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2. Biostatistician Department of Public Health Sciences, Penn State Hershey Medical Center, USA.
3. Department of Pediatrics and Medicine, Penn State Hershey Medical Center, USA.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background: Summertime is particularly problematic for obese youth, as this unstructured time typically shows accelerated weight gain. We hypothesized that obese adolescents participating in a pilot summer camp program, developed in partnership with the Boy Scouts of America, would demonstrate significant weight loss and improvement of metabolic parameters.
Methods: Obese and overweight adolescent males between ages 13 and 18 were eligible for enrollment. BMI (kg/m²) and additional anthropometric and metabolic measurements were measured at the start and end of the 4 week camp.
Results: Thirteen participants enrolled and ten participants with the mean age of 16.1 years finished camp. Among these ten participants, BMI decreased by 9.1% (40.2±13.0 kg/m² vs. 36.5±12.0 kg/m²; p<0.001). Waist circumference decreased by 7.4% (48.4±9.6 cm vs. 44.9±9.4 cm; p<0.001), and fasting glucose levels decreased by 23.1% (84 mg/dL vs. 62 mg/dL; p=0.001).
Conclusions: BMI and metabolic parameters significantly improved after 4 weeks of camp. Partnering with the Boy Scouts of America is an innovative approach to creating a summer weight management camp for adolescents.
Keywords: Childhood obesity, weight loss treatment, blood pressure, hyperlipidemia
Obesity is a global epidemic [1] and a public health crisis [2,3]. For overweight children, BMI increases more rapidly in summertime compared to the school year [4,5].
The Penn State Hershey Children’s Hospital in Hershey, Pennsylvania (USA) partnered with the Boys Scouts of America (BSA) to create an evidence-based weight-loss camp. The BSA organization promotes responsible citizenship through outdoor and educational activities. We hypothesized that adolescents participating in this pilot summer camp program would demonstrate significant weight loss and improvement of metabolic parameters.
Program overview
Penn State Hershey Children’s Hospital partnered with the Hidden Valley Boy Scout Reservation in Loysville, Pennsylvania. Camp staff consisted of two physicians, two BSA leaders, two dietitians, a psychologist, an exercise physiologist, one fitness leader, one cook, counselors and volunteers. A private donation and two grants funded all camp costs.
Participants
Obese (BMI>95th%) adolescent males ages 13 to 18 seen within 4 months before camp at the Hershey Medical Center’s Divisions of Pediatric Endocrinology and Pediatric Weight Management were eligible for enrollment. Exclusion criteria included uncontrolled mental health. No eligible participants were excluded.
Parents and campers consented to research with prior approval from the Penn State Hershey Medical Center IRB.
Intervention
Participants spent 4 uninterrupted weeks attending camp in July, 2008. Healthier options were added to the Boy Scout menu by the dietitians at 1800kcals/day.
Dietitians created an educational nutrition curriculum and held daily group sessions to discuss healthy eating habits and menu planning. Activity (1-3 hours a day) was led by a fitness leader and exercise physiologist and included swimming, team sports, hiking, canoeing, and archery. A psychologist ran weekly group meetings focused on behavior modification using cognitive behavior therapy.
The physicians and BSA leaders created the program and functioned to oversee the camper’s safety. A physician recorded measurements of height, weight, resting pulse and BP weekly. Fasting insulin, glucose and lipid profiles were obtained <1 month prior to camp start and the last day of camp.
Statistical analysis
Categorical variables were summarized with percentages while continuous variables were summarized with means and standard deviations (Table 1). After checking the distributions of outcome variables, a linear mixed effects model for repeated measures analyzed the mean change in outcome variables from the start to the end of camp (Tables 2 and 3). This model allows data for all subjects to be used regardless of complete data. Model assumptions were determined to hold true by plotting the studentized residuals versus the predicted values as well as by using a normal QQ plot of the studentized residuals. Statistical significance was set at p<0.05. Statistical analyses used SAS software version 9.3 (SAS Institute, Cary, NC).
Table 1 : Baseline characteristics of study sample (N=11).
Table 2 : Comparisons of biometrics between start and end.
Table 3 : Comparisons of fasting metabolic parameters between start and end.
Thirteen participants enrolled. Two campers left the first day, and one was dismissed after 2 weeks for behavior concerns. Ten participants (mean age of 16.1) finished camp (Table 1). Medical problems included elevated blood pressure (6), hyperlipidemia (4), and hyperinsulinemia (6).
Among the eleven participants, the mean±SD pre-camp weight was 260.7±78.4 lbs., compared with the mean postcamp weight of 237.9±71.9 lbs., a 8.7% reduction (p<0.001) (Table 2). The mean±SD pre-camp BMI was 40.2±13.0 kg/m² compared with the mean post-camp BMI of 36.5±12.0 kg/m², a 9.1% reduction (p<0.001).
Systolic and diastolic blood pressures, waist circumference, waist-to-hip ratio and resting pulse significantly decreased (Table 2). Waist circumference decreased 7.4% (48.4±9.6 cm vs. 44.9±9.4 cm; p<0.001).
Insulin, glucose, total cholesterol, LDL cholesterol and triglycerides significantly decreased (Table 3). Fasting glucose decreased 23.1% (84 mg/dL vs. 62 mg/dL; p=0.001). At camp’s end, 66% (4/6) with elevated blood pressure, 75% (3/4) with hyperlipidemia, and all with hyperinsulinemia (6/6) normalized.
Summertime is problematic for obese youth, as this unstructured time typically shows accelerated weight gain. This pilot study demonstrates that collaboration with the BSA is an effective strategy for implementing summertime weight loss for adolescents.
Our findings of reduced weight, BMI [6-8] and blood pressure [9] are consistent with other previously published reports.
To our knowledge, this is the first published report of improved waist circumference, waist-to-hip ratio, insulin and hyperlipidemia, suggesting a unique contribution to the literature.
Previous studies show sustainable weight loss is possible after camp; [10-12] however, further study is needed regarding long-term health outcomes and the feasibility of wide scale implementation. Major limitations of this study include a small sample size with lack of control group and follow-up after camp.
Physicians should consider networking with community organizations, like the BSA, to create desired summer weightloss programs.
BSA: Boy Scouts of America
BMI: Body mass index
BP: Blood pressure
HDL: High density lipoprotein
LDL: Low density lipoprotein
The authors declare that they have no competing interests.
| Authors' contributions | MBN | EL | RJW |
| Research concept and design | √ | -- | √ |
| Collection and/or assembly of data | √ | -- | √ |
| Data analysis and interpretation | √ | √ | √ |
| Writing the article | √ | √ | √ |
| Critical revision of the article | √ | √ | √ |
| Final approval of article | √ | √ | √ |
| Statistical analysis | √ | √ | √ |
We would like to thank Jeanne and Edward Arnold, Children’s Miracle Network, and Friends and Faculty of Penn State Milton S. Hershey Medical Center for their generous donations to sponsor Camp LION. Thank you to Jack Carr, Kevin Gill and Jack Dalton of the Hidden Valley Boy Scout Reservation of Perry County, Pennsylvania, Susan Reeves, RD, Caroline Claus, RD, Kathy Simmons, Scott Makibbin, Andrea Gorman, PhD, Barbara Ostrov, MD, Gill Pak, Kristen Shaver, and Carlos Juan Sandoval. A special thanks to Danielle Ehrgood and Ian Paul, MD, and the campers, parents, and volunteers of Camp LION.
Editors: Charles L. Schleien, Hofstra North Shore-LIJ School of Medicine, USA.
Mario A. Cleves, Arkansas Children’s Nutrition Center, USA.
Mohamed Ibrahim Ali Omer, University of West Indies, Trinidad and Tobago.
Senior Editor: Victor C. Strasburger, UNM School of Medicine, USA.
Received: 05-Dec-2014 Final Revised: 05-Jan-2015
Accepted: 11-Feb-2015 Published: 19-Feb-2015
Copyright © 2015 Herbert Publications Limited. All rights reserved.
