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Research Article: Effects of a “5?+?2” dietary management model on body composition and behavioral modification in Chinese children with obesity: a prospective, non-randomized controlled trial

Date Published: 2026-09-01

Abstract:
Continuous energy restriction may be associated with poor adherence and a risk of muscle mass loss in pediatric obesity management. This study evaluated the effects of a structured “5?+?2” dietary management model—cycling 5 weekdays of calorie-restricted diet with 2 weekend days of high-protein diet—supported by standardized supplements and professional supervision. In this prospective, non-randomized controlled trial conducted in Shenzhen, China, 84 children with persistent obesity (median age 11.1?years) were enrolled. The intervention group ( N =?31) followed an 8-week “5?+?2” protocol with dietitian-led behavioral guidance and satiety-enhancing supplements, followed by a 12-week follow-up period. Controls ( N =?53) received conventional weight-loss advice. Propensity score matching was employed to balance baseline cohorts ( N =?74; 30 intervention, 44 control). Changes in weight, body composition, metabolic parameters, and behavior were assessed at weeks 8 and 20. At week 8, the intervention group achieved significantly greater weight loss (?1.42?±?1.73?kg vs. ?0.44?±?1.54?kg, p =?0.015) and body mass index (BMI) standard deviation score (SDS) reduction (?0.21?±?0.14 vs. -0.11?±?0.14, p =?0.005) compared to controls. The median behavior score in the intervention group improved significantly from 66.0 to 82.0 ( p <?0.001), with marked increases in self-weighing frequency and physical activity. At the 20-week follow-up (post-summer break), the intervention group maintained greater reductions in body fat mass (?1.42?±?3.41 vs. +1.84?±?3.67?kg, p <?0.001) and greater skeletal muscle gain (3.90?±?3.46 vs. 2.21?±?2.36?kg, p =?0.031) than the control group, with significantly lower fat mass index (FMI) Z -scores and higher muscle mass index (MMI) Z -scores. Linear regression identified boys ( ? =??0.758, p =?0.015), older children ( ? =??0.240, p =?0.003) and children with higher baseline adherence ( ? =??0.356, p =?0.004) as key predictors for BMI SDS reduction. The “5?+?2” dietary management model was associated with favorable changes in body composition and health-related behaviors in children with obesity and may represent a practical dietary management strategy.

Introduction:
Continuous energy restriction may be associated with poor adherence and a risk of muscle mass loss in pediatric obesity management. This study evaluated the effects of a structured “5?+?2” dietary management model—cycling 5 weekdays of calorie-restricted diet with 2 weekend days of high-protein diet—supported by standardized supplements and professional supervision.

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