Annesi James J, Walsh Ann M, Smith Alice E
Perm J. 2010 Fall;14(3):29-37. doi: 10.7812/TPP/10-034.
Although 7% of US adolescents have impaired fasting glucose, a precursor of type 2 diabetes, research has suggested that few interventions for obese adolescents at risk for diabetes have been effective. Therefore, pediatricians seek effective behavioral treatments for referral for this age group.
We wanted to determine the effects of two different durations of nutritional and exercise treatments on changes in nutrition, physical activity, body mass index (BMI), and psychological predictors of BMI change in overweight and obese adolescents at risk for type 2 diabetes.
We obtained data from 64 pediatrician-referred patients with diabetes risk factors (mean age, 14.1 years; BMI, ≥99th percentile.) Study participants were assigned to nutrition and exercise treatments for 12 weeks (n = 35) or 24 weeks (n = 29). A specific weight-loss goal was given only for the 24-week group.
Both treatments demonstrated significant within-group changes over 12 weeks in days per week of physical activity of at least 60 minutes, physical self-concept, general self, and overall mood. However, they failed to demonstrate significant 12-week increases in fruit and vegetable intake, decreases in sweetened-beverage consumption, or decreases in BMI. Between-group differences were found only in mood changes in favor of the 12-week treatment. In the 24-week treatment, BMI change from week 12 to week 24 was significantly better than corresponding normative data (d = 0.37). Physical self-concept, general self, and mood scores at week 12 explained a significant portion of the variance in BMI change (R2 = 0.13, p = 0.04).
Nutrition education alone may be insufficient for nutrition behavior change. Behavioral treatment lasting longer than 12 weeks and having a specific weight-loss goal may be useful for BMI improvements, and attention to participants' self-concept and mood may be important treatment considerations.
尽管7%的美国青少年存在空腹血糖受损的情况，这是2型糖尿病的一个先兆，但研究表明，针对有糖尿病风险的肥胖青少年的干预措施很少有效果。因此，儿科医生寻求有效的行为治疗方法，以便为这个年龄组进行转诊。
我们想确定两种不同时长的营养和运动治疗对超重和肥胖的、有2型糖尿病风险的青少年在营养、身体活动、体重指数（BMI）以及BMI变化的心理预测因素方面的变化所产生的影响。
我们从64名由儿科医生转诊的、有糖尿病风险因素的患者（平均年龄14.1岁；BMI处于第99百分位及以上）获取数据。研究参与者被分配到为期12周（n = 35）或24周（n = 29）的营养和运动治疗组。只有24周组设定了具体的减肥目标。
两种治疗在12周内均显示出组内有显著变化，包括每周至少60分钟身体活动的天数、身体自我概念、总体自我以及整体情绪方面。然而，它们在12周内未能显示出水果和蔬菜摄入量显著增加、含糖饮料消费显著减少或BMI显著降低。组间差异仅在情绪变化方面发现，12周治疗组更有优势。在24周治疗中，从第12周到第24周的BMI变化显著优于相应的标准数据（d = 0.37）。第12周时的身体自我概念、总体自我和情绪得分解释了BMI变化中很大一部分方差（R2 = 0.13，p = 0.04）。
仅营养教育可能不足以改变营养行为。持续时间超过12周且有具体减肥目标的行为治疗可能对改善BMI有用，关注参与者的自我概念和情绪可能是重要的治疗考量因素。
