Supervised play, exercise, shows psychosocial benefit to children with obesity

A program with clear rules, routines and activities, as well as attentive adults and a chance to interact with peers, can improve the quality of life, mood, and self-worth of a child who is overweight or obese as well as a regular exercise program, according to a new study published in the journal Translational Behavioral Medicine.

Researchers looked at 175 predominantly black children ages 8-11 years old who were overweight or diagnosed with obesity and were previously inactive. Children participated in either a fun-driven aerobic exercise program or a sedentary after-school program where they played board games and did artistic activities.

The investigators hypothesized that they would find that the exercise intervention would be more effective at improving quality of life, mood and self-worth than the sedentary program. They found instead that, while the exercise program had the additional benefits of reducing body fat, improving fitness, and even improved brain health, there was no mood advantage from the exercise program. Weight and fitness did not change as much in the sedentary group.

Boys in the sedentary group reported depressive symptoms decreased more over time than their peers in the exercise group, according to the study abstract. Among participating girls, depressive symptoms yielded similar improvements whether in the exercise or sedentary group. About 10 percent of children in both groups had symptoms indicating depression at the start of the study. Depressive symptoms in children include things like a sad mood, interpersonal problems, and inability to feel pleasure.

In the exercise program, the instructor led fun aerobic activity for 40 minutes daily based on the interests and abilities of the children. Rather than time on a treadmill, for example, there were more entertaining strategies to get and keep the heart rate up like a version of the age-old game tag. Children wore heart rate monitors and were rewarded for an average heart rate above 150 beats per minute during the exercise and they got more points for a higher average.

In the other group, children participated in instructor-led activities like board games, puzzles, arts, and music, and were rewarded for participation and good behavior. There were arts and crafts, challenging games like the board games, guitar music, and singing popular songs, and the children were rewarded with points for being nice and cleaning up behind themselves. The children were free to talk with each other as long as it was not disruptive.

Relationships the children built with each other over the course of both programs likely were beneficial in elevating their mood and quality of life, Williams says. The sedentary program may have given children more time to talk with each other and develop friendships with little competitive pressure.

Other investigators have shown that children in the 8-11 age range may prefer just talking or socializing with their friends as a fun activity, rather than some form of exercise, while younger children may think it's more fun to run around, according to Celestine Williams, MS, first author of the study and senior research associate at the Georgia Prevention Institute in Augusta.

The fact that both programs provided psychosocial benefit to the children led researchers to conclude that some benefits of exercise found in previous studies resulted from the regular opportunity to be with attentive adults who provide behavioral structure, researchers said. It also resulted from the children enjoying interacting with each other, sharing snacks and other activities, while spending less time watching television, according to Catherine Davis, PhD, corresponding author and clinical health psychologist at the Georgia Prevention Institute.

Rates of obesity among children and the adolescents in this country have more than tripled since the 1970s, according to the Centers for Disease Control and Prevention, and currently about 1 in 5 school-age children and young people has obesity.

There is plenty of evidence that obesity and overweight can impact overall quality of life and that children with these conditions can have increased problems with anxiety, bullying, fatigue, anger, and general behavior problems, and that generally higher body mass index is associated with a lower self-worth in children, researchers said.

"Exercise is very well demonstrated to improve mood,” Davis said. “However, I think you have to consider exercise in the context that it occurs, so the social context counts too.”