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Odense Overweight Intervention Study

 

Background

Only few well-designed randomized controlled trials (RCT) has been implemented with the aim to elucidate whether it is possible to reduce the degree of overweight and obesity among children and adolescents, and the few studies that exist have often included highly selected groups.
The project is a randomized controlled trial involving children from 5th grade from Odense municipality, that has been measured by the school nurse to be overweight according to age-related BMI standards. The fact that the project is carried out in close collaboration with the Municipality of Odense means that we are able to extract a population-based sample from the background group of overweight and obese children, which greatly helps to increase the generalisability of the results, thereby making them relevant to a wide range of stakeholders. In addition, the cooperation will make it possible to conduct the study in an environment where continued future interventions can be carried out. This means that the results are potentially useful in other municipalities and among practitioners, etc.

Purpose

The primary purpose is to test the hypothesis that six weeks of participation in intensive day school and subsequent 46 week follow-up interventions targeting the whole family is effective with respect to reduction in obesity (measured by Body Mass Index (BMI)) after 12 months of follow- up compared with a standard lifestyle intervention among 11-13 year old overweight and obese children. The secondary objectives are:
• To test the effect of intervention (day camp + subsequent 46 week follow-up intervention) relative to the risk factors for cardiovascular disease
• To test the effect of intervention (day camp + subsequent 46 week follow-up intervention) relative to the determinants of behavior change and wellbeing
• To describe the pedagogical methods and use it to develop a "best practice" manual
• To measure the effect of BMI 48 months after baseline


Intervention

The children participate in a six week dayschool (07:00 to 20.30 seven days a week) where they are involved in fun physical activities and are taught physical education and have health classes, math hours, Danish lessons and scientific disciplines. All lessons and all teaching is planned and carried out by health professionals and specialized instructors. Teaching in sport and physical activity takes place largely outside with the use of recreational facilities like soccer fields, basketball courts, and woodlands within biking distance from the school. Three lessons of physical activity and sport are scheduled each day and these lessons are designed to enhance coordination, cardio-respiratory fitness, muscle strength, and the familiarity with the physical and sporting surroundings.
After the six-week intervention a 46-week follow-up family-based intervention will be carried out with individual families in four different sessions, focusing through the appreciative interview at "family's daily diet," "active transport and sport participation", "weight control in the family" and "networking and support."
The children allocated to the standard intervention will be offered: 1) a weekly physical activity session (one hour) arranged by the municipality over the six week period, 2) two training sessions for parents dealing with diet and physical activity led by a dietitian and exercise specialist.

Measurements

The primary outcome is the BMI. Secondary outcome include: hip and waist circumference, blood pressure, blood glucose, insulin resistance (HOMA-IR), TC, HDL, LDL, TG, insulin, adiponectin, ghrelin, leptin, c-reactive protein, TNF-α, IL-6, APO proteins (APO A1 and B), intima-media thickness in the carotid artery, heart rate variability, and cardio-respiratory fitness (direct measurement of maximum oxygen absorption by the use of a bicycle ergometer). Physical activity / inactivity objectively will be measured with an accelerometer and body composition, bone area and bone mineral content and density will be measured by DXA scan. The cognitive function will also be measured by mapping of processes dealing with planning, attention, simultaneity and sequence, as well as the concentration of brain-derived neurotrophic factor in the blood will be measured.

There are two PhD students associated with the project. Kristian Larsen Traberg, who examines the development of obesity, risk factors of cardiovascular disease and motor skills, and Tao Huang, who examines the effect of intervention on cognitive functioning and the potential importance of Brain Derived Neurotrophic Factor (BDNF) in this context.

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