besity is a serious problem among young people, as well as adults 1,2 for whom an important association between obesity and insulin resistance, hypertension, dyslipidemia, and coronary heart diseases has been recognized. [3][4][5] Once established, obesity is frustrating and difficult to treat. The Examination Committee of Criteria for "Obesity Disease" of the Japan Society for the Study of Obesity has published new criteria for the Japanese adult population 6 at the same time as the publication of a new definition of "Obesity Disease" for Japanese children. 7 Currently, however, a generalizable conclusion on the effectiveness of interventional programs cannot be drawn, 8 and how practical and effective the intervention strategies for treating childhood obesity are remains a controversial subject.School-based interventions have been reported to improve health-related behaviors, but they have resulted in no or little change in the prevalence and/or grade of obesity 9-12 with few exceptions. 13 In clinic-based interventions, important factors were the involvement of parents or caregivers, 14,15 a combined diet -exercise intervention, 14,[16][17][18] and frequent visits and/or a shorter intervals between visits 19-21 and these were predictors of the success of the intervention.A recent report has indicated that the prevalence of obesity in elementary school children has been increasing rapidly in Japan since the mid-1990s. 22 How practical and effective intervention strategies are is an important and urgent issue for Japanese children. We conducted a familyinvolved, combined dietary-exercise intervention program and the purposes of the present study were to evaluate the effect of the intervention program at 12 months after the first visit, and to determine predictive factors in the success of the intervention to establish practical and effective strategies.
Methods
ParticipantsThe subjects were elementary school children who participated in the program from August 1998 to January 2004. Inclusion criteria for subjects were (1) visiting the program at least 4 times, (2) having an observation period between the first and last visits of 12 months or longer, (3) having measurements taken at around 12 months after the first visit, and (4) being able to take all measurements. The primary goal of this program was to promote healthy eating and physical activity among the subjects, and the secondary goal was to obtain an index of obesity <20%.
Index of ObesityAs a measure of being overweight, we computed the percent relative body weight (%RBW): (individual body weight)/(age-, sex-, and height-specific body weight from a reference population) ×100. 23
ProcedureThe program was designed as a longitudinal, non-randomized, clinical study of a family-involved, combined Tomoko Tachikawa, MD**; Shinichiro Shimizu, MD*; Katsura Arima, MD* Background Currently, a generalizable conclusion on the effectiveness of treatment programs for childhood obesity cannot be drawn, and how practical and effective the intervention strategies are re...
