Running head: CHILDHOOD OBESITY 1

Childhood Obesity
A Review of Literature and the Recommended Exercise
Prescription
Zoe Conover
EXSC 511
Fall 2017
Dr. Wojcik
November 27, 2017
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Childhood Obesity

A Review of Literature and the Recommended Exercise Prescription

Childhood obesity is reaching epidemic levels in the United States, with 17 percent of

children ages 2-19 classified as obese (Stoler, 2016). Children who are greater than the 95th

percentile on the BMI chart are classified as obese. Children, who are classified as overweight

and at risk of obesity, fall between the 85th and 95th percentile on the BMI chart (Stoler,

2016). Obesity is caused by an energy imbalance, where the calories consumed are greater than

the calories expended each day. Lifestyle behaviors are a cause of obesity that are

modifiable. Although genetics play a role in obesity, the poor lifestyle behaviors of children are

a main cause of these alarming rates of obesity. Children are consuming more sugary

beverages, processed food, fast food, and eating large portioned meals. With parents working

and rushing around, t.v. dinners, lunchables, and fast food are becoming quick, yet less nutritious

and more processed options. The increased use of technology is also causing children to live a

more sedentary lifestyle, getting too much screen time and not outside to play. The environment

can also play a role, where children may live in an area with unsafe parks or an area without

access to a grocery store (Stoler, 2016).

These poor lifestyle habits can lead to childhood obesity, and childhood obesity can lead

to hypertension, type 2 diabetes, asthma, cardiovascular disease, orthopedic problems, and a

sedentary lifestyle as an adult (Watson, Baker, & Chadwick, 2016). Obesity does not only affect

the body physically, but psychologically, causing low self-esteem and confidence. Children who

are obese are more likely to be teased, causing harm to their emotional development, affecting

them for life (Stoler, 2016). Obesity in children should be taken as serious as a disease, causing

lifelong health problems, if there is no intervention. There have been many studies to determine
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the most effective exercise prescription and programs to intervene and decrease the rates of

childhood obesity.

Literature Review

The study, The effects of a children’s summer camp programme on weight loss, with a 10

month follow up, assessed the long term effects of a multidisciplinary approach involving

structured fun-type skill learning in the treatment of overweight and obese children (Gately,

Cooke, Butterly, Mackreth, & Carroll, 2000). There were 102 subjects, 38 males, 64 females,

ages 10-16. BMI was measured before the camp, after the 8 week camp, and at the 44 week

follow up period (Gately et al., 2000). This camp in Massachusetts consisted of a physical

activity component, a nutrition component, and a behavior change and modification

component. The physical activity component focused on building confidence, baseline fitness,

and basic skills for the first two weeks. Then, competitive and more social activities were

introduced. These activities consisted of aerobic exercise, such as orienteering and swimming,

circuit- based resistance training, and bone-strengthening activities, such as basketball and

soccer. These activities emphasized fun, were varied, and gave the children the power to

choose. The nutritional component focused on cutting calories to 1400 kcal a day, in order to

burn more calories than consumed. Food was nutritional with sufficient energy content, and

appropriate portion sizes were emphasized. The behavioral change component focused on

educating the children twice a week in a classroom setting. These sessions were kept light and

informal with competition and games. Parents were also a part of this component, and had a

weekend session focusing on positive reinforcement, physical activity, and nutrition. The results

revealed that at the 44 week follow up period, 40% continued to reduce their BMI, while 91%

had lower BMI’s than week 0 (Gately et al., 2000). The average BMI at week 0 was 32.9, at
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week 8 was 29.1, and at week 52 was 30.05 (Gately et al., 2000). There was a slight increase in

the average BMI at the 44 week follow up period, when compared to the 8-week mark, but this

average was still lower than the the average at week 0. It was concluded, that fun-based skill

learning programmes are an effective alternative method of exercise prescription, and further

research needs to be done on investigating factors of long-term lifestyle intervention (Gately et

al., 2000).

The study, Kids just wanna have fun: Children’s experiences of weight management

programme, explored children’s accounts of their experiences of the UK’s largest childhood

obesity programme, MEND. The subjects were 14 children, 8 males and 6 females, ages 11-14

years old (Watson et all, 2016). Data was collected through semi structured interviews with

children who completed MEND. MEND is a 12-week multi-component community based

weight program, with sessions twice a week, and the inclusion of a parent in these sessions

(Watson et al., 2016). The MEND curriculum contains children-friendly education on nutrition

and physical activity, behavioral change, and positive parenting techniques. Common themes

that showed in the results were fun, power and influence of others, and the changed self (Watson

et al., 2016). Children described the program as fun, being an active participant in the moment

without discomfort and effortful thinking. The theme of power and influence was also prevalent,

with healthy behaviors being more fun with the support and participation of peers. Positive

family support and the involvement of parents were also important in the success of the

program. The changed self was another theme, where children enjoyed learning new things and

seeing their positive changes and improvements. It was concluded that children have fun when

emerged in interactive and varied activities, and optimizing fun is a priority over structured

information to obesity (Watson et al., 2016).

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The final study, School-based individualised lifestyle intervention decreases obesity and

the metabolic syndrome in Mexican children, analyzed the prevalence of being overweight,

obese, and having metabolic syndrome in relation to a 10-month lifestyle intervention based on

individualized face-to-face sessions and parental education in school settings (Elizondo-

Montemayor, Gutierrez, Moreno, Martinez, Tamargo, & Trevino, 2013). The subjects included

a cross sectional sample of 94 overweight or obese Mexican children, ages 6-12, from 8 schools

(Elizondo-Montemayor et al., 2013). Methods of collecting data were BMI, blood pressure, skin

folds, blood samples, TC, HDL, LDL, and triglycerides (Elizondo-Montemayor et al.,

2013). The program consisted of an individualized meal plan for each child, based on the most

recent dietary intake. Calories were also systematically cut at a healthy rate to promote weight

loss. An exercise plan consisting of 60 minutes of exercise and less than 2 hours of screen time

was also enforced. Plans were tailored and changed every 3 weeks to progress the nutritional

and exercise plan. Of the 44% with metabolic syndrome, 16% had it at the end of the 10 months,

of the 19% with high BP, 0% had it at the end, of the 64% with hypertriglyceridemia, 35% had it

at the end, of the 60% with HDL less than 40, 41% had it at the end, and of the 72% with waist

circumference over the 90th percentile, 57% had it at the end (Elizondo-Montemayor et al.,

2013). Of the overweight participants, 32% achieved normal weight (Elizondo-Montemayor et

al., 2013). Of the obese participants, 24% dropped to being overweight, and 1% achieved

normal weight (Elizondo-Montemayor et al., 2013). To conclude, a school setting lifestyle

intervention led to a decreased prevalence of being overweight and obese to a striking reduction

in the prevalence of metabolic syndrome (Elizondo-Montemayor et al., 2013).

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Recommended Exercise Prescription

Exercise prescription for obese children includes aerobic fitness, bone strengthening

activities, resistance training, and flexibility. Getting children to enjoy physical activity and

maintain a fit and healthy lifestyle should be the main goal of exercise prescription with

children. For aerobic fitness, it is recommended children get a minimum of 60 minutes daily of

moderate to vigorous activity, but when working with obese children, start off slow with 30-45

minutes (Riebe, Ehrmen, Liguori, & Magal, 2016). It is important for these children to build a

baseline for fitness, be comfortable, and to build confidence going forward with the

program. When the child is ready, vigorous activity and longer time periods can be added into

the program as a progression. Aerobic activity should be anything the child finds fun, such as

swimming, biking, or dance. For resistance training with obese children, heavy lifting and

finding a one rep max is not necessary. Body weight or lightweight circuits should be the main

focus of resistance training with obese children. Circuits are a great way to get the heart rate up

and build strength, while keeping the exercises varied, fun, and upbeat. Exercise options for

circuits are endless, and it is easy to give the child the power to choose certain exercises. Lastly,

it is important to incorporate a flexibility component before exercise for injury prevention and

after exercise to prevent muscle tightness and soreness. Dynamic flexibility exercises before

exercise, not only warm up major muscles to prevent injury, but work on a child’s basic

coordination. Static stretches after exercises should focus on the major muscle groups worked to

prevent stiffness, such as the quadriceps and hamstrings. Along with following exercise

prescription, children should also look to cut screen time to less than two hours. Nutritionally,

water should be the beverage of choice, fruit and vegetable intake should increase, and fatty and

processed foods high in cholesterol should be cut. Parents should look to be involved in their
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child’s journey to lose weight, using positive reinforcement and providing their child with

healthy food options. Parents should also encourage less screen time, getting plenty of sleep, and

getting the recommended 60 minutes of daily exercise. Intervening and stopping obesity at a

young age is key to allowing children to enjoy a happy, healthy life in the future.

Table 1 FITT-VP Principles for Obese Children

Aerobic Bone Resistance Flexibility

Strengthening
Frequency Daily 3 days/ week 3days/week Daily
Intensity Moderate High Impact Bodyweight To point of
(11-14 RPE) discomfort
Time 45 min 30 minutes 30 minutes 10-30 sec hold
Type Fun and Running, Circuits (30 sec Dynamic
enjoyable jumping rope, on, 30 sec off) Movements for
activities basketball, 3x3, keep varied warmup:
(swimming, hopscotch. karaoke, high
dancing, biking) kicks, high
knees.
Static Stretches
for cool down:
focus on major
muscle groups.
Volume 7000 steps
Pattern One bout
Progression When
comfortable,
increase
Intensity to
vigorous (15-16
RPE) 3x week.
Increase time to
60min and
Volume to
10,000 steps
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References

Elizondo-Montemayor, L., Gutierrez, N. G., Moreno, D. M., Martínez, U., Tamargo, D., &

Treviño, M. (2013). School-based individualised lifestyle intervention decreases

obesity and the metabolic syndrome in Mexican children. Journal Of Human

Nutrition & Dietetics, 2682-89.

Gately, P. J., Cooke, C. B., Butterly, R. J., Mackreth, P., & Carroll, S. (2000). The effects

of a children's summer camp programme on weight loss, with a 10 month

follow-up. International Journal Of Obesity & Related Metabolic Disorders,

24(11), 1445.

Riebe, D., Ehrmen, J.K., Liguori, G., Magal, M. (2016). ACSM’s guidelines for exercise testing

and prescription: Tenth Edition. Philadelphia, PA: Wolters Kluwer.

Stoler, F.D. (2016). Childhood overweight & obesity. American College of Sports Medicine.

Retrieved from http://www.acsm.org/public-information/sportsmedicinebasics/childhood-

obesity.

Watson, L. A., Baker, M. C., & Chadwick, P. M. (2016). Kids just wanna have fun:

Children's experiences of a weight management programme. British Journal Of

Health Psychology, 21(2), 407-420.