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For Obese Children and Adolescents, Small Steps Help

Even slight decreases in BMI will improve insulin response in overweight children and teens.

Obese children and teenagers often display insulin resistance and other markers of the metabolic syndrome. To evaluate how much weight loss is needed to reverse insulin resistance in obese children (BMI 97th percentile), investigators studied changes in insulin sensitivity and fat metabolism in 57 children (age range, 6-14 years) participating in a weight loss program over a 1-year period. The authors obtained insulin levels and free-fatty-acid and blood-glucose concentrations at baseline and 1 year; they then calculated an insulin sensitivity index (ISI) for each child. They also studied ISI values in 10 normal-weight children during a 3-month period.

All values were significantly higher in the obese children than in the controls. Because BMI scores are not normally distributed, the investigators calculated BMI-standard deviation scores (BMI-SDS). They classified the children by degree of reduction in BMI-SDS at 1 year (0.5; 0.25-0.5; <0.25; or increase in BMI-SDS). Only children and adolescents whose BMI-SDS decreased by 0.5 or more had significant decreases in insulin and free-fatty-acid levels and improvement in ISI.

Comment: According to the author (personal communication), a change in BMI-SDS of 0.5 is equivalent to a change in BMI of 1 to 2 points (e.g., from a BMI of 27 to 26 or 25). Growing children who maintain their weight over 12 months can decrease their BMI-SDS by 0.5 or more. A menarcheal 15-year-old girl -- height 5'5", BMI 28 -- could achieve the same goal by losing 10-15 pounds (<10% of her body weight). Pediatricians can reassure patients and families that modest loss or maintenance of weight (depending on age and pubertal status) can enhance the health of obese children.

— Alain Joffe, MD, MD, MPH, FAAP

Published in Journal Watch Pediatrics and Adolescent Medicine February 1, 2005

Citation(s):

Reinehr T et al. Insulin sensitivity among obese children and adolescents, according to degree of weight loss. Pediatrics 2004 Dec; 114:1569-73.

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