Background. Metabolic risk factors like insulin resistance and dyslipidemia are frequently observed in severly obese children. We investigated the hypothesis that moderate weight reduction by a low-threshold intervention is already able to reduce insulin resistance and cardiovascular risk factors in severely obese children. Methods. A group of 58 severely obese children and adolescents between 8 and 17 years participating in a six-month-long outpatient program was studied before and after treatment. The program included behavioral treatment, dietary education and specific physical training. Metabolic parameters were measured in the fasting state, insulin resistance was evaluated in an oral glucose tolerance test. Results. Mean standard deviation score of the body mass index (SDS-BMI) in the study group dropped significantly from +2.5 ± 0.5 to 2.3 ± 0.6 ( ) after participation in the program. A significant decrease was observed in HOMA (6.3 ± 4.2 versus 4.9 ± 2.4, , and in peak insulin levels (232.7 ± 132.4 versus 179.2 ± 73.3？μU/mL, ). Significant reductions were also observed in mean levels of hemoglobin A1c, total cholesterol and LDL cholesterol. Conclusions. These data demonstrate that already moderate weight reduction is able to decrease insulin resistance and dyslipidemia in severely obese children and adolescents. 1. Introduction During the last decade a steady rise in the prevalence of obesity in children and adolescents has been observed worldwide [1, 2] and in several age-groups the extent of obesity was also on the increase. Concurrently certain diseases, characteristically occurring in middle-age adults in association with enhanced body fat mass (e.g., metabolic syndrome and type 2 diabetes), have emerged in children and adolescents with severe obesity, suggesting a coherence between both trends [3, 4]. Likewise, further investigations have shown that obese children and adolescents have a high risk between 30 and 80% for the persistence of overweight into adulthood, and that morbidity and mortality are higher in those obese adults who became overweight during childhood compared to those whose weight-gain evolved later in life . On the other hand epidemiological studies showed that the majority of severely obese adults became overweight when they were still children. A tremendous increase in obesity-related morbidity and furthermore an immense rise in the medical costs associated with it, are to be expected, if this trend continues . For instance, at present type 2 diabetes mellitus is already predominant in some pediatric diabetes
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