Impact of Family YMCA Membership on Childhood Obesity: A Randomized Controlled Effectiveness Trial

摘要

id="p1">Background: Treatment studies about childhood obesity in primary care are lacking. We hypothesized that providing a paid family membership to the YMCA would be effective in reducing weight. id="p-2">Methods: Patients 5 to17 years old in at least the 85th body mass index (BMI) percentile were eligible. All participants were scheduled to attend 4 nutrition classes and to return for evaluation at 2, 4, 6, 9, and 12 months. Participants were randomized to nutrition classes only (n = 39) or nutrition classes and family YMCA membership (n = 44). The primary outcome measure was year change in BMI-for-age percentile. id="p-3">Results: Median BMI percentile at baseline was 99. Only 27 of 36 evaluable participants in the treatment group visited the YMCA. Four participants in the control group and one in the treatment group achieved the target reduction of 2 BMI percentile points (Fisher's exact, P = .17). Within the treatment group, YMCA attendees had a mean increase of 0.30 BMI points compared with an increase of 0.60 BMI points in nonattendees (P = .28). id="p-4">Conclusion: In very obese children, eliminating financial barriers to YMCA membership is insufficient to induce more weight loss during 1 year compared with nutrition classes alone. Improvements in nutrition intake were reported by both groups. class="kwd-group KWD">

>class="kwd-search" href="/search?fulltext=Obesity&sortspec=date&submit=Submit&andorexactfulltext=phrase">Obesity

>class="kwd-search" href="/search?fulltext=Child&sortspec=date&submit=Submit&andorexactfulltext=phrase">Child

>class="kwd-search" href="/search?fulltext=Pediatrics&sortspec=date&submit=Submit&andorexactfulltext=phrase">Pediatrics

>class="kwd-search" href="/search?fulltext=Exercise&sortspec=date&submit=Submit&andorexactfulltext=phrase">Exercise

>class="kwd-search" href="/search?fulltext=Body+Mass+Index&sortspec=date&submit=Submit&andorexactfulltext=phrase">Body Mass Index id="p-5">Childhood obesity is a major public health problem in the United States. Data from National Health And Nutrition Examination Surveys (NHANES 1976 to 1980 and 2003 to 2006) show that the prevalence of obese children (ie, those at or above the 95th percentile of the Centers for Disease Control and Prevention growth charts) has increased: for those aged 6 to 11 years, prevalence increased from 6.5% to 17.0%; for those aged 12 to 19 years, prevalence increased from 5.0% to 17.6%.id="xref-ref-1-1" class="xref-bibr" href="#ref-1">1 Obesity and overweight (body mass index [BMI] percentile 85 to 94) among children and adolescents can result in a variety of adverse health outcomes, including type 2 diabetes, obstructive sleep apnea, hypertension, dyslipidemia, and the metabolic syndrome.id="xref-ref-2-1" class="xref-bibr" href="#ref-2">2 Up to 80% of overweight adolescents may become obese adults,id="xref-ref-2-2" class="xref-bibr" href="#ref-2">2 and successful efforts to reduce the incidence of childhood obesity may reduce adult obesity and its associated diseases.id="xref-ref-3-1" class="xref-bibr" href="#ref-3">3 id="p-6">Evidence from the most recent Cochrane reviewid="xref-ref-4-1" class="xref-bibr" href="#ref-4">4 shows that family-based lifestyle interventions, with a behavioral program aimed at changing thinking patterns about diet and physical activity, provide a significant and clinically meaningful decrease in overweight among both children and adolescents compared with standard care or self-help in the short and the long terms. Dietary patterns are typically addressed through education; the American Heart Association recommends the use of a registered dietitian to provide nutritional education.id="xref-ref-5-1" class="xref-bibr" href="#ref-5">5 In addition to addressing diet, including exercise in treatment improves outcomes over nutritional education alone.id="xref-ref-6-1" class="xref-bibr" href="#ref-6">6id="xref-ref-7-1" class="xref-bibr" href="#ref-7">,7 Family-based behavioral interventions are most effective in treatment of overweight children; Epstein et alid="xref-ref-6-2" class="xref-bibr" href="#ref-6">6 demonstrated maintenance of treatment effects over 10 years when parents were included as active participants in treatment. id="p-7">Unfortunately, treatment studies have largely been conducted in academic centers and have yet to be translated to primary care. Primary care physicians are expected to screen for and address this health problem,id="xref-re