Limited Weight Loss or Simply No Weight Gain following Lifestyle-Only Intervention Tends to Redistribute Body Fat, to Decrease Lipid Concentrations, and to Improve Parameters of Insulin Sensitivity in Obese Children

The United States population has experienced a twofold to fourfold increase in the prevalence of obesity in the last two decades [1, 2], with a higher incidence among young African-Americans and Latinos [3]. Data obtained in a major city in the Venezuelan Andes seem to indicate a similar trend [4, 5]. Childhood obesity may lead to diabetes mellitus, cardiovascular disease, and premature death in adulthood [6]. Similarly, diseases such as dyslipidemias and type 2 diabetes are now being more frequently detected in both children and adolescents. Obese children have exhibited insulin resistance, elevated blood pressure, and increased concentrations of serum lipids. Higher body weight has been accompanied by an accumulation of visceral fat as well as elevated levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) with hepatic steatosis [7–13]. Obese children have also been found to be in a proinflammatory state, characterized by increased ultrasensitive C-reactive protein (CRP) concentrations, changes in endothelial function, and alterations in arterial structure [14, 15].The effect of modest nonpharmacological lifestyle-only intervention on auxological and metabolic parameters in obese children has not been conclusively determined, but several recent studies have demonstrated an improvement in body composition, a decrease in hemostatic and inflammatory markers, and an improvement in markers of insulin sensitivity following intervention [16–19]. It is not yet clear whether weight loss is required for these parameters to improve and to be sustained in time. In this study, we hypothesized that lifestyle-only intervention in obese children could lead to an improvement of both anthropometric and metabolic markers, even if weight loss was discrete or if weight remained stable.One hundred and eleven overweight or obese children (63 females and 48 males), with a mean chronological age of 11.3 ± 2.8 years, participated in the study. Fifty-three of the pati