Effects of Exercise Sequence and Meal Sequence on Weight Management Among Children and Adolescents With Overweight or Obesity: The STEP Trial

The goal of this clinical trial is to learn how the order of exercise and the order of eating food affect weight management in overweight and obese children and adolescents. The main questions it aims to answer are whether doing aerobic or anaerobic exercise first changes weight loss results, and whether eating vegetables and proteins before carbohydrates improves health outcomes compared to a standard diet. Furthermore, the study asks how the exercise order and eating order work together to affect weight and health. Researchers will compare four different groups to see if these specific exercise and eating orders work better to treat obesity. Participants will stay at a closed weight loss camp for 28 days and do daily aerobic and anaerobic exercises in a randomly assigned order. They will eat meals in either a strict order, consuming vegetables and proteins first, or a standard order. Throughout the trial, participants will give blood, urine, stool, saliva, and sweat samples for lab tests, while also checking their body weight, body composition, and heart rate. Finally, they will answer surveys about their diet, physical activity, hunger, and tiredness.

Study Overview

• Status: Not yet recruiting
• Conditions: Insulin Resistance; Obesity & Overweight; Inflamation
• Intervention / Treatment: Behavioral: Sequential training; Behavioral: Carbohydrate-last eating

• Study Type: Interventional
• Enrollment (Estimated): 480
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Xingbo Li, PhD; Phone Number: 8618000315430; Email: 2616394236@bjmu.edu.cn

Study Locations

• China
  • Beijing, China, 100083
    • Peking University
    • Contact: Xingbo Li, PhD; Phone Number: 8618000315430; Email: 2616394236@bjmu.edu.cn
  • Beijing, China, 101499
    • DF Fit Beijing Huairou
    • Contact: Xingbo Li, PhD; Phone Number: 8618000315430; Email: 2616394236@bjmu.edu.cn
  • Anhui
    • Wuhu, Anhui, China, 241303
      • DF Fit Anhui Wuhu
      • Contact: Xingbo Li, PhD; Phone Number: 8618000315430; Email: 2616394236@bjmu.edu.cn
  • Henan
    • Zhengzhou, Henan, China, 451100
      • DF Fit Henan Zhengzhou
      • Contact: Xingbo Li, PhD; Phone Number: 8618000315430; Email: 2616394236@bjmu.edu.cn
  • Liaoning
    • Shenyang, Liaoning, China, 110326
      • DF Fit Liaoning Shenyang
      • Contact: Xingbo Li, PhD; Phone Number: 8618000315430; Email: 2616394236@bjmu.edu.cn
  • Shandong
    • Zibo, Shandong, China, 256402
      • DF Fit Shandong Zibo
      • Contact: Xingbo Li, PhD; Phone Number: 8618000315430; Email: 2616394236@bjmu.edu.cn
  • Shanghai Municipality
    • Shanghai, Shanghai Municipality, China, 201418
      • DF Fit Shanghai Fengxian
      • Contact: Xingbo Li, PhD; Phone Number: 8618000315430; Email: 2616394236@bjmu.edu.cn
  • Zhejiang
    • Hangzhou, Zhejiang, China, 311256
      • DF Fit Zhejiang Hangzhou
      • Contact: Xingbo Li, PhD; Phone Number: 8618000315430; Email: 2616394236@bjmu.edu.cn
    • Jinhua, Zhejiang, China, 321035
      • DF Fit Zhejiang Jinhua
      • Contact: Xingbo Li, PhD; Phone Number: 8618000315430; Email: 2616394236@bjmu.edu.cn

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

To be included in the study, participants must be between 10 and 17 years old and have a Body Mass Index equal to or greater than the 95th percentile for their age and sex, which meets the Chinese screening standard for overweight and obesity in school-aged children and adolescents. Additionally, participants and their legal guardians must have signed a service contract and paid in full for the commercial weight loss camp service before signing the study consent form. Participants must possess basic communication skills and the ability to comply with study instructions. They must also pass the mandatory pre-camp exercise risk medical screening, which includes blood and urine tests, blood pressure, resting electrocardiograms, and exercise electrocardiograms. Finally, participants and their legal guardians must provide dual signed informed consent.

Exclusion Criteria:

Individuals are excluded from the study if they have been diagnosed with secondary obesity or genetic obesity syndromes. Furthermore, individuals who have taken medications affecting body weight or bone metabolism within the past three months are not eligible to participate. The study also excludes individuals with clinically diagnosed eating disorders, depression, or other severe psychiatric illnesses. Individuals who are unable or unwilling to cooperate with venous blood sampling or other biological sample collections are excluded as well. Finally, individuals with severe cardiopulmonary dysfunction, severe scoliosis, or other clear medical contraindications to exercise cannot participate in the trial.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Factorial Assignment
• Masking: Single

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Aerobic first and usual eating; In this arm, participants will follow each of their training sessions by starting with warm up, then aerobic training, followed by anaerobic training, and lastly stretching and relaxation. For each meal, participants will be offered all food and can eat ad libitum.	Behavioral: Sequential training; This intervention requires participants to follow each structured training session with designated sequence of physical activity. Participants will either follow aerobic training first and anaerobic training second within each session, or vice versa.
Experimental: Anaerobic first and usual eating; In this arm, participants will follow each of their training sessions by starting with warm up, then anaerobic training, followed by aerobic training, and lastly stretching and relaxation. For each meal, participants will be offered all food and can eat ad libitum.	Behavioral: Sequential training; This intervention requires participants to follow each structured training session with designated sequence of physical activity. Participants will either follow aerobic training first and anaerobic training second within each session, or vice versa.
Experimental: Anaerobic first and carbohydrate-last eating; In this arm, participants will follow each of their training sessions by starting with warm up, then anaerobic training, followed by aerobic training, and lastly stretching and relaxation. They will eat half to two-thirds of all vegetables and meat/protein foods, and then start eating carbohydrate such as starchy tubers or staple foods to finish their meal.	Behavioral: Sequential training; This intervention requires participants to follow each structured training session with designated sequence of physical activity. Participants will either follow aerobic training first and anaerobic training second within each session, or vice versa.; Behavioral: Carbohydrate-last eating; This intervention requires participants to eat each meal in sequencial order. They will eat half to two-thirds of all vegetables and meat/protein foods, and then start eating carbohydrate such as starchy tubers or staple foods to finish their meal.
Experimental: Aerobic first and carbohydrate-last eating; In this arm, participants will follow each of their training sessions by starting with warm up, then aerobic training, followed by anaerobic training, and lastly stretching and relaxation. They will eat half to two-thirds of all vegetables and meat/protein foods, and then start eating carbohydrate such as starchy tubers or staple foods to finish their meal.	Behavioral: Sequential training; This intervention requires participants to follow each structured training session with designated sequence of physical activity. Participants will either follow aerobic training first and anaerobic training second within each session, or vice versa.; Behavioral: Carbohydrate-last eating; This intervention requires participants to eat each meal in sequencial order. They will eat half to two-thirds of all vegetables and meat/protein foods, and then start eating carbohydrate such as starchy tubers or staple foods to finish their meal.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Weight	Measures the body weight change in kg	From enrollment to the end of treatment at 28 days
Body fat	Changes in body fat percentage	From enrollment to the end of treatment at 28 days
HOMA-IR	Changs in HOMA-IR, or insulin resistance, in participants	From enrollment to the end of treatment at 28 days

Collaborators and Investigators

• Sponsor: Peking University

Study record dates

Study Major Dates

• Study Start (Estimated): July 1, 2026
• Primary Completion (Estimated): August 31, 2026
• Study Completion (Estimated): September 30, 2026

Study Registration Dates

• First Submitted: July 13, 2026
• First Submitted That Met QC Criteria: July 13, 2026
• First Posted (Actual): July 17, 2026

Study Record Updates

• Last Update Posted (Actual): July 17, 2026
• Last Update Submitted That Met QC Criteria: July 13, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Keywords: child and adolescent obesity; obesity & overweight; child and adolescent insulin resistance
• Additional Relevant MeSH Terms: Nutrition Disorders; Metabolic Diseases; Overnutrition; Body Weight; Glucose Metabolism Disorders; Hyperinsulinism; Pathological Conditions, Signs and Symptoms; Nutritional and Metabolic Diseases; Signs and Symptoms; Overweight; Obesity; Insulin Resistance; Pediatric Obesity
• Other Study ID Numbers: 2026131DFQ

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No