, Volume 17, Issue 3, pp 405–413 | Cite as

The effectiveness of a health promotion and stress-management intervention program in a sample of obese children and adolescents

  • Chrysoula-Christina Emmanouil
  • Panagiota Pervanidou
  • Evangelia Charmandari
  • Christina DarviriEmail author
  • George P. Chrousos
Original Article



Our study aimed to evaluate the effectiveness of an 8-week stress management intervention program that included progressive muscle relaxation, diaphragmatic breathing, guided imagery, and cognitive restructuring in obese Greek children and adolescents.


Thirty-six patients were prospectively recruited to participate in this randomized controlled study. Of these, 16 participants formed the intervention group and 20 participants the control group. Anthropometric measurements and salivary cortisol, determined serially 3 times a day, were assessed at the beginning and at the end of the study. Participants also completed the state–trait anxiety in children questionnaire (STAIC), the stress in children questionnaire (SiC), and the child behavior checklist (CBCL).


The intervention resulted in a significant reduction of waist-hip ratio (p = 0.008) in the intervention group compared with the control group. Moreover, school performance was improved in the intervention group (p = 0.025), while both the intervention and the control group adopted healthier daily habits (p = 0.020 and 0.011, respectively). However, there was no statistically significant difference between body mass index (BMI) z-score, stress, anxiety, and diurnal patterns in salivary cortisol.


The present study supports the effectiveness of stress management intervention programs on waist-hip ratio reduction. Further research is required to investigate biomarkers able to predict and evaluate the effectiveness of stress management intervention programs.


Stress Anxiety Obesity Children Adolescents Cortisol 



We are grateful to Mrs. Αimilia Μantzou for her assistance with the processing of saliva samples and to Dr. Artemios Artemiadis for his assistance in the statistical analyses.

Funding information

Funding for this work was received from the National and Kapodistrian University of Athens.

Compliance with ethical standards

The study was approved by the Human Research Ethics Committee of “Aghia Sophia” Children’s Hospital and written informed consent was obtained by the parents of all participants.

Conflict of interest

The authors declare that they have no conflict of interest. The authors alone are responsible for the content and writing of the paper. Funding for this work was received from the National and Kapodistrian University of Athens. The funding source played no role in the study design, in the collection, analysis and interpretation of data, in the writing of the report, or in the decision to submit the report for publication.


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Copyright information

© Hellenic Endocrine Society 2018

Authors and Affiliations

  • Chrysoula-Christina Emmanouil
    • 1
  • Panagiota Pervanidou
    • 2
  • Evangelia Charmandari
    • 2
  • Christina Darviri
    • 1
    Email author
  • George P. Chrousos
    • 1
    • 2
  1. 1.Postgraduate Course Stress Management and Health PromotionUniversity of Athens Medical SchoolAthensGreece
  2. 2.First Department of PediatricsUniversity of Athens Medical School, “Aghia Sophia” Children’s HospitalAthensGreece

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