Increased Frequency of Dietitian Visits Is Associated with Improved Body Mass Index Outcomes in Obese Youth Participating in a Comprehensive Pediatric Weight Management Program

By Kirk, Shelley; Woo, Jessica G. et al. | Childhood Obesity, April 2015 | Go to article overview

Increased Frequency of Dietitian Visits Is Associated with Improved Body Mass Index Outcomes in Obese Youth Participating in a Comprehensive Pediatric Weight Management Program


Kirk, Shelley, Woo, Jessica G., Jones, Margaret N., Siegel, Robert M., Childhood Obesity


[Author Affiliation]

Shelley Kirk. 1 Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.

Jessica G. Woo. 2 Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.

Margaret N. Jones. 1 Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.

Robert M. Siegel. 1 Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.

*

Margaret N. Jones is currently a second-year medical student at the University of Cincinnati, College of Medicine, Cincinnati, OH.

Address correspondence to: Shelley Kirk, PhD, RD, LD, Associate Professor, University of Cincinnati Department of Pediatrics, Director, HealthWorks!, Center for Better Health and Nutrition, The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, E-mail: Shelley.Kirk@cchmc.org

Introduction

The epidemic of obesity in youth is recognized as one of the leading public health problems in the United States. The most recent outcomes of the National Health and Nutrition Examination Survey conducted in 2009-2010 found that nearly 17% of children and adolescents ages 2-19 years were obese (BMI ≥95th percentile for age and gender),1 more than a 3-fold increase since 1980.2 Though trends over the past 7 years have shown a leveling off of this epidemic,1 the prevalence of childhood obesity remains alarmingly high, whereas the prevalence of severe obesity (BMI ≥99th percentile for age and gender) is increasing.3 In addition, the concurrent increase in obesity-related medical complications, such as hypertension, hyperlipidemia, abnormal glucose tolerance, and lower quality of life,4 underscores the critical need for developing effective weight management interventions for obese children and adolescents.

When obese youth are not successful at achieving a healthier weight under the guidance of a primary care provider (PCP), the American Academy of Pediatrics recommends participation in a comprehensive weight management (CWM) program.5 A systematic review of the literature found that CWM interventions were effective when they offered multiple components, such as nutrition, physical activity (PA), supportive parental involvement, and behavioral strategies.6 However, in regard to the nutrition component, this review did not evaluate the effectiveness of various dietary approaches or disciplines delivering this component of the CWM treatment model.

Though nutrient-balanced, low-calorie diets can lead to modest short-term improvement in BMI, long-term adherence to these diets is more difficult.7 An alternative dietary approach that uses glycemic load to guide healthier food and drink choices has shown some promise as an effective intervention with obese adolescents.8,9 Glycemic load accounts for the amount of carbohydrate consumed and the food's glycemic index (GI), which measures the rate of absorption of a food's carbohydrate.10 Foods with a low GI have been shown to trigger a reduced insulin response, resulting in prolonged satiety.11 A small study of a reduced glycemic load diet was conducted with obese children ages 5-12 years in a primary care setting using a "traffic light" approach (e.g., emphasis on healthy low-GI "green" foods, moderation of intermediate-GI "yellow" foods, and avoidance of unhealthy high-GI "red" foods).12 They reported that 15 of 35 children (43%) had a significant decrease in BMI z-score over 12 weeks. A randomized, control trial by our research team subsequently demonstrated that a reduced glycemic-load diet was as effective as a low-carbohydrate and standard, portion-control diets in terms of significant improvement in BMI z-score. …

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