Getting in the game pares weight gain in children

Credit: Dana Weintraub

Most of the fourth- and fifth-graders who played on a soccer team in a pilot study of overweight children had not played team sports before, and many discovered they liked the camaraderie of their teammates.

After-school sports can be a fun and rewarding way for a child to work off steam after a day behind a desk. But children who stand to benefit most from the increased exercise - those who are struggling with their weight - often avoid organized teams.

Now researchers and physicians at Lucile Packard Children's Hospital and the School of Medicine have found that creating teams composed exclusively of overweight children can slow their weight gain. The teams also foster a newfound love of sports and physical activity that may launch them into a life of regular exercise.

'Obesity is a challenging problem in this country,' said lead researcher and Packard Children's pediatrician Dana Weintraub, MD. 'Just telling these kids they need to exercise more isn't enough. They need positive, supportive opportunities to do so.'

Given an inch, the kids take - or is that run? - a mile. Weintraub and her colleagues found that many of the children who participated in a six-month, 'overweight only' soccer program went on to join other 'regular' school teams, from boxing to tennis to flag football and, of course, soccer. That's a turnaround from the reluctance some had to taking that first step out onto the field.

'Many of the kids who agreed to participate were hoping to be placed in the 'health-education' arm of the trial, either because they were unfamiliar with organized sports or they had had a negative experience on a team in the past,' said Weintraub, a clinical instructor in pediatrics at the medical school. 'We had to explain to them that the trial was randomized, and we couldn't control which group they would end up in.'

The small pilot study was the first to see whether 'overweight only' teams are a viable way to reduce weight gain. The trial pitted traditional classroom learning about nutrition and exercise - heavy on sitting and light on sweating - against active team participation that focused on building skills and positive reinforcement. The results were published in the March 3 issue of the Archives of Pediatric and Adolescent Medicine.

The researchers devised the Stanford Sports to Prevent Obesity Randomized Trial, or SPORT, after becoming frustrated with increasing numbers of obese, physically inactive children they were seeing in their clinics. Although the children and their families clearly realized that exercise is an important way to control or slow weight gain, they were unable to incorporate it into their daily lives.

Beginning in April 2005, Weintraub recruited 21 overweight fourth- and fifth-graders at Cesar Chavez Elementary School in East Palo Alto - a low-income community mostly comprising racial and ethnic minorities - to participate in the six-month study. The children had body-mass indexes at or above the 85th percentile for their gender and age. Fourteen had never before been on a sports team. They were randomly assigned to either a coed soccer team that met three days a week, or to a weekly health-education group that taught the importance of healthy nutrition and exercise.

Parents of the nine participants assigned to the soccer team reported their children felt more confident, comfortable and safe when playing with children of similar weight. The kids reported having fun, making friends and - a first for many - enjoying the camaraderie of the team. All nine soccer players also reduced their age- and gender-adjusted body-mass index after six months on the team, but only five of the 12 health-education participants had done so. The soccer players were also significantly more physically active than the education-only group.

The results suggest that after-school sports teams comprised of overweight children may be a relatively easy way to teach new habits, control weight gain and encourage a lifelong interest in sports participation. Weintraub and her colleagues are now conducting a larger SPORT trial of nearly 100 children in Bay Area schools. Soccer is particularly well-suited for a variety of reasons: it doesn't require a lot of equipment, it's easy to learn, it's very active even for beginners and it's extremely popular in diverse communities. Providing the team sports at schools is also important.

'SPORT allows us to help kids where they are: at school,' said Weintraub. She added that weight-control programs at hospitals or clinics can be difficult for low-income families without a car or flexible work schedules. 'It keeps them occupied during a time of day when many students are snacking in front of the television or computer, and it instills confidence and a love of team sports. Every kid should have this opportunity.'

Other Stanford authors include Evelyn Tirumalai, MPH, project coordinator and social science research assistant; database manager and software developer Farish Haydel; data analyst Michelle Fujimoto, and Thomas Robinson, MD, director of Packard Children's Center for Healthy Weight and the Irving Schulman, MD, Endowed Professor in Child Health at the medical school.

The study was supported under a cooperative agreement from the U.S. Centers for Disease Control and Prevention through the Association of American Medical Colleges.