Fitness Article of the Month
November 1998

November's fitness article of the month is written by guest contributor and good friend Rich Destefano. Rich works at Yale University School of Medicine as an Clinical Exercise Physiologist & Research Associate and is currently ranked as one of the best javelin throwers in the country. His article deals with children and exercise. A topic that I feel could pave the way to a healthier next generation. If you would like to contact Rich regarding this article or would be interested in his clinics, E-mail to: or check out his professional and athletic history page.

Best of Health,

Childhood “Juvenile” Obesity: Weight Management
by Richard A. DeStefano, BS, ACSM
Yale University School of Medicine, Department of Pediatrics

Childhood and adolescent obesity is the most common pediatric chronic illness in technologically developed countries. Its prevalence in North America ranges from 10-25%, depending on the assessment methods and the criteria used to define it. Most importantly, this prevalence has been on the rise for the past decade. Overweight and obesity in the USA are particularly prevalent among African Americans and Hispanics of low socioeconomic status. The tracking of obesity from childhood to adulthood is only fair, but it is higher from adolescence to adulthood. Still, an obese child has a higher likelihood than a non-obese child of becoming an obese adolescent and adult.

Because enhanced physical activity is one of the cornerstones in the management of obesity, there are some important issues that should be focused on:

The evidence for a link between juvenile obesity and insufficient activity
Physiological and medical considerations in the response of the obese child to exertion
The role of physical training in the management of juvenile obesity
Characteristics of the optimal training program
The role of the school in the prevention and management of juvenile obesity

The program that we conduct here at Yale is a multidisciplinary weight management program that we call Bright Bodies. We combine behavior modification with an exercise training program for children ages 8 through 18. By using this multidisciplinary plan we found the following significant changes: reduced arterial blood pressures, improved lipid profiles, a decrease in plasma insulin levels, weight loss, decreases in fat mass, increases in fat free mass, increases in oxygen uptake.
The role of our behavior modification class, run by Mary Savoye, R.D., involves using a non-diet approach that emphasizes healthy food choices. The children gain insight into food intake and activity behavior while learning concrete skills to help change obesity-causing behavior and achieve a healthier lifestyle. Some of the classes taught include:

Reasons why we become overweight
Understanding and learning to enjoy exercise
Making better food choices
Handling our feelings
Understanding food labels

The exercise training program meets twice a week involving the children in a full ½ hr of exercise using various pieces of equipment. We emphasize the use of large muscle groups and duration. There is a gradual increase in frequency and daily volume based on the child’s improvements. All activities selected are like by the child and there is a strong push for parental involvement. Most importantly we keep the program fun to in which the comradery itself self propels the program. Children look forward on coming to a private place where they meet other children who have common goals. The objective to our program is to get these children to a level to where they find themselves wanting to be a part of school or community activities.

Some important considerations include:

Safety: Are there any medical concerns for the child
Asthma or exercise induced asthma
Musculoskeletal abnormalities

Or other underlined problems that should be known


Activities that the child likes should be identified
Token rewards may have to be used to be given once a milestone has been reached
Program should include games and some playful situations for adherence

Rich has been directing Bright Bodies for the past 4 ½ years now at Yale-New Haven Children’s Hospital. There are currently 3, 16- week sessions conducted throughout the year. The program includes 25-30 children, ages 8 to 18, who meet in age appropriate sessions each week to learn about behavior modification and exercise. The Children’s hospital also conducts a weight management/ lipid clinic each week aside from Bright Bodies. The clinic is led by Endocrinologist, Sonia Caprio, M.D., and includes a social worker, a registered dietitian, a nurse, and an exercise physiologist.

For more information on pediatric obesity related issues or references, Rich can be reached at (203)785-4934

This fitness article is for educational purposes only. It is not medical advice and is not intended to replace the advice or attention of health-care professionals. Consult your physician before beginning or making changes in your diet, supplements or exercise program, for diagnosis and treatment of illness and injuries, and for advice regarding medications. Thanks. RM

Copyright 2001, Ron McConnell. All rights reserved.
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