity category over
the period 16-45 years. Consistent with these analyses, change in activity was
associated with the change in BMI in females, e.g. females active at 16 and 42
years gained less BMI than inactive females (2,1vs 2.5kg/m2/10years).
Results for males inconsistent over the periods examined.

2Nareshkumar Randhirbhai (2012) Effect of BMI on Physical Fitness of Human

Being internet j phy. edu. pp.126-128.

15

Kavehmanesh, et al., (2013)3 conducted on the study comparison

of body mass index on children with functional constipation and healthy
controls object of the Constipation is one of the most common pediatric
disorders, especially in developed population, which categorized to organic or
functional (non-organic) constipation. Furthermore, obesity is a growing
chronic pediatric problem that could cause any compromise in weight and
height. The aim of this study is the evaluation of probable relation between
obesity and pediatric functional constipation. Methods of the study were
conducted as a case-control investigation on 2-14-years-old children those
referred to Baqiyatallah University clinic during 2009-2011. The constipated
children with organic causes were excluded. The control group of children was
those who had not any disorders affecting on height and weight. Quantitative
variables were expressed by mean and standard deviation and the correlation
was tested with chi2 through SPSS version 17.results of the study A total of
259 children (male 51.7%) consisting 124 cases and 135 controls were
enrolled. The mean age in constipated and normal children was 69.47 35.03
and 74.15 39.68, respectively. BMI over 95% in the control group was 11.9%
and in the constipated group was 17.7% that the difference was not
statistically significant either (P = 0.188). The only significant association was
found between obesity and the duration of constipation and also age (P =
0.008, 0.042, respectively).conclusion of the study although we found a
significant relationship between duration of constipation and obesity, there was
not a clear association between obesity and presence of constipation.
Furthermore, we suggest extended cohort or clinical trial study regarding to the
regional nutritional and growth patterns to confirm weight decrease or increase
the effect on defecation.

3Kavehmanesh et.al.,(2013) Comparison of Body Mass Index on Children with

Functional Constipation and Healthy Controls Retrieved
http://www.ncbi.nlm.nih.gov/pubmed/24479087 on from 25 December 2013.

16

Weng, et al., (2006)4 conduct the study Use of Body Mass Index to
Identify Obesity-Related Metabolic Disorders in the Chinese Population.
Excess of body adiposity is defined as obesity/overweight. In the 1980s, the
approach of the ideal body weight was replaced by Body Mass Index (BMI),
which is derived from the equation: body weight in kilograms (kgs.) divided by
length or height in squared meters (m) [weight in kg./(height in m)]. BMI
commonly uses parameters for underweight (BMI < 20), ideal weight (BMI 20
25), overweight (BMI 25 30) and obesity (BMI > 30), for both men and
women.
Rampersaud, et al., (2005)5 conduct the study Breakfast Habits,
Nutritional Status, Body Weight, and Academic Performance in Children and
Adolescents. In reviewing 47 studies that the prevalence of skipping breakfast
in the United States and Europe ranged from 10% to 30%. In addition, they
stated that compared to their breakfast-skipping peers, children who reported
eating breakfast on a consistent basis tended to have superior nutritional
profiles.
Eatonet, et al., (2010)6 conduct the study Centers for Disease Control
and Prevention (CDC): Youth Risk Behavior Surveillance. A tremendous
lifestyle change over the last decades has been seen in Saudi Arabia.
Sedentary lifestyle was prevalent especially among Saudi children and youth.
For example, among 2,908 Saudi school students from grades 10, 11, and 12,
data were collected during October and November 2009, revealing that 60% of
children and more than 70% of adolescents do 11not engage in sufficient
physical activity. Based on the results from the Youth Risk Behavior

4 X. Weng et a., (2006). Use of Body Mass Index to Identify Obesity-Related Metabolic
Disorders in the Chinese Population, Eur. J. Clin. Nutr, vol. 60, pp.93137.

5 G. C. Rampersaud et al., (2005). Breakfast Habits, Nutritional Status, Body Weight, and
Academic Performance in Children and Adolescents. J Am Diet Assoc. pp. 743-760.

6 D. K. Eaton et al., (2010). Centers for Disease Control and Prevention (CDC): Youth Risk
Behavior Surveillance, United States, 2009. MMWR Surveill Summ, vol.59(5), pp.1-142.

17

Surveillance Survey, compared to US youth who participate in physical activity,

only 18.4% engaged in physical activity to meet the guidelines (38).
Abahussaine, et al., (2012)7 conduct the study Lifestyle Factors
Associated with Overweight and Obesity among Saudi Adolescents . A recent
study done by Al-Hazzaa et al., in Saudi Arabia, among 2,906 adolescents
(1,400 males and 1,506 females), about 50% of the males and more than 75%
of the females did not meet the recommendation of 60 minutes of daily
moderate-intensity physical

activity. In

addition,

results

showed

that

overweight/obesity were significantly and inversely associated with vigorous

physical activity levels. Moreover, physical inactivity patterns were found to be
significantly higher among females.
P. M. Anderson, et al., (2003)

conduct the study Maternal

Employment and Overweight Children. Maternal employment may also play

an important role in the increase of being overweight or obese among children
and youth. Studies have found a relationship between maternal employment
and childhood obesity. For example, from the National Longitudinal Survey of
Youth (NLSY), Anderson et al. studied 6,283 US women, between the ages of
14 and 22 annually between 1979 -1994 and biannually since then. The
children of those women have been surveyed biannually as well since 1986.
They found that the number of hours per week that the mother worked was
positively correlated with the probability of the children being overweight or
obese.
El-Hazmi, et al., (1997)9 conduct the study Prevalence of Obesity in
the Saudi Population. El-Hazmi and Warsy screened a total of 14,660 Saudi
7 A. Nada Abahussaine et a.l, (2012). Lifestyle Factors Associated with Overweight and
Obesity among Saudi Adolescents, BMC Public Healt, pp.12-354.

8 P. M. Anderson et al., (2003). Maternal Employment and Overweight Children, J Health

Econ, pp.477-504.

9 M. A. El-Hazmi et al., (1997). Prevalence of Obesity in the Saudi Population. Ann Saudi
Med, pp.302-306.

18

adult males and females (>14 years of age). They documented that the
prevalence of obesity was 13% in males and 20% in females, and the
prevalence of overweight was 27% in males and 25% in females. The
prevalence of obesity was highest in the females in the central province and in
the males in the western province, 19 while overweight was more prevalent in
both male and female populations in the central province. Generally, obesity
was more common in females and overweight was more common in males.
Sidoti, et al., (2009)10 conduct the study Body Mass Index, Family
Lifestyle, Physical Activity and Eating Behavior on a Sample of Primary School
Students in a Small town of Western Sicily. Obesity is actually a discernible
issue in prosperous western society and is dramatically increasing in children
and adolescents. Many studies indicate that obesity in childhood may become
chronic disease in adulthood and, particularly, those who are severely
overweight have an increased risk of death by cardiovascular disease.
Understanding the determinants of life style and behavior in a persons youth
and making attempts to change childrens habits is considered a key strategy
in the primary prevention of obesity. This study aims to find a correlation
between Body Mass Index, (BMI), physical activity and eating behaviour and
to identify, eventually, risks, protective factors and possible directions for
interventions on incorrect nutritional/physical activity and intra-familiar life
styles in a sample of young adolescents in a small town of Western Sicily. The
research surveyed the entire population of the last three curricular years of two
Primary Schools in a town of western Sicily, (n=294). The instrument used for
the survey was a questionnaire containing 20 different items with multiple
choices answers. Personal information, physical activity and eating behaviors
were collected both for parents and students to cross students and parents
characteristics. Data were codified and statistical analysis was computed
through Statistics and Openstat software Data obtained demonstrated a
relevant percentage (18%) of obese children. Prevalence of overweight was
high as well, (23%), and many in this area (12%) were at risk since they were
10 Enza Sidoti et al., (2009). Body Mass Index, Family Lifestyle, Physical Activity
and Eating Behaviour on a Sample of Primary School Students in a Small Town of
Western Sicily, Italian journal of public health vol.6, N. 3.

19

on the limits of the lower class. A significant association was found between
the percentage of students classified as having an elevated BMI and a
sedentary habit and/or an incorrect eating behavior. Among the overweight
and obese children a direct statistical association was also shown between the
weight of their parents and some daily life styles. An inverse association, on
the contrary, was observed between those variables and the cultural level of
the family. Cultural level, in fact, was significantly associated with having
breakfast, fruit and vegetable consumption and practice of physical exercise.
Multi linear regression analysis showed the weight of some independent
variables which were more strictly correlated with childrens BMI. Increasing
the proportion of adolescents meeting recommended dietary and physical
activity guidelines has been identified as an important strategy to contrast the
epidemic increase in obesity, especially in western countries. This study
stressed the need to increase the knowledge and monitoring of the
consequent behaviors of adolescents with regards to dietary habits and the
practice of physical activity. School, communities and families are considered
the best pathways to disseminate correct information and knowledge and the
more suitable channels to raise the awareness of the importance of correct
dieting and regular physical activity School and community-based intervention
programs are, then, strongly requested to activate preventive actions early in
life and mainly in the development age. The importance of the family and of
the social context factors in health behavior was also emphasized. A familiar
eco-systemic model that takes into account the whole bio-social-psychological
aspects was also sustained for a global therapeutic approach to the obese
child.
Ardalan, et al., (2007)11 conduct the study Association of Physical
Activity and Dietary Behaviors in Relation to the Body Mass Index in a National
sample of Iranian Children and Adolescents: CASPIAN Study. To examine the
relation of dietary and physical activity (PA) patterns with the body mass index
(BMI), and the associations between these patterns among children. .A
representative sample of 21 111 school students aged 618 years was
11 Gelayol Ardalan et al., (2007). Association of physical Activity and Dietary Behaviours in
Relation to the Body Mass Index in a National Sample of Iranian Children and Adolescents:
CASPIAN Study, Journal of Bull World Health Organ, 85(1), pp.1926.

20

selected by multistage random cluster sampling from 23 provinces in the

Islamic Republic of Iran. PA and dietary pattern were assessed by selfadministered validated questionnaires. Fruit and vegetables, dairy products
and snacks (salty, fatty or sweet) had a similar consumption frequency of
approximately twice a day. The type of fat most frequently consumed was
hydrogenated solid fat (consumed by 73.8% of families). The PA level was
significantly higher among boys than girls, in rural than in urban residents, and
in intermediate students than high-school students. Among boys, the
frequency of consumption of vegetables and plant proteins (R = 0.46); and
among girls, the frequency of consumption of dairy products and fruits, as well
as high PA level had a significant inverse association with BMI (R = 0.57).
Among boys, the low frequency of consumption of fruits, the time spent on PA
and the energy expenditure; and among girls, the time spent on PA and the
energy expenditure, had significant relationships with overweight. When
controlling for covariates, PA levels had significant relationships with the
frequency of consumption of all food groups. Unhealthy lifestyles make Iranian
young people prone to chronic diseases later in life. When examining their
health benefits, the interrelationship of dietary and PA behaviors should be
considered.
Kelley, et al., (2014)12 conduct the study O Effects of Exercise on BMI
Z-Score in Overweight and Obese Children and Adolescents: a Systematic
Review with Meta-Analysis. Overweight and obesity are major public health
problems in children and adolescents. The purpose of this study was to
conduct a systematic review with meta-analysis to determine the effects of
exercise (aerobic, strength or both) on body mass index (BMI) z-score in
overweight and obese children and adolescents. Studies were included if they
were randomized controlled exercise intervention trials 4 weeks in
overweight and obese children and adolescents 2 to 18 years of age,
published in any language between 19902012 and in which data were
available for BMI z-score. Studies were retrieved by searching eleven
12A. George Kelley, et.al,(2014), O Effects of Exercise on BMI Z-Score in Overweight and
Obese Children and Adolescents: a Systematic Review with Meta-Analysis, retrieved on 16
Sep 2014 from online website http://www.biomedcentral.com/1471-2431/14/225/abstract

21

electronic databases, cross-referencing and expert review. Two authors (GAK,

KSK) selected and abstracted data. Bias was assessed using the Cochrane
Risk of Bias Assessment Instrument. Exercise minus control group changes
were calculated from each study and weighted by the inverse of the variance.
All results were pooled using a random-effects model with non-overlapping
95% confidence intervals (CI) considered statistically significant. Heterogeneity
was assessed using Q and I2 while funnel plots and Eggers regression test
were used to assess for small-study effects. Influence and cumulative metaanalysis were performed as well as moderator and meta-regression analyses.
Of the 4,999 citations reviewed, 835 children and adolescents (456 exercise,
379 control) from 10 studies representing 21 groups (11 exercise, 10 control)
were included. On average, exercise took place 4 x week for 43 minutes per
session over 16 weeks. Overall, a statistically significant reduction equivalent
to

3%

was

found

for

score

BMI

. No small-study

effects were observed and results remained statistically significant when each
study was deleted from the model once. Based on cumulative meta-analysis,
results have been statistically significant since 2009. None of the moderator or
meta-regression analyses were statistically significant. The number-needed-to
treat was 107 with an estimated 116,822 obese US children and adolescents
and approximately 1 million overweight and obese children and adolescents
worldwide Exercise improves BMI z-score in overweight and obese children
and adolescents and should be recommended in this population group.
However, a need exists for additional studies on this topic.
Lee, et al., (2013)13 conduct the study Nutrition, Physical Activity, and
Obesity, Centers for Disease Control and Prevention. School-based BMI
measurement has attracted attention across the nation as a potential
approach to address obesity among youth. However, little is known about its
impact or effectiveness in changing obesity rates or related physical activity
and dietary behaviors that influence obesity. This article describes current
13 M. L. Sarah Lee et al., (2013), Nutrition, Physical Activity, and Obesity, Centers for
Disease Control and Prevention, retrieved on 16 Sep 2014 from online website
http://pediatrics.aappublications.org/content/124/Supplement_1/S89.

22

BMI-measurement

programs

and

practices,

research,

and

expert

recommendations and provides guidance on implementing such an approach.

An extensive search for scientific articles, position statements, and current
state legislation related to BMI-measurement programs was conducted. A
literature and policy review was written and presented to a panel of experts.
This panel, comprising experts in public health, education, school counseling,
school medical care, and parenting, reviewed and provided expertise on this
article.

School-based

BMI-measurement

programs are

conducted

for

surveillance or screening purposes. Thirteen states are implementing schoolbased BMI-measurement programs as required by legislation. Few studies
exist that assess the utility of these programs in preventing increases in
obesity or the effects these programs may have on weight-related knowledge,
attitudes, and behaviors of youth and their families. Typically, expert
organizations support school-based BMI surveillance; however, controversy
exists over screening. BMI screening does not currently meet all of the
American Academy of Pediatrics criteria for determining whether screening for
specific health conditions should be implemented in schools. Schools initiating
BMI-measurement programs should adhere to safeguards to minimize
potential harms and maximize benefits, establish a safe and supportive
environment for students of all body sizes, and implement science-based
strategies to promote physical activity and healthy eating.
Skouteris, et al., (2012)14 conduct the study Body Mass Index and
Dental Caries in Children and Adolescents. A Systematic Review of literature
published 2004 to 2011.The authors undertook an updated systematic review
of the relationship between body mass index and dental caries in children and
adolescents. The authors searched Medline, ISI, Cochrane, Scopus, Global
Health and CINAHL databases and conducted lateral searches from reference
lists for papers published from 2004 to 2011, inclusive. All empirical papers
that tested associations between body mass index and dental caries in child
and adolescent populations (aged 0 to 18 years) were included. Dental caries
14 Helen Skouteris et al., (2012). Body Mass Index and Dental Caries in Children and
Adolescents, retrieved on 16 November 2014 from online website
http://www.systematicreviewsjournal.com/content/1/1/57

23

is associated with both high and low body mass index. A non-linear
association between body mass index and dental caries may account for
inconsistent findings in previous research. We recommend future research
investigate the nature of the association between body mass index and dental
caries in samples that include a full range of body mass index scores, and
explore how factors such as socioeconomic status mediate the association
between body mass index and dental caries.
Harris, et al., (2012)15 conduct the study Effect of School-based
Physical Activity Interventions on Body Mass Index in Children: a MetaAnalysis. The prevalence of childhood obesity is increasing at an alarming
rate. Many local governments have enacted policies to increase physical
activity in schools as a way to combat childhood obesity. We conducted a
systematic review and meta-analysis to determine the effect of school-based
physical activity interventions on body mass index (BMI) in children. We
searched MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of
Controlled Trials up to September 2008. We also hand-searched relevant
journals and article reference lists. We included randomized controlled trials
and controlled clinical trials that had objective data for BMI from before and
after the intervention, that involved school-based physical activity interventions
and that lasted for a minimum of 6 months. Of 398 potentially relevant articles
that we identified, 18 studies involving 18 141 children met the inclusion
criteria. The participants were primarily elementary school children. The study
duration ranged from 6 months to 3 years. In 15 of these 18 studies, there was
some type of co-intervention. Meta-analysis showed that BMI did not improve
with physical activity interventions (weighted mean difference 0.05 kg/m 2,
95% confidence interval 0.19 to 0.10). We found no consistent changes in
other measures of body composition. School-based physical activity
interventions did not improve BMI, although they had other beneficial health
effects. Current population-based policies that mandate increased physical

15 C. Kevin Harris, et al., (2012). Effect of School-based Physical Activity Interventions on

Body Mass Index in Children: a Meta-Analysis. retrieved on 16 November 2014 from online
website http://www.cmaj.ca/content/180/7/719.full

24

activity in schools are unlikely to have a significant effect on the increasing

prevalence of childhood obesity.
Verma, et al., (2005)16 conduct the study Change in BMI after Mid-foot
and Hind-foot Arthrodesis A retrospective review of prospectively collected
data. Obesity has become a major public health epidemic, with recent reports
citing that 22% of English men and 24% of women are clinically obese. Painful
foot and ankle joints are often pointed out as an impending factor for lack of
mobility and weight reduction. There is an assumption that weight loss will
occur after their surgery due to increased mobility. The current study aimed to
evaluate the effect of surgery on post operative body mass index (BMI) in
patients who underwent mid-foot or hind-foot arthrodesis. All patients who
underwent mid-foot and hind-foot arthrodesis under the care of senior author
from April 2005 to Nov. 2006 were identified from the operating theatre
records. In total 33 procedures were done in 31 patients. Each patients BMI
recorded pre-operatively was compared with that recorded at a minimum of 6
months postoperatively using the paired Students t-test. Analysis of the data
was also conducted by stratifying pre-operative BMI, good pain relief (i.e
AOFAS>80), sex and fusion site. It was found that there was a mean increase
of BMI by 0.25 (95% CI of 0.95 to 0.44) with p-value of 0.47.It was noted that
BMI of patients in obese group increased post-operatively by 0.07 (95%
confidence interval of 1.52 to 1.66) with p-value of 0.9.This study highlights
the fact that there is no significant effect on BMI in obese patients despite
significant increase in mobility and pain levels after mid-foot and hind-foot
arthrodesis. The change in BMI after fusion surgery is not significantly affected
by sex or quality of pain relief.
Rajib, et al, (2013)17 conduct the study Body Mass Index-Mortality
Paradox in Hemodialysis. Can It Be Explained by Blood Pressure Unlike the
16 R. Verma et al., (2005) Change in BMI after Mid-Foot and Hind-Foot Arthrodesis,
retrieved on 16 November 2014 from online website
http://www.bjjprocs.boneandjoint.org.uk/content/92-B/SUPP_IV/591.3.

17 Rajib Agarwal et al., (2013). Body Mass Index-Mortality Paradox in Hemodialysis,

retrieved on 29 December 2014 from online website
http://hyper.ahajournals.org/content/58/6/1014.abstract

25

general population, among hemodialysis patients body mass index (BMI) is

related to blood pressure (BP) and mortality inversely. To explore the reasons
for this risk-factor paradox, the cross-sectional association of obesity with the
following factors was examined: the prevalence of hypertension, its control,
and echocardiographic left ventricular mass index (LVMI). Longitudinal followup explored the relationship of BMI with all-cause mortality. Furthermore, it
explored whether poorer survival in leaner individuals was related to either
high BP or greater LVMI. Among 368 hemodialysis patients, both the
prevalence of hypertension and its poor control were inversely related to BMI.
BMI was also inversely associated with evidence of excess extracellular fluid
volume, but adjustment for this variable did not completely remove the inverse
relationship between BP and BMI. Over 1122 patient-years of cumulative
follow-up (median: 2.7 years), 119 patients (32%) died. In the first 2 years of
follow-up, the mortality hazard for the lowest BMI group was increased;
thereafter, the survival curves were similar. Adjusting for several risk factors
including BP and LVMI did not remove the inverse relationship of BMI with
mortality. In conclusion, leaner patients on dialysis have a higher prevalence of
hypertension, poorer control of hypertension, more LVMI, and greater
evidence of extracellular fluid volume excess. However, volume explains the
greater prevalence or poorer control of hypertension only partially. Leaner
patients have an accelerated mortality rate in the first 2 years; this is not
completely explained by BP, LVMI, or other cardiovascular or dialysis-specific
risk factors.

Zeller, et al., (2005)18 conduct the study The Relationship of Health

Outcomes to Improvement in BMI in Children and Adolescents .To evaluate
the clinical outcomes of patients participating in an outpatient program for
managing childhood and adolescent obesity. Research Methods and
Procedures: Based on a retrospective chart review, 394 physician-referred
obese youth (BMI > 95th percentile), 5 to 19 years of age, were treated in an
18 M. Zeller et al., (2005). The Relationship of Health Outcomes to Improvement in BMI in
Children and Adolescents, International Journal of health out com, Volume 13, Issue
5, pages 876882,

26

interdisciplinary, family-centered, behavioral weight management program in a

hospital-based outpatient setting. Treatment included group exercise, parent
education, and behavioral intervention therapies to improve diet and physical
activity. A total of 177 (45%) completed the initial phase of treatment (mean
duration = 5.6 months). For the completion group, there were significant
improvements (all p < 0.001) in weight (2.0 4.9 kg), BMI (1.7 1.9 kg/m 2),
and BMI z score (0.15 0.15), without interfering with growth (height, 2.2
1.3 cm; p < 0.001). Significant improvement was also found for blood
pressure,

total

cholesterol,

low-density

lipoprotein

(LDL)-cholesterol,

triglycerides, insulin, and aerobic fitness. At onset of treatment, 134 (84%)

patients had abnormal fasting insulin concentration, 88 (50%) had abnormal
total cholesterol, 14 (8%) had abnormal diastolic blood pressure, and 69 (40%)
had abnormal LDL-cholesterol. At the end of treatment, a significant proportion
of patients with baseline abnormal blood pressure, total cholesterol, and LDLcholesterol had normal values (p < 0.001). A decrease in BMI z score was
associated with significant improvements in insulin and lipid values (all p <
0.05).We have demonstrated that a modest decrease in BMI in an ongoing
clinical pediatric weight management program is accompanied by significant
improvements in related health measures. These results may be helpful in
counseling families with overweight children and adolescents.