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The Effects of a Children's Summer Camp Programme on Weight Loss, with a 10 Month Follow-Up

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The Effects of a Children's Summer Camp Programme on Weight Loss, with a 10 Month Follow-Up International Journal of Obesity (2000) 24, 1445±1453 ß 2000 Macmillan Publishers Ltd All rights reserved 0307±0565/00 $15.00 www.nature.com/ijo The effects of a children's summer camp programme on weight loss, with a 10 month follow-up PJ Gately1*, CB Cooke1, RJ Butterly1, P Mackreth1 and S Carroll1 1School of Leisure and Sports Studies, Leeds Metropolitan University, Fairfax Hall, Beckett Park, Leeds LS6 3QS, UK OBJECTIVE: To assess the long-term effects of a multidisciplinary approach involving structured fun-type skill learning physical activities in the treatment of obese and overweight children. DESIGN: A longitudinal investigation incorporating repeated measurements before and after the 8 week intervention and after the 44 week follow-up period. METHODS: The camp programme (Massachusetts, USA) utilised structured fun-based skill learning physical activities, moderate dietary restriction and behaviour modi®cation. The primary aims of the intervention were to reduce body mass and promote the maintenance of the reduction in body mass using an alternative to standard exercise prescription. SUBJECTS: One-hundred and ninety-four children (64 boys and 130 girls, aged 12.6Æ 2.5 y) enrolled at a summer weight loss camp, of which 102 children (38 boys and 64 girls aged 13.6Æ 2.4 y) returned 1 y later. MEASUREMENTS: On commencement of the programme all children were assessed for body mass and stature. At follow-up, data was available on 102 subjects for body mass and stature. RESULTS: Over the 8 week intervention signi®cant reductions (P 0.00) in body mass were obtained. During the 44 week follow-up signi®cant increases (P 0.00) were noted in body mass, body mass index (BMI) and stature, but as expected there were large variations in the responses. One year after the initial measures had been taken mean body mass and BMI were lower than at the start of the intervention, BMI signi®cantly so (week 0, 32.9 Æ 7.4 kg=m2; week 8 29.1Æ 6.5 kg=m2; week 52, 30.05Æ 7.04 kg=m2); (P 0.00). Stature increased signi®cantly (week 0, 1.58Æ 0.12 m; week 52, 1.64Æ 0.11 m) (P 0.00) during this period, demonstrating a reduction in mean body mass over a 1 y period whilst subjects continued to increase in stature. When changes in BMI are analysed with the use of standard scores, there is a non-signi®cant increase (P 0.07) in BMI during the follow-up phase and 89% of children had a lower BMI than at week 0. CONCLUSIONS: These ®ndings suggest that the use of a structured fun-based skill learning programme may provide an alternative method of exercise prescription to help children prolong the effects of the 8 week intervention. Further investigations will help identify the key factors that are necessary for long-term lifestyle modi®cation. International Journal of Obesity (2000) 24, 1445±1452 Keywords: childhood obesity; physical activity; multidisciplinary approach; weight loss Introduction of physical activity) and follow-up measurements are rarely carried out. Most studies have been conducted Obesity is recognized as a major cause of morbidity on adult subjects and have shown that intervention and mortality and has been identi®ed as a major factor strategies are dif®cult to maintain.8,9 This lack of in a range of hypokinetic diseases.1,2 Trends described success is attributed to adjustments in dietary intake from the National Health and Nutrition Examination when subjects return to their normal environment,10 or Surveys (NHANES) indicate a dramatic increase in poor adherence to exercise.11 overweight prevalence in the US adult and paediatric Many treatments of obesity have used dietary populations.3,4 interventions to effect a negative energy balance.12 Numerous studies have reported short-term success However, researchers have identi®ed that some sub- in the treatment of obesity.5±7 However, these studies jects undertaking dietary interventions may become contain methodological problems (small sample, lack susceptible to over-eating and success in dietary of control over energy intake, problems in assessment programmes is limited.7,8 It has been suggested that obesity may be due to a lack of physical activity.13,14 Researchers have sug- *Correspondence: PJ Gately, School of Leisure and Sports gested that physical activity is necessary to increase Studies, Leeds Metropolitan University, Fairfax Hall, Beckett energy expenditure, decrease appetite, positively Park, Leeds LS6 3QS, UK. Received 31 March 1999; revised 21 January 2000; accepted affect eating behaviour, improve cardiovascular func- 3 April 2000 tioning and psychological well being.14,15 Despite Children's weight loss programme PJ Gately et al 1446 these ®ndings, little is known about what factors affect The aim of this study was to evaluate the overall adherence. Parker16 has suggested that structured fun- effects of a multifactorial intervention for reducing type exercise is a form of intervention which can be body mass in children using moderate calori®c restric- used to promote adherence and motivation to develop tion, educational and behavioural modi®cation and a habitual physical activity which will lead to an structured fun-based skill learning physical activity increase in energy expenditure and positive changes programme. The acute effects of the 8 week pro- in body mass. An alternative approach to structured gramme were assessed pre- and post-treatment with a physical activity prescription has been proposed by follow-up after a further 44 weeks. Epstein,17 which involves the reduction of sedentary behaviour which has a positive effect on physical activity levels. This research illustrates that alterna- Methods tives to structured physical activity prescription should be developed to investigate their potential Eight-week programme for improving adherence to physical activity One-hundred and ninety-four children (64 boys and interventions. 130 girls aged 12.6Æ 2.5 y) enrolled on the camp Approaches which have used diet and exercise to programme. The programme is a traditional residen- effect reductions in body mass are more successful than tial summer camp in a rural setting (Massachusetts, diet or exercise alone.5,18 ± 21 Many programmes, how- USA) with a speci®c aim of weight loss. The very ever, are short-term in nature and do not educate the nature of the programme prohibits the opportunity of participants or provide them with the necessary skills to identifying an appropriate control group. In addition, maintain their reduced body mass. In general, results this type of programme is restricted to children of have been disappointing, with typical treatments result- higher socio-economic status, although a number of ing in a 5 ± 20% reduction in body mass, only to return children were supported by assisted places or social to original levels of body mass within 5 y.8 services funding. Some studies have produced some success during follow-up programmes. Pavlou's15 study on Boston policemen in a work-centred programme demon- Follow up strated a signi®cant reduction in body mass using a One-hundred and two children (38 boys and 64 girls combination of dietary restriction and exercise and aged 13.6Æ 2.4) re-enrolled on the camp programme illustrated a non-signi®cant change in body mass in 1 y later. All subjects were assessed for body mass and the subjects who continued to exercise during the 18 stature. All measures were taken by the same month follow-up phase. researcher during the initial programme and the There have been numerous studies undertaken on follow-up. No signi®cant differences were found in the treatment of obesity in the adult population. In any of the variables between the returners and non- contrast, there has been little work carried out on the returners. As part of the camp programme a selection paediatric population.10,11 This would seem to be of non-returners were contacted to investigate reasons problematic, given that levels of inactivity and obesity for non-return. A variety of reasons were identi®ed by persist into adulthood.22 ± 26 Indeed evidence continues the parents or children for not returning to the camp. to mount with regard to the risks associated with These included families who reported that their child obesity during childhood, signi®cant morbidity being had continued to lose weight and did not need to the immediate consequence and increases in adult return to the camp and families who reported that their mortality also being highlighted by a number of child did not enjoy their experience at camp the studies.27,28 Many practitioners see obesity as a dif®- previous year. There seemed to be no common cult problem to treat, as there is limited success from responses or reasons for children not returning. It interventions.7 Without research evidence on appro- must be noted that this information was purely obser- priate interventions for children the likelihood of vational data recorded by the camp programme rather developing appropriate treatments for this population than the current investigators, so caution must be is low. taken when interpreting this information. Despite this, Epstein17 has proposed the use of One confounding factor in the analysis of long- behavioural interventions to increase participation in itudinal data for children is growth, which will sig- physical activity, rather than using regimented exer- ni®cantly affect body mass during the intervention cise to affect reductions in body mass. In addition, and follow-up. The contribution of growth to the these interventions offer the opportunity of establish- change in body mass over the follow-up therefore ing longitudinal effects, as they have been followed has to be accounted for within the present study. The up over 5 and 10 y, with data provided by Epstein29 use of population data for comparison is problematic, illustrating that 34% of the sample decreased percen- due to the sample of obese children not being compar- tage overweight by 20% or more and 30% were no able to the normal population data provided by the longer obese.
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