Effectiveness of individual versus group programs to treat obesity and reduce cardiovascular disease risk factors in pre-pubertal children: A randomized controlled trial

Introduction: Childhood obesity results in premature atherosclerosis and
requires early intervention.
Objectives: Compare the effectiveness of 6-month lifestyle interventions
(with choice of either individual or group therapy) with standard care on
body mass index (BMI) z-score and cardiovascular disease (CVD) risks
factors in children with obesity.
Methods: This 6-month randomized controlled trial with a 6-month
follow-up included 74 pre-pubertal children with obesity (7.5-11.9 years)
assigned randomly (2:1) to intervention or control. Families in the
intervention arm choose between an individually delivered treatment
(3h. pediatrician + 4h. dietician) or group treatment (35h. with a
multidisciplinary team). Children participated also to a weekly physical
activity program. We measured: BMI, BMI-z score; waist circumference
(WC); total and abdominal fat; blood pressure; common carotid artery
intima-media-thickness and incremental elastic modulus (Einc);
endothelium-dependent and independent dilation (NTGMD) of the
brachial artery; fasting plasma glucose, insulin, lipids; high-sensitivity Creactive
protein (hs-CRP).
Results: Compared to controls, at 6 months, abdominal fat and hs-CRP
were reduced in both interventions. The group intervention was alsoeffective in reducing BMI (-0.55 kg/m2; 95% CI -1.16 to 0.06) and BMIz
(-0.08; -0.15 to 0.00) at 6 months, and BMI, BMI-z, WC, NTGMD, total
and abdominal fat at 12 months.
Discussion: Abdominal fat and low grade inflammation were significantly
decreased in both interventions. High-intensity group treatment
improved early signs of atherosclerosis in children with obesity. These
findings are important for the promotion of cardiometabolic health in this
population.