{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T10:40:43Z","timestamp":1789123243978,"version":"build-2803163510"},"reference-count":43,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2019,1,10]],"date-time":"2019-01-10T00:00:00Z","timestamp":1547078400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003669","name":"Korea Centers for Disease Control &amp; Prevention","doi-asserted-by":"publisher","award":["2015-ER6401-00"],"award-info":[{"award-number":["2015-ER6401-00"]}],"id":[{"id":"10.13039\/501100003669","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>This study aimed to develop a multidisciplinary lifestyle intervention program targeted at children and adolescents with moderate to severe obesity, and assess the additional effects of exercise intervention when compared to usual care. Overall, the 103 enrolled participants were \u226585th percentile of age and sex-specific body mass index (BMI). Participants were divided into groups that received 16 weeks of either usual care or exercise intervention. The BMI z-score of the overall completers decreased by about 0.05 after the 16-week intervention (p = 0.02). After the intervention, only the exercise group had a significantly lower BMI z-score than the baseline score by about 0.1 (p = 0.03), but no significant group by time interaction effects were observed. At the 16-week follow-up, significant group by time interaction effects were observed in percentage body fat (%BF) (\u03b2 = \u22121.52, 95%CI = \u22122.58\u2013\u22120.45), lean body mass (LM) (\u03b2 = 1.20, 95%CI = 0.12\u20132.29), diastolic blood pressure (\u03b2 = \u22125.24, 95%CI = \u22129.66\u2013\u22120.83), high-sensitivity C-reactive protein (\u03b2 = \u22121.67, 95%CI = \u22122.77\u2013\u22121.01), and wall sit test score (\u03b2 = 50.74, 95%CI = 32.30\u201369.18). We developed a moderate-intensity intervention program that can be sustained in the real-world setting and is practically applicable to both moderate and severe obesity. After interventions, the exercise group had lower %BF and cardiometabolic risk markers, and higher LM and leg muscle strength compared to the usual care group.<\/jats:p>","DOI":"10.3390\/nu11010137","type":"journal-article","created":{"date-parts":[[2019,1,11]],"date-time":"2019-01-11T04:10:16Z","timestamp":1547179816000},"page":"137","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":87,"title":["The Effect of a Multidisciplinary Lifestyle Intervention on Obesity Status, Body Composition, Physical Fitness, and Cardiometabolic Risk Markers in Children and Adolescents with Obesity"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8294-1741","authenticated-orcid":false,"given":"Young-Gyun","family":"Seo","sequence":"first","affiliation":[{"name":"Department of Family Medicine, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do 14068, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyunjung","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Medical Nutrition, Kyung Hee University, Yongin, Gyeonggi-do 17104, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"YoonMyung","family":"Kim","sequence":"additional","affiliation":[{"name":"University College, Yonsei University International Campus, Incheon 21983, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2829-9457","authenticated-orcid":false,"given":"Young-Su","family":"Ju","sequence":"additional","affiliation":[{"name":"Department of Occupational and Environmental Medicine, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do 14068, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hye-Ja","family":"Lee","sequence":"additional","affiliation":[{"name":"Center for Biomedical Sciences, Korea National Institute of Health, Cheongju, Chungbuk 28159, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Han Byul","family":"Jang","sequence":"additional","affiliation":[{"name":"Center for Biomedical Sciences, Korea National Institute of Health, Cheongju, Chungbuk 28159, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sang Ick","family":"Park","sequence":"additional","affiliation":[{"name":"Center for Biomedical Sciences, Korea National Institute of Health, Cheongju, Chungbuk 28159, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9806-0076","authenticated-orcid":false,"given":"Kyung Hee","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do 14068, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,1,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2292","DOI":"10.1001\/jama.2016.6361","article-title":"Trends in Obesity Prevalence Among Children and Adolescents in the United States, 1988\u20131994 Through 2013\u20132014","volume":"315","author":"Ogden","year":"2016","journal-title":"JAMA"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1001\/jamapediatrics.2014.21","article-title":"Prevalence and trends in obesity and severe obesity among children in the United States, 1999\u20132012","volume":"168","author":"Skinner","year":"2014","journal-title":"JAMA Pediatr."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1016\/S0140-6736(14)60460-8","article-title":"Global, regional, and national prevalence of overweight and obesity in children and adults during 1980\u20132013: A systematic analysis for the Global Burden of Disease Study 2013","volume":"384","author":"Ng","year":"2014","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"869","DOI":"10.1056\/NEJM199709253371301","article-title":"Predicting obesity in young adulthood from childhood and parental obesity","volume":"337","author":"Whitaker","year":"1997","journal-title":"N. Engl. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1136\/adc.2008.140905","article-title":"Predicting adult metabolic syndrome from childhood body mass index: Follow-up of the New Delhi birth cohort","volume":"94","author":"Sachdev","year":"2009","journal-title":"Arch. Dis. Child."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1876","DOI":"10.1056\/NEJMoa1010112","article-title":"Childhood adiposity, adult adiposity, and cardiovascular risk factors","volume":"365","author":"Juonala","year":"2011","journal-title":"N. Engl. J. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2362","DOI":"10.1056\/NEJMoa031049","article-title":"Obesity and the metabolic syndrome in children and adolescents","volume":"350","author":"Weiss","year":"2004","journal-title":"N. Engl. J. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1689","DOI":"10.1161\/CIR.0b013e3182a5cfb3","article-title":"American Heart Association Atherosclerosis, Hypertension, and Obesity in the Young Committee of the Council on Cardiovascular Disease in the Young, Council on Nutrition, Physical Activity and Metabolism, and Council on Clinical Cardiology. Severe obesity in children and adolescents: Identification, associated health risks, and treatment approaches: A scientific statement from the American Heart Association","volume":"128","author":"Kelly","year":"2013","journal-title":"Circulation"},{"key":"ref_9","unstructured":"Student Health Policy Division (2018, November 12). Announcement of Sample Results of the 2016 Student Health Examination. Ministry of Education, Available online: https:\/\/www.moe.go.kr\/boardCnts\/fileDown.do?m=0503&s=moe&fileSeq=2524cb8df965e5bc297eae34d7289ecf."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1111\/j.1365-2265.2007.03115.x","article-title":"Prevalence of metabolic syndrome (MS) in children and adolescents with varying degrees of obesity","volume":"68","author":"Calcaterra","year":"2008","journal-title":"Clin. Endocrinol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/j.jpeds.2013.01.020","article-title":"The cardio-metabolic risk of moderate and severe obesity in children and adolescents","volume":"163","author":"Rank","year":"2013","journal-title":"J. Pediatr."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/1687-9856-2014-3","article-title":"Severe obesity in children: Prevalence, persistence and relation to hypertension","volume":"2014","author":"Lo","year":"2014","journal-title":"Int. J. Pediatr. Endocrinol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.jpeds.2006.08.042","article-title":"Cardiovascular risk factors and excess adiposity among overweight children and adolescents: The Bogalusa Heart Study","volume":"150","author":"Freedman","year":"2007","journal-title":"J. Pediatr."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2427","DOI":"10.1001\/jama.2017.0332","article-title":"Screening for Obesity and Intervention for Weight Management in Children and Adolescents: Evidence Report and Systematic Review for the US Preventive Services Task Force","volume":"317","author":"Evans","year":"2017","journal-title":"JAMA"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1111\/obr.12680","article-title":"Effects of multidisciplinary interventions on weight loss and health outcomes in children and adolescents with morbid obesity","volume":"19","author":"Zolotarjova","year":"2018","journal-title":"Obes. Rev."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1965","DOI":"10.1002\/oby.21967","article-title":"A Novel Home-Based Intervention for Child and Adolescent Obesity: The Results of the Wh\u0101nau Pakari Randomized Controlled Trial","volume":"25","author":"Anderson","year":"2017","journal-title":"Obesity"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"3572","DOI":"10.1210\/jc.2015-1444","article-title":"Children with Morbid Obesity Benefit Equally as Children with Overweight and Obesity From an Ongoing Care Program","volume":"100","author":"Rijks","year":"2015","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1001\/jamapediatrics.2014.521","article-title":"Inpatient treatment of children and adolescents with severe obesity in the Netherlands: A randomized clinical trial","volume":"168","author":"Benninga","year":"2014","journal-title":"JAMA Pediatr."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.jadohealth.2007.08.015","article-title":"Effects of a multidisciplinary inpatient intervention on body composition, aerobic fitness, and quality of life in severely obese girls and boys","volume":"42","author":"Radtke","year":"2008","journal-title":"J. Adolesc. Health"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1159\/000487328","article-title":"Health-Related Quality of Life in Children and Adolescents with Severe Obesity after Intensive Lifestyle Treatment and at 1-Year Follow-Up","volume":"11","author":"Hoedjes","year":"2018","journal-title":"Obes. Facts"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3345\/kjp.2008.51.1.1","article-title":"2007 Korean National Growth Charts: Review of developmental process and an outlook","volume":"51","author":"Moon","year":"2008","journal-title":"Korean J. Pediatr."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1210\/jc.2016-2573","article-title":"Pediatric Obesity-Assessment, Treatment, and Prevention: An Endocrine Society Clinical Practice Guideline","volume":"102","author":"Styne","year":"2017","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1060","DOI":"10.1542\/peds.2008-3727","article-title":"Family-based treatment of severe pediatric obesity: Randomized, controlled trial","volume":"124","author":"Kalarchian","year":"2009","journal-title":"Pediatrics"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1038\/sj.ijo.0802845","article-title":"Longitudinal changes in activity patterns, physical capacities, energy expenditure, and body composition in severely obese adolescents during a multidisciplinary weight-reduction program","volume":"29","author":"Lazzer","year":"2005","journal-title":"Int. J. Obes."},{"key":"ref_25","first-page":"943","article-title":"Development of the Korean Form of the Kovacs\u2019 Children\u2019s Depression Inventory","volume":"29","author":"Cho","year":"1990","journal-title":"J. Korean Neuropsychiatr. Assoc."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1111\/j.1469-7610.1988.tb00758.x","article-title":"Validation of the Children\u2019s Depression Scale and the Children\u2019s Depression Inventory in a prepubertal sample","volume":"29","author":"Knight","year":"1988","journal-title":"J. Child. Psychol. Psychiatry"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1037\/0022-006X.55.5.755","article-title":"Children\u2019s Depression Inventory: Construct and discriminant validity across clinical and nonreferred (control) populations","volume":"55","author":"Carey","year":"1987","journal-title":"J. Consult Clin. Psychol"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1123\/jpah.6.6.790","article-title":"Global physical activity questionnaire (GPAQ): Nine country reliability and validity study","volume":"6","author":"Bull","year":"2009","journal-title":"J. Phys. Act. Health"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1016\/j.jpeds.2010.09.049","article-title":"Smaller weight changes in standardized body mass index in response to treatment as weight classification increases","volume":"158","author":"Johnston","year":"2011","journal-title":"J. Pediatr."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1007\/s00431-003-1247-2","article-title":"Changes in fat mass, fat-free mass and aerobic fitness in severely obese children and adolescents following a residential treatment programme","volume":"162","author":"Deforche","year":"2003","journal-title":"Eur. J. Pediatr."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1093\/ajcn\/41.4.753","article-title":"Energy expenditure before and during energy restriction in obese patients","volume":"41","author":"Ravussin","year":"1985","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_32","first-page":"11","article-title":"Resting metabolic rate in obese children before, during and after weight loss","volume":"16","author":"Zwiauer","year":"1992","journal-title":"Int. J. Obes. Relat. Metab. Disord."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2583","DOI":"10.1161\/CIRCULATIONAHA.117.032432","article-title":"Associations of Fitness, Physical Activity, Strength, and Genetic Risk with Cardiovascular Disease: Longitudinal Analyses in the UK Biobank Study","volume":"137","author":"Tikkanen","year":"2018","journal-title":"Circulation"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1801","DOI":"10.1111\/sms.13077","article-title":"Strength and cardiometabolic risk in young adults: The mediator role of aerobic fitness and waist circumference","volume":"28","year":"2018","journal-title":"Scand. J. Med. Sci. Sports"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1249\/MSS.0000000000001063","article-title":"Strength Training and the Risk of Type 2 Diabetes and Cardiovascular Disease","volume":"49","author":"Shiroma","year":"2017","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1769","DOI":"10.1161\/STROKEAHA.115.009008","article-title":"Influence of Cardiovascular Fitness and Muscle Strength in Early Adulthood on Long-Term Risk of Stroke in Swedish Men","volume":"46","author":"Kuhn","year":"2015","journal-title":"Stroke"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"575016","DOI":"10.1155\/2013\/575016","article-title":"School-based health center intervention improves body mass index in overweight and obese adolescents","volume":"2013","author":"Kong","year":"2013","journal-title":"J. Obes."},{"key":"ref_38","first-page":"319","article-title":"Exercise intervention in childhood obesity: A randomized controlled trial comparing hospital- versus home-based groups","volume":"12","author":"Arguisuelas","year":"2012","journal-title":"Acad. Pediatr."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e443","DOI":"10.1542\/peds.2004-2172","article-title":"Short- and long-term beneficial effects of a combined dietary-behavioral-physical activity intervention for the treatment of childhood obesity","volume":"115","author":"Nemet","year":"2005","journal-title":"Pediatrics"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"S247","DOI":"10.1016\/j.amepre.2012.11.026","article-title":"Latino families, primary care, and childhood obesity: A randomized controlled trial","volume":"44","author":"Kurowski","year":"2013","journal-title":"Am. J. Prev. Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1038\/ijo.2011.182","article-title":"Family-based behavioural treatment of childhood obesity in a UK National Health Service setting: Randomized controlled trial","volume":"36","author":"Croker","year":"2012","journal-title":"Int. J. Obes."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"2697","DOI":"10.1001\/jama.297.24.2697","article-title":"Effects of a weight management program on body composition and metabolic parameters in overweight children: A randomized controlled trial","volume":"297","author":"Savoye","year":"2007","journal-title":"JAMA"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1002\/eat.1091","article-title":"Is family-based behavioral weight control appropriate for severe pediatric obesity?","volume":"30","author":"Levine","year":"2001","journal-title":"Int. J. Eat. Disord."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/11\/1\/137\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T12:25:00Z","timestamp":1760185500000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/11\/1\/137"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,1,10]]},"references-count":43,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2019,1]]}},"alternative-id":["nu11010137"],"URL":"https:\/\/doi.org\/10.3390\/nu11010137","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,1,10]]}}}