A multi-disciplinary approach to weight management of school-age girls: a study protocol

Introduction
There is lack of data about the combination of multiple approaches to control being overweight and obesity in adolescents. This study aimed to evaluate the effect of a combination program including smart-phone nutrition education, physical activity, and cognitive behavioral therapy (CBT) programs in the management of obesity and overweight among elementary school girls in comparison with a traditional education method.

Material and methods
The primary outcome of this study is the assessment of changes in anthropometric data after 10 weeks. The secondary outcome is investigating the effect of treatment on biochemical data. Sixty-two elementary school girls aged 9–12 years with the body mass index (BMI) for age above 85th percentile will be chosen and randomly assigned to one of the two groups of control or intervention. During the 10 weeks of the intervention, smartphone games will be given to the children with some information at the beginning about the causes and complications of obesity, food sources of fiber and vitamins, and banned foods during the intervention period. Students in the intervention group will participate in an aerobics exercise for 45 minutes three times per week under the supervision of an experienced trainer and eight CBT Sessions which were designed for children by a clinical psychologist. Anthropometric measurements, including height, weight, waist circumference (WC), hip circumference and waist to hip ratio(WHR), and biochemical and metabolic lab data, including fasting blood sugar (FBS), total cholesterol, high density lipoproteins (HDL), low density lipoproteins (LDL), leptin and will be measured at the baseline and 10 weeks later at the end of intervention period . Also, both questionnaires of metabolic equivalent test (MET) and Dutch Eating Behavior Questionnaire (DEBQ) will be completed for each student at baseline and after 10 weeks. The students in the control group will receive traditional education in the form of lectures given by a nutritionist regarding weight management.

Discussion
The primary outcome of this study is the assessment of changes in anthropometric data after 10 weeks. The secondary outcome is investigating the effect of treatment on biochemical data. Sixty-two elementary school girls aged 9–12 years with the body mass index (BMI) for age above 85th percentile will be chosen and randomly assigned to one of the two groups of control or intervention. During the 10 weeks of the intervention, smartphone games will be given to the children with some information at the beginning about the causes and complications of obesity, food sources of fiber and vitamins, and banned foods during the intervention period. Students in the intervention group will participate in an aerobics exercise for 45 minutes three times per week under the supervision of an experienced trainer and eight CBT Sessions which were designed for children by a clinical psychologist. Anthropometric measurements, including height, weight, waist circumference (WC), hip circumference and waist to hip ratio(WHR), and biochemical and metabolic lab data, including fasting blood sugar (FBS), total cholesterol, high density lipoproteins (HDL), low density lipoproteins (LDL), leptin and will be measured at the baseline and 10 weeks later at the end of intervention period . Also, both questionnaires of metabolic equivalent test (MET) and Dutch Eating Behavior Questionnaire (DEBQ) will be completed for each student at baseline and after 10 weeks. The students in the control group will receive traditional education in the form of lectures given by a nutritionist regarding weight management.