Aims: To compare the short- and long-term effects of intervention programs on body weight and cardiometabolic risk factors. Methods: 162 obese children (6–11 years) were randomly assigned to three 12-week interventions with a 9-month follow-up period: exercise (E): 90 min moderate exercise 3 days/week (n = 52); diet (D): balanced hypocaloric diet, weekly meetings with dietician (n = 55), and diet + exercise (D+E) (n = 55). Changes in anthropometric variables, cardiometabolic profile and psychological outcome were assessed. Results: At 12 weeks BMI-SDS, cardiometabolic profiles, and psychological score improved in all groups. The decrease in BMI-SDS was greater in D and D+E compared with E (p < 0.001), without a significant difference between the first two groups. Waist circumference and LDL cholesterol decreased more in D+E compared with E (p = 0.026 and p = 0.038, respectively). The increase in adiponectin was greater in D and D+E compared with E (p = 0.004). Anthropometric and cardiometabolic variables regressed without significant differences between groups after 9 months. However, BMI-SDS, body fat percentage and LDL cholesterol were lower compared to baseline. Conclusions: Diet alone or combined with exercise are the most effective short-term interventions for weight loss and improved cardiometabolic profiles, without a difference between them. In the long term, obese children need the long-term support of maintenance approaches.

Ebbeling CB, Pawlak DB, Ludwig DS: Childhood obesity: public-health crisis, common sense cure. Lancet 2002;360:473–482.
Reilly JJ, Methven E, McDowell ZC, Hacking B, Alexander D, Stewart L, Kelnar CJ: Health consequences of obesity. Arch Dis Child 2003;88:748–752.
Must A, Strauss RS: Risks and consequences of childhood and adolescent obesity: In J Obes Relat Metab Disord 1999;23(suppl 2):S2–S11.
Braet C, Mervielde I, Vandereycken W: Psychological aspects of childhood obesity: a controlled study in a clinical and non-clinical sample. J Pediatr Psychol 1997;22:59–71.
Speakman JR: Obesity: the integrated roles of environment and genetics. J Nutr 2004;134:2090S–2105S.
Koivisto Hursti UK: Factors influencing children’s food choice. Ann Med 1999;31:26–32.
Philippas NG, Lo CW: Childhood obesity: etiology, prevention, and treatment. Nutr Clin Care 2005;8:77–88.
Maffeis C, Castellani M: Physical activity: an effective way to control weight in children? Nutr Metab Cardiovasc Dis 2007;17:394–408.
Reilly JJ, McDowell ZC: Physical activity interventions in the prevention and treatment of pediatric obesity: a systematic review and critical appraisal. Proc Nutr Soc 2003;62:611–619.
Gortmaker SL, Must A, Sobol AM, Peterson K, Colditz GA, Dietz WH: Television watching as a cause of increasing obesity among children in the United States, 1986–1990. Arch Pediatr Adolesc Med 1996;150:356–362.
Gutin B, Owens S: Role of exercise intervention in improving body fat distribution and risk profile in children. Am J Hum Biol 1999;11:237–247.
Owens S, Gutin B, Allison J, Riggs S, Ferguson M, Litaker M, Thompson W: Effects of physical training on total and visceral fat in obese children. Med Sci Sports Exerc 1999;31:143–148.
Thompson PD, Yurgalevitch SM, Flynn MM, Zmuda JM, Spannaus-Martin D, Saritelli A, Bausserman L, Herbert PN: Effect of prolonged exercise training without weight loss on high-density lipoprotein metabolism in overweight men. Metabolism 1997;46:217–223.
Van Loan MD, Keim NL, Barbieri TF, Mayclin PL: The effects of endurance exercise with and without a reduction of energy intake on fat-free mass and the composition of fat-free mass in obese women. Eur J Clin Nutr 1994;48:408–415.
Sum CF, Wang KW, Choo DC, Tan CE, Fok AC, Tan EH: The effect of a 5-month supervised program of physical activity on anthropometric indices, fat-free mass, and resting energy expenditure in obese male military recruits. Metabolism 1994;43:1148–1152.
Summerbell CD, Ashton V, Campbell KJ, Edmunds L, Kelly S, Waters E: Interventions for treating obesity in children. Cochrane Database Syst Rev 2003;3:CD001872.
Collins CE, Warren J, Neve M, McCoy P, Stokes BJ: Measuring effectiveness of dietetic interventions in child obesity. A systematic review of randomized trials. Arch Pediatr Adolesc Med 2006;160:906–922.
Hughes AR, Stewart L, Chapple J, McColl JH, Donaldson MD, Kelnar CJ, Zabihollah M, Ahmed F, Reilly JJ: Randomized, controlled trial of a best-practice individualized behavioral program for treatment of childhood overweight: Scottish Childhood Overweight Treatment Trial (SCOTT). Pediatrics2008:121:e539–e546.
Votruba SB, Horvitz MA, Schoeller DA: The role of exercise in the treatment of obesity. Nutrition 2000;16:179–188.
Taylor RW, Jones IE, Williams SM, Goulding A: Evaluation of waist circumference, waist-to-hip ratio, and the conicity index as screening tools for high trunk fat mass, as measured by dual-energy x-ray absorptiometry, in children aged 3–19 years. Am J Clin Nutr2000;72:490–495.
Kuczmarski RJ, Ogden CL, Guo SS, Grummer-Strawn LM, Flegal KM, Mei Z, Wei R, Curtin LR, Roche AF, Johnson CL: 2000 CDC growth charts for the United States: methods and development. Vital Health Stat 11 2002;246:1–190.
Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC: Homeostasis model assessment: insulin resistance and β-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985;28:412–419.
Varni JW, Seid M, Kurtin PS: PedsQL 4.0: reliability and validity of the Pediatric Quality of Life Inventory version 4.0 generic core scales in healthy and patient populations. Med Care 2001;39:800–812.
Statistical Package for Social Science, Version 14.0. Chicago, SPSS, Inc.
Yackobovitch-Gavan M, Nagelberg N, Phillip M, Ashkenazi-Hoffnung L, Hershkovitz E, Shalitin S: The influence of diet and/or exercise and parental compliance on health-related quality of life in obese children. Nutr Res 2009;29:397–404.
Lissau I, Overpeck MD, Ruan WJ, Due P, Holstein BE, Hediger ML: Body mass index and overweight in adolescents in 13 European countries, Israel, and the United States. Arch Pediatr Adolesc Med 2004;158:27–33.
Golan M, Crow S: Targeting parents exclusively in the treatment of childhood obesity: long-term results. Obes Res 2004;12:357–361.
Nemet D, Barkan S, Epstein Y, Friedland O, Kowen G, Eliakim A: Short- and long-term beneficial effects of a combined dietary-behavioral-physical activity intervention for the treatment of childhood obesity. Pediatrics 2005;115:443–449.
Reybrouck T, Vinckx J, Van den Berghe G, Vanderschueren-Lodewevyckx M: Exercise therapy and hypocaloric diet in the treatment of obese children and adolescents. Acta Paediatr Scand 1990;79:84–89.
Miller WC, Koceja DM, Hamilton EJ: A meta-analysis of the past 25 years of weight loss research using diet, exercise or diet plus exercise intervention. Int J Obes 1997;21:941–947.
Redman LM, Heilbronn LK, Martin CK, Alfonso A, Smith SR, Ravussin E: Effect of calorie restriction with or without exercise on body composition and fat distribution. J Clin Endocrinol Metab 2007;92:865–872.
Mayo MJ, Grantham JR, Balasekaran G: Exercise-induced weight loss preferentially reduces abdominal fat. Med Sci Sports Exerc 2003;35:207–213.
Deforche B, De Bourdeaudhuij I, Tanghe A, Debode P, Hills AP, Bouckaert J: Role of physical activity and eating behavior in weight control after treatment in severely obese children and adolescents. Acta Paediatr 2005;94:464–470.
Sothern MS, Despinasse B, Brown R, Suskind RM, Udall JN Jr, Blecker U: Lipid profiles of obese children and adolescents before and after significant weight loss: differences according to sex. South Med J 2000;93:278–282.
Reinehr T, de Sousa G, Toschke AM, Andler W: Long-term follow-up of cardiovascular disease risk factors in children after an obesity intervention. Am J Clin Nutr 2006;84:490–496.
Cook DG, Mendall MA, Whincup PH, Carey IM, Ballam L, Morris JE, Miller GJ, Strachan DP: C-reactive protein concentration in children: relationship to adiposity and other cardiovascular risk factors. Atherosclerosis2000;149:139–150.
Weiss R, Dziura J, Burgert TS, Tamborlane WV, Taksali SE, Yeckel CW, Allen K, Lopes M, Savoye M, Morrison J, Sherwin RS, Caprio S: Obesity and metabolic syndrome in children and adolescents. N Engl J Med 2004;350:2362–2374.
Gallisti S, Sudi KM, Aigner R, Borkenstein M: Changes in serum interleukin-6 concentrations in obese children and adolescents during a weight reduction program. Int J Obes Relat Metab Disord 2001;25:1640–1643.
Winer JC, Zern TL, Taksali SE, Dziura J, Cali AM, Wollschlager M, Seyal AA, Weiss R, Burgert TS, Caprio S: Adiponectin in childhood and adolescent obesity and its association with inflammatory markers and components of the metabolic syndrome. J Clin Endocrinol Metab 2006;91:4415–4423.
Reinehr T, Roth C, Menke T, Andler W: Adiponectin before and after weight loss in obese children. J Clin Endocrinol Metab2004;89:3790–3794.
Lazzer S, Vermorel M, Montaurier C, Meyer M, Boirie Y: Changes in adipocyte hormones and lipid oxidation associated with weight loss and regain in severely obese adolescents. Int J Obes 2005;29:1184–1191.
Kelly AS, Steinberger J, Olson TP, Dengel DR: In the absence of weight loss, exercise training does not improve adipokines or oxidative stress in overweight children. Metabolism 2007;56:1005–1009.
Zhu W, Huang X, Li M, Neubauer H: Elevated plasma homocysteine in obese schoolchildren with early atherosclerosis. Eur J Pediatr 2006;165:326–331.
Friedman JM, Halaas JL: Leptin and the regulation of body weight in mammals. Nature 1998;395:763–770.
Ahima RS: Revisiting leptin’s role in obesity and weight loss. J Clin Invest 2008;118:2380–2383.
Cummings DE, Purnell JQ, Frayo RS, Schmidova K, Wisse BE, Weigle DS: A preprandial rise in plasma ghrelin levels suggests a role in meal initiation in humans. Diabetes 2001;50:1714–1719.
Reinehr T, Roth CL, Alexy U, Kersting M, Kiess W, Andler W: Ghrelin levels before and after reduction of overweight due to a low-fat high-carbohydrate diet in obese children and adolescents. Int J Obes 2005;29:362–368.
Schwimmer JB, Burwinkle TM, Varni JW: Health-related quality of life of severely obese children and adolescents. JAMA 2003;289:1813––1819.
Eliakim A, Friedland O, Kowen G, Wolach B, Nemet D: Parental obesity and higher pre-intervention BMI reduce the likelihoods of a multidisciplinary childhood obesity program to succeed – a clinical observation. J Pediatr Endocrinol Metab 2004;17:1055–1061.
Sothern MS, Loftin JM, Udall JN, Suskind RM, Ewing TL, Tang SC, Blecker U: Safety, feasibility, and efficacy of a resistance training program in preadolescent obese children. Am J Med Sci 2000;319:370–375.
Araki S, Dobashi K, Kubo K, Asayama K, Shirahata A: High molecular weight, rather than total, adiponectin levels better reflect metabolic abnormalities associated with childhood obesity. J Clin Endocrinol Metab 2006;91:5113–5116.
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