African Americans have a higher incidence of obesity, obesity associated diabetes (NIDDM), and other complications however, few intervention studies have been devoted to this high risk population. Childhood presents an ideal time for intervention in obesity, since behavior patterns are malleable and linear growth is still possible. The investigators hypothesize that obesity in African American children can be successfully treated by a culturally appropriate lifestyle-based intervention for weight gain stabilization, permitting growth into a normal weight for height after several years. This intervention would reduce risk from NIDDM and other complications. The project will demonstrate not only the feasibility of weight gain intervention, but a decrease of circulating insulin levels, improvement-in insulin sensitivity, and enhancement and maintenance of behaviors likely to prevent recurrence of obesity. To test these hypotheses, the investigators will recruit 180 obese (>90 percentile weight for height, 2 hour oral glucose tolerance test glucose >50 percentile) African American children 5-10 years of age. Study participants will be randomized to either Intervention, Education or Standard Care groups. The Intervention, using lifestyle based strategies, focuses on the food choices (and preparation), daily eating and exercise habits of African American children and their primary caregivers. The Intervention group will be involved in sessions teaching nutrition, meal planning, and food preparation; self-management skills utilizing a behavioral problem solving approach; contracting for exercise/activity plans for the children; with peer group as well as staff psychologic support. Special incentives, follow up visits, and programs continue for the Intervention group over the course of the study. The Education group will be a control matched for attention and education with the Intervention group. The Standard Care control group will meet initially with a dietitian and receive a standard dietary prescription for weight control, but only receive annual follow up. Monitoring of body composition, medical, hormonal and psychologic status will be performed at scheduled periods during the study for the groups. Although tailored to the special needs of obese African American children and their parents, the success of the proposed approach could easily be adapted for other groups of high risk children.
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