Lifestyle interventions in the treatment of childhood overweight

A little health information is not enough to help obese children get into better shape, according to a recent analysis.

However, programs specifically aimed at changing eating and exercise habits are helpful, according to a new review of evidence in the September issue of the journal Health Psychology .

Moreover, children who do not receive an offer for intervention or who receive information only tend to experience weight gains. Children given guidance that is more direct get into better shape, according to the review.

“Providers make the assumption that providing information leads to changes,” said Denise Wilfley, Ph.D., lead author and professor in the department of psychiatry at the Washington University School of Medicine in St. Louis. “Providing information is a necessary component, but it's not sufficient.”

Children need interventions that provide more guidance that is active and strategies to help them make behavioral changes, Wilfley said. An “active” treatment, according to the review, involved “any combination of diet, physical activity or behavioral treatment recommendations.” Sessions varied widely — from family counseling sessions on diet, to child-only physical training sessions, to diet and exercise combinations.

The review appears in the September issue of the journal Health Psychology . Each evidence-based review in this series centers on a specific psychological assessment or treatment conducted in the context of a physical disease process or risk reduction effort.

The researchers looked at 14 studies involving 527 young children, adolescents and teenagers. Some children participated in active treatment programs with an average of about 18 sessions. Others had no treatment or were offered educational sessions only.

The children who participated in treatment programs experienced an 8 percent to 9 percent reduction in weight status, which is the child's weight in relation to various factors such as age and height. Without treatment or with education only, there was a 2.1 percent increase in weight status.

Measuring progress can be tricky when it comes to obese children. Wilfley is cautious about using the term ‘weight loss.' For example, if a child does not gain or lose weight but grows taller, he is still making strides toward getting into better shape.

Getting into shape is a matter of eating less and exercising more, Wilfley said, but the tough part is that children are drawn to food like hamburgers, fried chicken and pizzas — frequent lunchtime offerings in school cafeterias. “The cultural context is not supportive of managing your weight.”

The fact that children actually get worse if given only a little information worries Brian Saelens, associate professor of pediatrics at the University of Washington and Seattle Children's Hospital Research Institute.

“Five minutes during a doctor's visit is all a lot of kids get,” he says. “They [doctors] wish they had more time and more resources, but that's what they're given.”

With little information in hand, children sometimes try to make changes in eating habits on their own, but their efforts can backfire.

“My guess is that they try something, but they don't get the support,” he says. Parents buy food for the home, and they're the ones who decide to bring home fried chicken and french fries for dinner instead of making baked chicken.

Unless parents change what is in the pantry, the child must independently resist poor food choices.

“That's hard to do,” Saelens said. Ultimately, kids “feel like they've failed at something. The way they cope with failure is to eat.”

“Data suggest [that] intervening with a parent and child concurrently can have a marked impact,” Wilfley said.

Nationwide, 19 percent of children ages 6 to 11 and 17 percent of those ages 12 to 19 are overweight, according to the Centers for Disease Control and Prevention.

The dangers are clear: More than 80 percent of people who develop type 2 diabetes mellitus are overweight, according to the National Institutes of Health. Overweight people are more likely to suffer from high blood pressure and other risk factors for heart disease and stroke.

Kids do not think about this, of course. They are not marching into doctors' offices fretting about how being overweight could eventually lead to other complications down the road, Saelens said.

What children say is, “I want to fit in the clothes that other kids fit in. I want to keep up with my friends and I'm tired of getting teased,” he says. “They have alternative motives, but we have to help them meet those goals, too.”

“Evidence-based Treatment Reviews” is a series within Health Psychology, an official journal of the American Psychological Association. This series of articles is intended to inform health psychology practice, add to teaching and mentoring resources and inspire further evidence-based research and questions. For more information, contact editors Karina Davidson ([email protected]) and Timothy Smith ([email protected]).

Wilfley DE, et al. Lifestyle interventions in the treatment of childhood overweight: q meta-analytic review of randomized controlled trials. Health Psychology 26(X), 2007.

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