초등학교 비만관리 프로그램이 비만 아동의 체구성 성분과 혈청 지질 수준에 미치는 영향

Effects of a Weight Control Program on Anthropometric Measurements and Serum Lipid Profiles of Obese Elementary Students

  • 남정혜 (경민대학 웰빙건강학부 다이어트정보과)
  • Nam, Jung-He (Dept. of Dietary Information Management, Kyungmin College)
  • 발행 : 2007.03.31

초록

본 연구는 의정부 소재 초등학교에 재학중인 4${\sim}$6학년 비만 남학생 16명을 대상으로 운동과 영양교육을 중심으로 12주간 비만관리 프로그램을 실시한 후 대상자들의 비만도 및 신체둘레, 혈액 지질의 변화에 미치는 영향을 조사한 결과 다음과 같은 결과를 얻었다. 1. 프로그램 실시 전과 후 체중은 55.4${\pm}$10.9 kg에서 54.4${\pm}$9.7 kg으로 다소 감소된 경향을 보였다. 체지방량은 22.12${\pm}$6.53 kg에서 21.68${\pm}$6.05 kg으로, 체지방율도 38.3${\pm}$4.7%에서 37.9${\pm}$5.2%로 감소 경향을 보인 반면, 제지방량(LBM)은 34.56${\pm}$4.75 kg에서 34.70${\pm}$4.54 kg으로 거의 변화를 보이지 않았다. 2. 참가아동의 비만도(Obesity degree, %)와 체질량지수(BMI)는 프로그램 실시 전 각각 121.3${\pm}$8.10%, 25.9${\pm}$3.3에서 프로그램 실시 후 120.0${\pm}$8.2%, 25.6${\pm}$2.7로 감소하였다. 복부 비만도(WHR)도 0.95${\pm}$0.05에서 0.95${\pm}$0.05로 프로그램 실시 전과 후 변화가 없었다. 3. 프로그램 실시 전과 후 대상아동의 가슴둘레는 90.7${\pm}$7.2 cm에서 88.2${\pm}$7.1 cm로, 허리둘레는 87.8${\pm}$8.7 cm에서 86.7${\pm}$7.8 cm로, 엉덩이둘레는 95.3${\pm}$7.5 cm에서 94.8${\pm}$6.9 cm로 신체둘레의 경우 모두 감소된 경향을 보였다. 4. 프로그램 실시 전과 후 중성지방, 총콜레스테롤, HDL-콜레스테롤 모두 정상범위 및 위험수치에는 초과하지 않아 비만도가 크게 영향을 미치지 않음을 알 수 있었다. 총 콜레스테롤은 186.25${\pm}$31.44 mg/dl에서 187.23${\pm}$39.41 mg/dl로, 중성지방은 115.25${\pm}$65.17 mg/dl에서 113.15${\pm}$34.31 mg/dl로 변화하였다. 프로그램 실시 전과 후 혈액 중 LDL-콜레스테롤 및 HDL-콜레스테롤 농도는 큰 차이를 나타내지 않아 체중 조절 프로그램으로 인한 뚜렷한 효과는 볼 수 없었다. 5. 아동들의 체중은 BMI, 체지방량, 특히 허리둘레, 엉덩이 둘레, 허리-엉덩이 둘레비와 유의성있는 상관관계를 보인 반면 혈청 콜레스테롤과 중성지방, HDL-콜레스테롤, LDL-콜레스테롤 농도와는 상관관계를 나타내지 않았다. 총 콜레스테롤은 중성지방, LDL-콜레스테롤과 유의성있는 상관관계를 보였으며, 중성지방은 LDL-콜레스테롤과 양의 상관관계를, HDL-콜레스테롤과는 음의 상관관계를 보이고 있는 것으로 나타났다. 궁극적으로 비만 아동을 대상으로 한 학교 내 체중 조절 프로그램이 장직적인 효과를 얻기 위해서는 첫째, 무엇보다 아동이 성장기임을 고려하여 지속적인 모니터링과 함께 아동들의 식이, 운동습관 및 비만과 관련된 행동의 변화가 생활 가운데 근본적으로 일어날 수 있어야 한다. 둘째, 체중 조절 프로그램은 식이 및 운동 지도와 아울러 긍정적 강화(positive reinforcement)와 보상(reward)을 통해 충분한 동기를 부여하도록 하고 프로그램 실시 후 일정기간 부모와 함께 하는 추후 관리 프로그램을 실시한다면 더욱 지속적인 효과를 기대할 수 있을 것으로 사료된다. 마지막으로 현재 초등학교에는 보건교사와 영양사, 체육교사가 대부분 상주하고 있기 때문에 선생님들의 역할분담과 상호협력을 통하여 비만 예방교육, 비만 아동의 조기발견과 비만개선 프로그램을 수립하여 꾸준히 운영해 나간다면 성장기 아동의 비만문제를 해결하는데 큰 도움이 될 것으로 생각된다.

The purpose of this study was to investigate the effects of a 12 week weight control program, which included nutrition education and regular physical fitness, on body weight, degree of obesity, BMI, and lowering of blood lipids in 16 obese male elementary school students. Changes in waist and hip circumferences and their ratios were measured at the conclusion of the 12 week program conducted from September 9 to November 25, 2005. Body weight after 12 weeks on the program slightly reduced from 55.4${\pm}$10.9 kg to 54.4${\pm}$9.7 kg. Degree of obesity and BMI decreased from 121.3${\pm}$8.1%, and 25.9${\pm}$3.3 to 120.0${\pm}$8.2% and, 25.6${\pm}$2.7, respectively. Body fat percentage decreased slightly from 38.3${\pm}$4.7% to 37.9${\pm}$5.2%. Waist to hip ratio did not change after 12 weeks. There were slight changes in weight of body fat and lean body mass from 22.12${\pm}$6.53 kg and 34.56${\pm}$4.75 kg to 21.68${\pm}$6.05 kg and 34.70${\pm}$4.54 kg, respectively. Also, after 12 weeks on the weight control program, body, waist, and hip circumferences decreased. However, there were no significant differences among the blood lipid components, including triglycerides, total cholesterol, and HDL-cholesterol. Finally, body weight, degree of obesity, BMI, and body fat showed more significant correlations to waist, hip circumference and their ratio than to blood lipid levels.

키워드

참고문헌

  1. Moon, HN, Hong, SJ and Sub, SJ. The prevalence of obesity in children and adolescents. Kor. J. Nutr. 25:413-418. 1992
  2. Kang, HS. A review on the childhood obesity. Kor. J. Physical Education. 41:927-943. 2002
  3. Blackman, MB. Obesity, principles of ambulatory medicine. 4th ed. pp.l102-l109. 1994
  4. NIH Technology Assessment conference panel. Method of voluntary weight loss and control. Ann. Intern. Med. 119: 764-770. 1993
  5. You, JS, Choi, YJ, Kim, IS, Chang, KJ and Chyun, JH. A study on prevalence of obesity, eating habits and life styles of 5th grade students in Inchon. Kor. J. Community Nutr. 2:13-22. 1997
  6. Lee, SS and Oh, SH. Prevalence of obesity and eating habits of elementary school students in Kwangju. Kor. J. Community Nutr. 2:486-495. 1997
  7. Na, SH and Kim, SY. A study on the prevention and treatment of children obesity. Korea Sport Research. 14:11591174. 2003
  8. Kang, YJ, Hong, CH and Hong, YJ. The prevalence of childhood and adolescent obesity over the last 18 years in Seoul area. Kor. J. Nutr. 30:832-839. 1997
  9. Mossberg, HO. 40 year follow up of overweight children. Lancet. 2:491-493. 1989
  10. Chung, MY. Obesity and associated diseases. J. Kor. Soc. Study Obesity. 1:5-10. 1992
  11. Orchard, JJ, Donahue, RP, Kuller, LH, Hodge, PN and Drash, AL. Cholesterol screening in childhood : Does it predict adult hypercholesterolemia. J. Pediatrics. 103:687-691. 1983 https://doi.org/10.1016/S0022-3476(83)80458-2
  12. Laur, RM, Lee, J and Clarke, WP. Factors affecting the relationship between childhood and adult cholesterol levels, The rnascatine study. Pediatrics. 82:309-318. 1985
  13. No, YH, Lee, SY and Kang, JH. Short term effects of schoolbased obesity control programs performed on elementary students. J. Kor. Acad Farn Med. 23:1470-1479. 2002
  14. Brownell, KD and Kramer, FM. Behavioral management of obesity. In: Blackburn, GL and Kanders, BS, ed. Obesity: Pathophysiology, psychology and treatment. NY: Chapman & Hall. pp.231-252. 1994
  15. Alford, BB. Nutrition during the life cycle, Pretice Hall Inc. 1982
  16. Nuutinen, O and Knip, M. Long-term weight control in obese children : persistence of treatment outcome and metabolic changes. Int J. Obese. 16:279-287. 1992
  17. Nam, SN and Park, JH. Changes of body composition and fitness on combined weight loss programs in obese Korean children. Korean Soc. Sports Med. 16:215-223. 1998
  18. Song, YS. The effect of nutrition course on the nutrition knowledge and food habits in college students. Kor. J. Nutr. 19:420-426. 1986
  19. Dietz. Childhood obesity, susceptibility cause and management. J. Pediatrics. 103:676-685. 1983 https://doi.org/10.1016/S0022-3476(83)80457-0
  20. Lee, JH. Treatment of obesity. J. Kor. Soc. Study Obesity 23:347-350. 1990
  21. Kim, SH, Kim, KE and Kim, SY. A study on relations of obesity to the serum lipid and insulin concentrations in the elementary school children. Kor. J. Nutr. 31:159-165. 1998
  22. Kim, SH. Resting metabolic rate and body fat changes following weight loss by continuous aerobic exercise. J. Kor. Soc. Aerobic Exercise. 2:41-47. 1998
  23. Park, HS. Obesity and weight control. J. Kor. Acad. Fam. Med. 13:289-299. 1992
  24. Wood, PD and Stetanick, ML. et al. The effects on plasma lipoproteins of a prudent weight-reducing diet, with or with- out exercise, in overweight men and women. N. Engl. J. Med. 325:461-466. 1991 https://doi.org/10.1056/NEJM199108153250703
  25. Park, JK, Ahn, HS and Lee, DH. Effects of step by step diet control program in obese children. Kor. J. Obesity. 10:165173. 2001
  26. Kim, MG, Kim, SS, Kim, CY, Cha, KC and Jeong, IG. Comparison of body composition in obese children and normal children using segmental bioelectrical impedance and skinfo1d-thickness measurements, J. Sport Leisure Studies. 9:451-462. 1998
  27. Gwinup, G. Effect of exercise alone on the weight of obese women. Arch. Intern. Med. 135:676-680. 1975 https://doi.org/10.1001/archinte.135.5.676
  28. Lee, KY and Park, TJ. The influence of obesity on health in adults at or over forty years. J. Kor. Acad. Fam. Med. 18:284-293. 1997
  29. Kim, HS. Abdominal obesity and health and exercise. J. Kor. Soc. Living Environ. Sys. 6:1-10. 1999
  30. Larsson, B, Svardsudd, K, Welin, L, Wilhelmsen, L, Bjomtorp, P and Tibblin, G. Abdominal adipose tissue distribution, obesity and risk of cardiovascular disease and death : A 13 year follow up of participants in the study of men born in 1913. J. British Med. 288:1401-1404. 1984 https://doi.org/10.1136/bmj.288.6428.1401
  31. Yoo, YC. Abdominal obesity. Kyung Hee University. 18: 164-169. 2002
  32. Kissebab, AH, Vydelingum, N, Murray, R, Evans, DJ, Hartz, AJ, Kalkhoff, RK and Adams, PW. Relation of body fat distribution to metabolic complications of obesity. J. Clin. Endo. Meta. 54:254-260. 1982 https://doi.org/10.1210/jcem-54-2-254
  33. van Gaal, L, van Sant, G, van Campenhout, G, Lepoutre, L and De Leeuw, I. Apo1ipiprotein concentrations in obese subjects with upper and lower body fat mass distribution. Int. J. Obes. 13:255-263. 1989
  34. Janes, S, Skinner. Exercise testing and exercise prescription for special cases. Lea and Febiger. pp.127-138. 1993
  35. Park, HT, Park, SK, Lee, YI and Kim, IK. The effect of 24wks jogging training on aerobic power and BMD in post menopausal women. Kor. J. Sports Med. 15:36-44. 1997
  36. Eisenmann, P. Physical activity and body composition. In Seefedlt 5th ed. Physical activity well being, Reaton. VA, AAHPERD. pp.163-388. 1986
  37. Kim, YB, Jang, EC, Leu, PS and Lee, SC. Changes of body composition and blood profiles by 12-week aerobic exercise in obese children. Kor. Acad. Soc. Exercise Nutr. 1:59-66. 1977
  38. Hubinger, L and Mackinnon, LT. The effect of endurance training of lipoprotein levels in middle-aged males. Med. Sci. Sports Exercise 28:757-764. 1996 https://doi.org/10.1097/00005768-199606000-00015
  39. Hurley, BF, Hagberg, JM, Goldberg, AP, Seals, DR, Ehsani, AA, Brennan, RE and Holloszy, JO. Resistive training can reduce coronary risk factors without altering $VO_{2max}$ or percent body fat. Med. Sci. Sports Exercise. 20:150-154. 1988 https://doi.org/10.1249/00005768-198820020-00008
  40. van Itallie, TB. Waist circumference: a useful index in clinical care and health promotion. Nutr. Rev. 56:300-302. 1998 https://doi.org/10.1111/j.1753-4887.1998.tb01663.x
  41. Kannel, WB and Gordon, T. Physiological and medical concomitants of obesity :The Framingham Study. In: Obesity in America. Washington DC. NIH Publication. pp.125-163. 1979
  42. Lee, KS, Cho, JY, Choi, YE, Kang, MS and Kang, MY. A study on comparison of physical fitness and blood lipid components by body fat rate of obese students in elementary school. Research Institute Physical Education & Sports Sci. 12:45-57. 1993
  43. Cook, TC and Laport RE. Chronic low level physical activity as a determinant HDL-C and subfraction. Med. Sci. Sports Exercise. 18:653-657. 1986
  44. Young, DR and Steinhart, MA. The importance of physical fitness versus physical activity for coronary artery disease risk factor : A cross-sectional analysis. Research Quarterly Exercise Sport. 64:377-384. 1993 https://doi.org/10.1080/02701367.1993.10607590
  45. Hoummard, JA and Wheeler, WA. Effect of fitness level and regional distribution of fat on carbohydrate metabolism and plasma in middle to older aged men. Metabol. 40:714- 719. 1991 https://doi.org/10.1016/0026-0495(91)90089-F
  46. Ekelund, LG, Haskell, WL, John, JH, Whaley, FS, Criqui, MH and Sheps, DS. Physical fitness as a predictor of cardiovascular mortality in a symptomatic North American men : The lipid research clinics' mortality follow up study. N. Engl. J. Med. 319:1379-1384. 1988 https://doi.org/10.1056/NEJM198811243192104
  47. Nikkila, EA, Taskinen, MR, Rehumen, S and Harkonen, M. Lipoprotein lipase activity in adipose tissue and skeletal muscle of runners : relation to serum lipoproteins. Metabol. 27:1661-1671. 1978 https://doi.org/10.1016/0026-0495(78)90288-3
  48. Olefsky, JM. Obesity. In : Harrison TR editor, Principles of internal medicine. 12th ed. NY. McGraw-Hill Inc. pp.411-414. 1991