26 1 (2005 3 ) J Korean Oriental Med 2005;26(1):103-114 1) 2) 1) 2) The Effect of Education Program on Weight Control in Taeumin Childhood Obesity Jung-Hee Yoo, Il-Byung Song, Eui-Ju Lee, Sang-Ryong Back 1), Byung-Hee Koh, Hyang-Yeon Lee 2) Department of Sasang Constitutional Medicine, College of Oriental Medicine, Kyunghee University Maenangukjuk oriental clinic 1) Department of Nursing Science, Kyunghee University 2) Objective : Childhood obesity has become one of the most common health problems facing children in the world. Although a number of regimens have been developed and distributed for the treatment of adult obesity, few studies have focused on therapeutic programs for obese children. The objective of this study was to develop and measure the effects of Taeumin childhood obesity by a sasang constitutionbased education program. Methods : A total of 14 (%RBW 20) among 18 taeumin with childhood obesity from June to August 2003 participated in the constitution-based education program. It was designed to examine the effects of a constitution-based education program through anthropometric measurements, body composition indicates, biochemical indicates and serum level of taeumin childhood obesity. Results : The results of this study were as follows: 1. The anthropometric measurement of subscapular skinfold thickness was reduced after 4 weeks of the constitution-based education program. 2. The body composition indicates reduction in degree of obesity, percent body fat, and fat distribution. The other side increased in height, total body water, soft lean mass, and lean body mass. 3. For biochemical indicates, HDL-cholesterol was increased significantly after 4 weeks of the constitution-based education program. The other side decreased in AST and ALT. 4. There was a significant reduction in BMI and %RBW after the constitution-based education program. Conclusion : A constitution-based education program for weight control results in reduced degree of obesity among taeumin children. Key Words: childhood obesity, sasang constitution, obesity control program : 2004 9 3 : 2005 1 10 : 2005 2 4 :. 2 994-5 (Tel; 02-3457-9091, Fax; 02-3457-9069, E-mail; sasangin@khu.ac.kr) 1-3)., 4). 103

(104) 26 1 (2005 3 ) 5-8). 9-12).,..,,.,,,,,,,,,... 13,14).,, 15-16). 17),,,. 18) 70.2%,, 10. 10. 19). K ( ). (Fig. 1). K Fig. 1. Design of study 104

(105) 18.,. 4. 4 14 4.,,.. 8 2.... : 0.1 4.. : 0.1 4.. :, metal tape.. : Skinfold Caliper. Caliper 10g/. 8 15. 3000 rpm 15.. :, HDL-,, LDL- Friedwald formular. LDL = (HDL - /5). : 4. 8. leptin leptin kit(human Leptin RIA kit, LINCO Research, INC) radioimmuno assay(ria). Hexokinase, G6PD, UV, Leptin -conter (COBRA Quantum. USA) radioimmuno assay(ria). aspartate aminotransferase(ast), alanine aminotransferase(alt). 4,,,,, BIA ( ) Inbody 3.0.. (%RBW) 1998, 50 100 26). Body Mass Index(BMI: / ). 20%, 20-30%, 31-50%, 50%. X-ray /, QSCC ( 105

(106) 26 1 (2005 3 ) ),.,.. 5. (,,, )....,.,...,, 3. 40, 50-70% 4.,. ( 1). SPSS for window Version 11.0.,,,, (,,, ),, (Wilcoxon signed rank statistic). p<0.05.,,,,,,.,, 57% 43%. 11, 135, 53. 20%. 20-30%, 31-50%, 50% 37% (Table 1)., (Table 2). Skinfold Caliper. 106

(107) Table 1. General Caracteristics of the Taeumin Childhood Obesity Characteristcs Group(n=14) No(%) Mean SD Gender female 8(57.1) - male 6(42.9) - 9 2(14.3) 10 2(14.3) Age(year) 11 5(35.7) 11.0 1.2 12 4(28.6) 13 1(7.1) -130 1(7.1) 135-149 2(14.3) Height( ) 140-145 5(35.7) 146-149 2(14.3) 134.6 35.7 150-155 2(14.3) 156-2(14.3) -40 1(7.14) 40-49 3(21.4) Weight( ) 50-59 7(50.0) 60-69 1(7.14) 53.3 12.1 70-79 1(7.14) -79 1(7.14) overweight(%rbw 20) 2(14.3) Distribution of obese slight-obese(21 %RBW 30) 2(14.3) medium-obese(31 %RBW 50) 8(57.1) 37.3 13.5 high-obese(%rbw 51) 2(14.3) Table 2. Comparison of Anthropometry Pre-post Scores on Program(n=14) Pre-program Post-program 4 wks sig. Circumference( ) Chest 83.0 7.5 83.7 7.7.213 Upper arm 25.6 2.5 25.8 2.4.552 Abdominal 81.2 8.5 81.0 8.9.699 Buttock 89.3 8.1 89.3 6.8.826 Mid-thigh 53.7 5.9 54.0 4.7.220 Skinfold Thickness( ) Subscapular 25.4 6.3 22.6 5.3.004 Triceps 23.2 4.3 22.2 3.3.177 Biceps 12.4 2.7 12.5 2.7.683 Supra-iliac 27.6 4.9 26.7 6.0.433 * p<0.05; p<0.01,,,,,,, BMR BCM 4., BMR BCM.(Table 3, Fig. 2), (1.3%) (3.3%),, (BMR) 2.6%, (BCM) 3.3%, (5.3%) (2.2%). 4,,.,.. 107

(108) 26 1 (2005 3 ) Table 3. Comparison of Body Composition Pre-post Scores on Program(n=14) contents Pre-program Post-program 4 wks sig. Height( ) 144.3 9.6 146.1 9.8.001 Weight( ) 53.3 12.1 53.7 12.0.177 Obesity degree(%) 131.1 12.2 127.4 10.6.002 Total body water Intracellular fluid( ) 15.5 3.2 16.0 2.9.010 Soft lean mass Extracellular fluid( ) 7.4 1.8 7.7 1.7.002 Protein mass( ) 8.3 1.8 8.6 1.7.005 Lean body Mineral mass( ) 2.0.3 2.1.3.006 Weight Soft lean mass( ) 31.3 6.7 32.3 6.3.006 Fat mass( ) 20.1 5.1 19.3 5.8.081 Percent body fat(%) 37.4 3.9 35.4 4.6.019* Fat distribution(whr) 0.9.1 0.9.1.015* BMR( ) 1400.5 206.3 1437.0 189.3.013 BCM( ) 23.8 5.0 24.6 4.6.009 BMR;Basal metabolic rate; BCM;Body cell mass; WHR(%);waist hip ratio * p<0.05; p<0.01; p<0.001 Heigt( ) Obesity degree(%) Intracellular fluid( ) Extracellular fluid( ) Protein mass( ) Mineral mass( ) 108

(109) Soft lean mass( ) Percent body fat(%) Fat distribution BMR( ) BCM( ) Fig. 2. Comparison of body composition pre-post scores on program 4., HDL-,, LDL- Friedwald formular, HDL Cholesterol 10.2%., AST ALT 13.2% 33.74%. (Table 4, Fig. 3) Leptin. 109

(110) 26 1 (2005 3 ) Table 4. Comparison of Blood Chemistry Pre-post Scores on Program(n=14) Pre-program Post-program 4 wks sig. HDL Cholesterol( ) 42.6 9.5 46.9 9.4.051* LDL Cholesterol( ) 123.2 30.4 118.8 24.8.470 TG( ) 151.6 61.0 132.9 4.3.363 Glucose( ) 91.6 5.8 93.6 15.8.875 AST(GOT)(IU/L) 29.8 11.9 25.9 6.9.035 ALT(GPT)(IU/L) 40.4 23.8 26.8 14.7.001 Insulin(uIU/ ) 12.6 13.7 16.1 11.2.074 Leptin(ng/ml) 17.1 5.0 21.7 7.9.069 TSH(uIU/ ) 2.9 1.8 2.8 1.6.900 Free T4(ng/dL) 1.4.2 1.4.2.448 HDL;high density lipoprotein; LDL; low density lipoprotein; TG; triglyceride TSH; Thyroid stimulating hormone * p<0.05; p<0.01; p<0.001 Table 5. Comparison of BMI & %RBW Pre-post Scores on Program(n=14) Pre-program Post-program 4 wks sig. BMI 25.3 3.0 24.8 2.8.007 %RBW 37.3 13.5 31.9 11.7.004 BMI: body mass index= body weight(kg)/height(m 2 ) %RBW: relaive weight= body weight 100/standard weight * p<0.05; p<0.01; p<0.001 4 (BMI) 1.9% (%RBW) 14.5% (Table 5, Fig. 4.),,,,,,,,,. 20).. Goodrick et al(1991),. 8 21).,,. 6.,..,,,,,. 110

(111) HDL Cholesterol( ) AST(IU/L) ALT(IU/L) Fig. 3. Comparison of blood chemistry pre-post scores on program BMI( ) %RBW Fig. 4. Comparison of BMI & %RBW pre-post scores on program,. 70%. 22) total protein, total cholesterol, triglyceride, phospholipid, LDL-cholesterol, 23). ( ),.,, 111

(112) 26 1 (2005 3 )., 24)... 9-11) ( ) (, ),.,.,.,..,,,., (BMI) (%RBW)... K 14 4,,. 1. Skinfold Caliper 4 11.02%. 2. 4 (1.3%) (3.1%), (3.9%), (3.4%), (2.4%), (3.3%), (2.6%), (3.3%), (2.8%), (5.3%) (2.2%). 3. HDL- (10.2%), GOT(13.2%) GPT(33.74%). 4. BMI(1.9%) %RBW(14.5%). 112

(113) 1.,,,,,... 1994;27(1):79-89. 2.,,,,... 2003;46(4):326-334. 3.,,,,... 2000;21(7):866-875. 4.,,... 2002;31(6):1011-1017. 5. Leng AC. Robson WM. Childhood obesity. Postgraduate Medicine. 1989;87(4);123-133. 6. Styne DM. Childhood obesity. Time for action not complacency. Am Fam Physician. 1999;59;758-762. 7. Blackburn GL, Kanders BS(eds). Obesitypathophysiology, psychology and treatment. Chapman & Hall. 1994:51-147. 8. Epstein LH, Wing DR, Valoski A. Childhood Obesity. Pediatric Clin North Am. 1985;35(2):363-379. 9.,,... 2002;23(12):1470-1479. 10.,... 1996;29(3):307-320. 11.,,... 1998;19(10):787-800. 12... 1996; 39(8):1055-65. 13... :. 2001:19-284. 14... :. 2003:13-366. 15... 2000:57-65. 16.,... 1999;11(1): 185-199. 17.,,,,,.. 2001;15(6):1034-1038. 18.,.. 1996;8(1):319-335. 19... 1997;Supplement ( 7 ):47-61. 20.... 2000;21(2):254-264. 21. Skender ML, Goodrick GK, Deljunco DJ. et al. Comparision of 2-year weight loss trends in behavioral treatment of obesity: Diet, exercise and combination intervention. J Am Diet Assoc. 1996;96(4):342-346. 22.... 1995;5(1):139-146. 23.... 1991;3(1):151-172. 24.,,.,. 1996;8(2):219-237. 25.... 1991. 26.. 8. :. 1999:1135-1136. 113

(114) 26 1 (2005 3 ) 1. (6-7 ) walking & runninng 250-300 6 40-50 ( 1 4-5 x 10 ) (1) ( ) (2) 1, 1 4 10 4 55.,, ) (3) 1 100, 90, 80, 70 1-2 70, 3-6 80, 7-9 90, 10 (4) 2, 2., 10 50 45 30 2, 1/2 (5) 2. 40-50 (6). 114