Peanut consumption in adolescents is associated with improved weight status.

Studies have shown an association between nut consumption and health benefits in adults such as lower lipid levels, lower body mass indices, and reduced risk of coronary artery disease. Few studies have demonstrated these health benefits in children. To determine the association between peanut consumption and weight, intake of nutrients of concern, high-density lipoprotein, low-density lipoprotein, and cholesterol in Mexican American children, baseline data from 262 sixth-grade students (48% female) in a school-based weight management program were analyzed to compare differences between peanut and non-peanut eaters. It was hypothesized that Mexican American children who consume peanuts will be less overweight and have a better nutrient and lipid profile when compared to those who do not eat peanuts. Participants completed a food frequency questionnaire as a baseline dietary assessment before beginning the program. Children were identified as either a peanut consumer (n = 100) or non-peanut consumer (n = 162). Body mass index measurements were taken on all participants. A smaller sample of participants submitted blood for lipid analysis. Analyses revealed that children in the peanut consumer group were less likely to be overweight or obese than children in the non-peanut consumer group (χ(2) = 13.9, P = .001), had significantly higher intakes of several vitamins and micronutrients (i.e., magnesium, vitamin E), and had lower low-density lipoprotein and total cholesterol levels. These results illustrate that consumption of peanuts and/or peanut butter is associated with lower weight status, improved diet, and lipid levels among Mexican American children. Future research is needed to clarify the role of peanut consumption in children's overall health.

Achieving long-term weight maintenance in Mexican-American adolescents with a school-based intervention.

PURPOSE: This study evaluated 24-month outcomes of a school-based intensive lifestyle weight management program targeting overweight Mexican-American adolescents. METHODS: We recruited a total of 71 adolescents (32 males; 45.1%) between the ages of 10 and 14 years, at or above the 85th percentile for body mass index (BMI). Participants were randomized to a 6-month instructor-led intervention (ILI) or a self-help (SH) program. Both interventions were aimed at modifying eating and physical activity behaviors using behavior modification strategies. We assessed changes in participants' standardized BMI and BMI percentile at baseline, 1, and 2 years. RESULTS: Repeated-measures analyses showed that ILI participants showed significantly greater decreases in standardized BMI at 1 and 2 years (F = 8.58, p < .01; and F = 9.27, p < .01, respectively) compared with SH controls. Similar results were found for changes in BMI and BMI percentile. At 2 years, the ILI condition decreased their average BMI percentile by 3.9 percentile points, compared to an increase of 1.6 percentile points in the SH condition. CONCLUSIONS: A school-based intervention resulted in improved weight outcomes in overweight Mexican-American adolescents and results were maintained over 2 years.

Impact of a school-based pediatric obesity prevention program facilitated by health professionals.

BACKGROUND: This study evaluated a school-based obesity intervention for elementary school children (N = 835) where health professionals assisted teachers with the integration of healthy messages into the school curriculum. METHODS: Schools were randomized into a professional-facilitated intervention (PFI; N = 4) or a self-help (SH; N = 3) condition. Changes in weight-based outcomes were assessed in students enrolled in the second grade from all 7 schools (overall: N = 835 students; PFI: N = 509 students, SH: N = 326 students). Students were between ages 7 and 9 and from diverse ethnic backgrounds (Asian = 25.3%, Black = 23.3%, Hispanic = 23.1%, White = 28.3%). The sample included 321 overweight/obese (BMI ≥ 85th percentile), 477 normal-weight (BMI ≥ 5th percentile and <85th percentile), and 37 underweight (BMI < 5th percentile) students. RESULTS: After 2 years, children who were overweight/obese in the PFI condition significantly reduced their standardized BMI (zBMI) compared to children in the SH condition (Wald χ(2) = 28.7, p < .001). End-of-year grades decreased for overweight/obese students in both conditions; however, students in the PFI exhibited a smaller decrease in grades compared to the SH condition (Wald χ(2) = 80.3, p < .001). CONCLUSION: The results indicate that an obesity prevention program where health professionals assist teachers by integrating healthy messages into existing curriculum was effective in reducing zBMI compared to the SH condition.

The application of the Yerkes-Dodson law in a childhood weight management program: examining weight dissatisfaction.

OBJECTIVE: To determine the effect of dissatisfaction with one's weight on outcomes in a weight management program. METHODS: Participants included 149 children between the ages of 11 and 14 years who were enrolled in an intensive weight loss intervention. All participants had a body mass index (BMI) ≥ 85th percentile. Children were divided into tertiles based on their level of weight dissatisfaction as assessed by the Kids' Eating Disorder Survey. RESULTS: Analysis revealed significant differences across levels of weight dissatisfaction categories for weight loss. Specifically, children in the moderate dissatisfaction group lost weight while participants in low and high groups gained weight over 6 months. CONCLUSION: As the Yerkes-Dodson law would predict, these findings suggest that moderate levels of weight dissatisfaction are associated with improved outcomes in a weight management program.

Brief report: gum chewing affects standardized math scores in adolescents.

UNLABELLED: Gum chewing has been shown to improve cognitive performance in adults; however, gum chewing has not been evaluated in children. This study examined the effects of gum chewing on standardized test scores and class grades of eighth grade math students. Math classes were randomized to a gum chewing (GC) condition that provided students with gum during class and testing, or a control condition with no gum (NGC). Participants included 108 students. The math sections of the Texas Assessment of Knowledge and Skills (TAKS) and the Woodcock Johnson III Tests of Achievement (WJ-III), and math class grades were used to assess academic performance. Students in the gum chewing condition improved standardized test scores and maintained higher grades in math class compared to those in the no-gum chewing condition. These results are encouraging as gum chewing may be a cost-effective and easily implemented method to increase student performance. TRIAL REGISTRATION: NCT00792116.

Evaluation of treatment effects in obese children with co-morbid medical or psychiatric conditions.

The need for effective treatments for pediatric overweight is well known. To evaluate the applicability of an evidence-based treatment in an applied clinic setting that includes children with severe obesity and comorbid medical or psychiatric conditions. Forty-eight overweight children and their families were provided an evidence-based intervention at a for-profit clinic. Unlike typical lab-based samples, participants were self-selected and included children who were very overweight and/or had comorbid conditions. Change in standardized BMI was assessed. Overall, participants demonstrated a significant reduction in standardized BMI, t (40)=6.6, p<.001. Further analyses indicated that participants who were severely obese and children with a comorbidity significantly reduced their zBMI (t (11)=4.0, p<.01; t (14)=3.9, p<.01, respectively). Children who were severely obese reduced their BMI percentile by .2 (SD=.2) and those with a comorbidity reduced their BMI percentile by .6 (SD=.9). Nonsignificant interaction effects indicated comparable weight reductions in severely obese and overweight/obese participants, F (1,39) = 1.49, ns. Also, those with comorbidities and those without comorbidities experienced similar weight reductions, F (1,39)=.7, ns. This study provides promising evidence for the applicability of an evidence-based treatment for weight management in clinical practice.

Increasing vegetable intake in Mexican-American youth: a randomized controlled trial.

Despite the health benefits, vegetable intake in youth remains below recommended levels. The purpose of our study was to compare two methods for increasing vegetable consumption. It was hypothesized that participants randomized to both the exposure-only and the pairing condition would increase their vegetable consumption and increase the variety of vegetables consumed. A total of 78 Mexican-American middle school-aged children from a charter school in Houston, TX, were randomized to a pairing condition (n=40) or an exposure-only condition (n=38) during the Spring 2009 semester. Children in the pairing condition were provided a preferred taste (peanut butter) paired with vegetables weekly at school during a nutrition class for 4 months. Children in the exposure-only condition received vegetables weekly during a nutrition class that covered the same material as the pairing condition. After 4 months, the pairing condition participants demonstrated significant increases in vegetable consumption (F=13.40, P<0.001) as well as variety of vegetables eaten (F=13.69, P<0.001) when compared to those in the exposure-only condition. The findings of this study suggest that the pairing of vegetables with a preferred taste, such as peanut butter, may be an effective technique in increasing consumption, especially in children who report being resistant to eating vegetables.

Smaller weight changes in standardized body mass index in response to treatment as weight classification increases.

OBJECTIVES: To compare the differential efficacy of a weight loss program for Mexican-American children who are overweight, obese, and severely obese. STUDY DESIGN: Study participants were enrolled in an intensive weight loss intervention aimed at improving eating and physical activity behaviors with behavior modification strategies. Participants included 212 children (45% female) between the ages of 9 and 14 (mean = 12.0, standard deviation = 0.7). All participants were classified as overweight, obese, or severely obese. RESULTS: Repeated measures analyses revealed that children in the overweight, obese, and severely obese weight categories differed significantly in standardized body mass index (zBMI) decreases at baseline, 3, 6, and 12 months (F = 4.57, P < .01, η(p)(2) = .06). Follow-up paired samples t tests showed a significant change in zBMI from baseline to 3 and 6 months for children in the overweight, obese, and severely obese weight categories. However, at 12 months only the overweight and obese students continued to show significant improvement from baseline in zBMI. CONCLUSIONS: These findings suggest that an intensive behavioral weight loss intervention that has demonstrated efficacy for decreasing zBMI may have incrementally smaller effects for children as weight classification increases.

Effects of a school-based weight maintenance program for Mexican-American children: results at 2 years.

The prevalence of childhood overweight has increased significantly, with the highest rates noted among Mexican Americans. Many negative health outcomes are associated with overweight; thus, there is a need for effective weight-loss interventions tailored to this group. This study evaluated 24-month outcomes of a randomized, controlled trial involving an intensive lifestyle-based weight maintenance program targeting overweight Mexican-American children at a charter school in Houston, Texas. A total of 60 children (33 males, 55%) between the ages of 10 and 14 at or >85th percentile for BMI were recruited. Participants were randomized to an instructor-led intervention (ILI) or a self-help (SH) program, both aimed at modifying eating and physical activity behaviors using behavior modification strategies. Changes in participants' standardized BMI (zBMI) were assessed at baseline, 1, and 2 years. Tricep skinfold, total cholesterol, triglycerides, high-density lipoprotein cholesterol, and calculated low-density lipoprotein were assessed at baseline and 1 year. ILI participants showed significantly greater decreases in zBMI at 1 and 2 years (F = 26.8, P < 0.001, F = 4.1, P < 0.05, respectively) compared to SH controls. ILI participants showed greater improvements in body composition, as measured by tricep skinfold (F = 9.75, P < 0.01). Children in the ILI condition experienced benefits with respect to total cholesterol (F = 7.19, P < 0.05) and triglycerides (F = 4.35, P < 0.05) compared to children in the SH condition. Overall, the school-based intervention resulted in improved weight and clinical outcomes in overweight Mexican-American children, and zBMI was maintained over 2 years.

Relation between adiposity and disease risk factors in Mexican American children.

OBJECTIVE: Excess adiposity is associated with systemic low-grade inflammation, which has been implicated in the pathophysiology of various diseases. The purpose of this study was to examine the relation between measures of adiposity and disease risk factors in Mexican American children participating in a weight loss intervention. SUBJECTS AND METHODS: Boys and girls (N=170; 13.3+/-0.1 year) volunteered for additional testing from a larger study that demonstrated significant reduction in standardized body mass index. Insulin, C-reactive protein, soluble cluster of differentiation 14, glucose, and cholesterol profile were assessed. RESULTS: Linear mixed models regression showed that changes in adiposity (standardized body mass index and triceps skinfold) were significantly related with changes in total cholesterol (P=0.01), triglycerides (P<0.001), C-reactive protein (P<0.001), insulin (P<0.001), Homeostasis model assessment of insulin resistance (P<0.001), and high-density lipoprotein (P<0.001). CONCLUSIONS: The relation between measures of adiposity and disease risk factors was stable over time in children participating in an exercise/weight loss intervention. Also, our findings indicate that reducing adiposity results in an improvement of blood disease risk factors in Mexican American children.

Brief report: weight dissatisfaction, weight status, and weight loss in Mexican-American children.

OBJECTIVE: To assess the association between weight dissatisfaction, weight status, and weight loss in Mexican-American children participating in a weight management program. METHODS: Participants included 265 Mexican American children recruited for a school-based weight management program. All children completed baseline assessments and changes in standardized body mass index (zBMI) were monitored in at-risk for overweight and overweight children (i.e., > 85th BMI percentile) who had been randomized to receive the weight loss intervention (n = 101). RESULTS: Participants classified as at-risk for overweight or overweight reported greater weight dissatisfaction than normal weight children. Lower weight dissatisfaction at baseline was associated with greater changes in zBMI at 6 months. Weight dissatisfaction did not change across the course of treatment. CONCLUSIONS: Mexican-American children whose weight status is greater than normal have greater weight dissatisfaction. Children with greater weight dissatisfaction are less likely to lose weight in a weight management program and weight dissatisfaction remains stable over the course of treatment.

Quality of life in Mexican-American children following a weight management program.

OBJECTIVE: The objective was to evaluate quality of life (QOL) in at-risk-for-overweight and overweight Mexican-American children after participating in 6 months of intensive weight management or self-help. RESEARCH METHODS AND PROCEDURES: Eighty sixth- and seventh-grade at-risk-for-overweight (BMI >or=85th to <95th percentile) and overweight (BMI >or=95th percentile) Mexican-American children were randomly assigned to either intensive instructor-led intervention (ILI) or self-help (SH). The ILI condition included daily participation for 12 weeks in a school-based program comprised of nutrition education, physical activity, and behavior modification, followed by ongoing monthly maintenance. QOL was assessed at baseline and 6 months via child self-report PedsQL. QOL outcomes were compared across treatment groups, and the impact of change in zBMI on change in QOL was evaluated. RESULTS: Children in the ILI condition not only achieved significantly greater weight loss (zBMI, -0.13 +/- 0.14; p < 0.001) but also significantly greater physical QOL improvements than those in the SH condition at 6 months (p < 0.05). Furthermore, physical QOL increases were associated with zBMI reduction (p < 0.05). However, neither psychosocial nor total QOL was significantly impacted by intervention or zBMI change. DISCUSSION: These findings show that even modest decreases in zBMI after weight management result in improved physical QOL in Mexican-American children. These results illustrate the clear need to include evaluation of QOL in the process of identifying effective weight management programs.

Weight loss in overweight Mexican American children: a randomized, controlled trial.

OBJECTIVES: Childhood overweight has increased significantly in the past 20 years, with the highest rates noted among Mexican Americans. Although this minority group is in significant need of intervention, few programs have demonstrated actual decreases in weight. In this study we evaluated an intensive healthy lifestyle program designed to result in weight reduction for overweight Mexican American children. We hypothesized that children randomly assigned to an intensive intervention would significantly reduce their standardized BMI when compared with children randomly assigned to a self-help condition. PATIENTS AND METHODS: A total of 60 children (33 boys; 55%) between the ages of 10 and 14 years at or above the 85th percentile for BMI were randomly assigned to a 6-month intensive-intervention or self-help condition. RESULTS: Children in the intensive-intervention condition significantly reduced their standardized BMI when compared with the children in the self-help condition. The change in standardized BMI was significantly different at both 3 and 6 months, with intensive-intervention participants showing greater decreases in weight. CONCLUSIONS: Overall, the results were promising, suggesting that an intensive, individualized intervention may be an effective means for promoting weight loss in overweight Mexican American children.

Results of an intensive school-based weight loss program with overweight Mexican American children.

Childhood overweight has increased significantly in the past 20 years, with the highest rates noted among Mexican Americans. Schools are an optimal setting for intervention efforts; however, few programs have demonstrated actual decreases in weight. This study evaluated an intensive school-based program designed to result in weight reduction for overweight Mexican American children. A total of 71 children (32 males, 48%) between the ages of 10 and 14 at or above the 85th percentile for body mass index (BMI) were randomized into a six-month intensive intervention (II) or self-help (SH) condition. Results revealed that children in the II condition significantly reduced their standardized BMI (zBMI) when compared with the children in the self-help condition (F(2,62)=6.58, p=0.003). The change in zBMI was significantly different at both 3 and 6 months (F(1,63)=5.74, p=0.019, F(1,63)=12.61, p=0.001, respectively) with II participants showing greater decreases in weight. The 3-month change in zBMI for the II participants was a decrease of 0.07 compared with a decrease of 0.01 for SH participants. The 6-month change in zBMI was a decrease of 0.11 for II and an increase of 0.03 for SH. Overall, the results are promising, suggesting that an intensive school-based intervention may be an effective means for promoting weight loss in overweight Mexican American children.

Inflammatory markers are elevated in overweight Mexican-American children.

OBJECTIVE: The purpose of the present study was to determine the effect of body weight on blood lipid profile, insulin resistance and inflammatory biomarkers in Mexican-American children. METHODS: Children (13.3+/-0.1 year) were recruited from a local school and assigned to one of three groups as a volunteer sample: healthy weight (HW) (> or =10th and <85th BMI percentile; n=42), at risk of overweight (RO) (> or =85th and <95th; n =25) or overweight (OW) (> or =95th; n=42). Plasma concentrations of hsCRP, sCD14, sIL-6R, sTNF-alphaR1, sTNF-alphaR2, IL-6 and TNF-alpha were determined by ELISA. RESULTS: OW children had significantly greater plasma concentrations of hsCRP (P =0.003), sCD14 (P =0.013), sIL-6R (P =0.010), sTNF-alphaR1 (P<0.001), sTNF-alphaR2 (P=0.005), insulin (P=0.001), TC:HDL ratio (P<0.001) and triglycerides (P <0.001) than HW children. Also plasma concentrations of hsCRP, sIL-6R and sTNF-alphaR1 were significantly greater in OW compared with RO children. CONCLUSION: Overweight Mexican-American children had a higher concentration of inflammatory biomarkers than healthy weight children. To our knowledge, this is the first study to report that sCD14 is elevated in overweight compared with healthy weight Mexican-American children.

Reduced quality of life in very overweight Mexican American adolescents.

Quality of life (Pediatric Quality of Life Inventory, PedsQL) was assessed for 175 Mexican American adolescents with measured height and weight used to determine body mass index (BMI) percentile/weight classification. Main effects for weight classification were detected using One-way ANOVAs (p < .05 for total, physical, and psychosocial), with the heaviest adolescents demonstrating the lowest ratings.

Behavioral management of obesity.

The behavioral management of obesity is an approach designed to provide individuals with a set of skills that promote a healthier weight. A number of strategies are used to assist individuals in making gradual changes that can realistically be incorporated into their lives. Evidence is promising for behavioral programs, as results demonstrate an 8% to 10% reduction in initial weight during the first 6 months to 1 year of treatment. However, the long-term impact of these treatments remains unclear, as many individuals regain weight lost over time. The Diabetes Prevention Program and the Look AHEAD (Action for Health in Diabetes) trial are providing strong data on the long-term results of intensive behavioral management interventions.