Insulin Resistance and Cognitive Dysfunction in Obese Adolescents: Pilot Study

The short-term goal of this project is to conduct a feasibility study at Winthrop University
Hospital to determine how well extremely obese (BMI > 99%tile corrected for age) children and
adolescents can be recruited into an exercise program and evaluated in an efficient fashion,
and to identify particular strategies (e.g., medical examination feedback) that can serve as
potential benefits to research subjects and their families. In addition investigators will
evaluate the effect of the exercise program on physical fitness, insulin resistance, and
neurocognitive functioning as well as the relationship between insulin sensitivity and
neurocognitive function among adolescents who participate in the exercise program.

The long-term goal of this project is to evaluate a large, multi-ethnic sample of
adolescents, 14 to 19 years of age, to systematically assess cognitive function and school
performance, fitness and examine the relationship between performance on those outcome
variables and a variety of biomedical and psychosocial factors that may directly or
indirectly influence brain function and test-taking performance.

High body mass index (BMI) among children and adolescents continues to be a public health
concern in the United States. The most recent figures from the National Health and Nutrition
Examination Survey (NHANES) for 2007-2008 report that 18.1% (95% CI, 14.5%-21.7%) of 12-
through 19-year-old adolescents were at or above the 95th percentile of BMI for age. Children
with high BMI often become obese adults, and obese adults are at risk for many chronic
conditions. High BMI in children may also have immediate consequences, such as elevated lipid
concentrations and blood pressure.

It now appears that neurocognitive dysfunction is also more common in obese children and
adolescents. In a large population study of 2,519 children, 8 to 16 years of age, a brief
neuropsychological assessment showed a statistically significant, albeit modest relationship
between cognitive test scores and BMI that persisted after adjusting for confounding
variables. Obesity is also associated with several conditions which known to affect brain
function, including sleep apnea, insulin resistance, hypertension, and chronic inflammatory
factors (e.g., by these variables cannot be determined, unfortunately, because those
variables were not measured.

It is important to note, however, that there is not complete agreement on linkages between
obesity and cognition.

Inclusion Criteria:

- Male and female subject's ages 14 to 19 years old, extremely obese (BMI ≥ 99th
percentile).

- Clearance by pediatric cardiologist, including evaluation of V02Max.

Exclusion Criteria:

- Male and female less than 14years of age or more than 19 years of age.

- Patients with type 1 or type 2 diabetes

- Patients with serious medical conditions.

- Anyone who is deemed inappropriate by pediatric cardiologist during clearance
evaluation.