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The aim of the study was to determine the persistence of weight loss achieved during treatment for two years, and to evaluate whether the clinical and metabolic changes associated with successful weight loss in obese children are maintained in the long run.

Obese children had to have relative body weight greater than 120%. Normal weight children had to have a relative body weight less than 120%.

Three children dropped out of the obese group. Three of the 32 children initially classified as having normal weight were found to be obese at the beginning of the study and had to be excluded.

The first 16 children were given individual treatment, while the subsequent 16 were treated in group sessions based on behavior modification. The third group of 16 was treated in a school health care setting. 

In the intensively treated groups (individual and group settings) body weight and height, biceps, triceps and sub-scapular skinfolds and blood pressure were measured by the same physician.

In the school health care group these parameters were measured by a trained school nurse once a month during the first year and twice a month during the observation year. 

Height was measured with a wall-mounted standiometer.  Skinfolds were measured with Harpenden skinfold calibers three times on the right side of the body, and the mean value was then calculated.  Relative weight was calculated from the child’s actual weight divided by the expected weight for height and multiplied by 100.  Relative height was estimated from growth charts.  The stage of puberty was assessed and body density was calculated from the combined results for triceps and subscapular skinfold thicknesses.  Fat mass was then calculated for body density.  Blood pressure was measured with a standard mercury gravity sphygmomanometer from the subject’s right arm while sitting in an upright position with the forearm at heart level.

Forty-eight obese children, aged 6-16 years. A control group of 32 normal weight children from the same comprehensive school was also enrolled in the study and was matched for sex and age with the group that was treated individually.

Before weight reduction, the relative weight did not differ between children in the successful and unsuccessful groups. The relative weight loss during the initial study period was 24.7% in the successful subjects, and relative weight tended to increase during the subsequent observation; but at 5 years it was still 17.8% lower than at baseline.  In the unsuccessful the relative weight remained unchanged over the initial two year study period, while there was a modest decrease of 6.8% during the subsequent three year observation period.  At two years, the successful subjects had lower relative body weight than the unsuccessful subjects had, but at five years there was no significant difference between the two groups.  After five years, the number of children whose weights were normal for their age was 14.

Height increased and did not differ between the different groups at any point in the study. In the successful weight losers, relative height decreased during the subsequent observation and at five years was lower than at baseline. In unsuccessful subjects and normal weight children no changes in relative heights were observed during the five-year period.

Lean body mass increased in both successful and unsuccessful subjects and normal weight children during the initial study period as well as during the subsequent observation.  Based on skinfold measurements, at baseline the successful weight losers had more fat tissue than the unsuccessful subjects did.  During the initial study period, fat mass decreased in the successful subjects; and at two years they had less fat tissue than the unsuccessful children. 

Only fourteen children could be regarded as persistently successful weight losers with a decrease of at least 10% in relative weight maintained up to five years.  These persistently successful weight losers showed a significantly greater decrease in relative weight (P < 0.001) and in concentrations of plasma insulin (P = 0.01) during the initial study period and they had higher mean grades for their school work both at baseline (P = 0.05) and after two years (P < 0.05) than did the other obese children.  At entry the children in the persistently successful group had a mean age of 11.6 years while the remaining children had a mean age of 10.9 years.

After a treatment program of one year treatment and another year of observation successful weight losers were able to maintain their lower relative weight over the next 3 years without adverse effects on linear growth or lean body mass.

Long-term weight loss was associated with favorable in the serum lipid profile and a decrease in concentrations of circulating insulin.  Successful subjects were characterized by initial treatment success during the weight reduction program. Not all obese children who were treated successfully initially were able to maintain their reduced body weight. Therefore development of effective methods for weight reduction should be continued, and multi-disciplinary research to identify factors that prevent relapses should be encouraged.

University/Hospital:	University of Kuopio, University of Oulu (Finland)
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Subjects participating in three different interventions were combined for long term analysis; thus it is not possible to determine which type of intervention was more successful at 5 year follow-up. It is not clear whether the subjects were analyzed equally since they were stratified into groups of successful and non-successful subjects. The control group included normal weight children, not obese controls.