An increase of cereal intake as an approach to weight reduction in children is effective only when accompanied by nutrition education:: a randomized controlled trial

Background: The main emphasis of dietary advice for control of obesity has been on reducing dietary fat. Increasing ready to eat cereal (RTEC) consumption could be a strategy to reduce fat intake and increase carbohydrate intake resulting in a diet with lower energy density. Objectives: 1. To determine if an increase in RTEC intake is an effective strategy to reduce excess body weight and blood lipids in overweight or at risk of overweight children. 2. To determine if a nutrition education program would make a difference on the response to an increase in cereal intake. 3) To determine if increase in RTEC intake alone or with a nutrition education program has an effect on plasma lipid profile. Experimental design: One hundred and forty seven overweight or at risk of overweight children (6-12 y of age) were assigned to one of four different treatments: a. One serving of 33 +/- 7 g of RTEC for breakfast; b. one serving of 33 +/- 7 g of RTEC for breakfast and another one for dinner; c. one serving of 33 +/- 7 g of RTEC for breakfast and a nutrition education program. d. Non intervention, control group. Anthropometry, body composition, physical activity and blood lipids were measured at baseline, before treatments, and 12 weeks after treatments. Results: After 12 weeks of intervention only the children that received 33 +/- 7 g of RTEC and nutrition education had significantly lower body weight [-1.01 (-1.69,-0.34)], p < 0.01], lower BMI [-0.95 (-1.71,-0.20), p < 0.01] and lower total body fat [-0.71 (-1.71, 0.28), p < 0.05] compared with the control group [1.19 (0.39, 1.98), 0.01 (-0.38, 0.41), 0.44 (-0.46, 1.35) respectively]. Plasma triglycerides and VLDL were significantly reduced [-20.74 (-36.44, 5.05), -3.78 (-6.91,-0.64) respectively, p < 0.05] and HDL increased significantly [6.61 (2.15, 11.08), p < 0.01] only in this treatment group. The groups that received 1 or 2 doses of RTEC alone were not significantly different to the control group. Conclusion: A strategy to increase RTEC consumption, as a source of carbohydrate, to reduce obesity is effective only when accompanied by nutrition education. The need for education could be extrapolated to other strategies intended for treatment of obesity.