Effect does wane over time, study finds
TUESDAY, Oct. 9 (HealthDay News) -- Maintenance treatment programs might help children who've lost weight keep it off, new research suggests.
However, the study also found that the effect of the maintenance programs wears off over time, suggesting the need for longer follow-up programs to help children maintain healthier lifestyles.
"We were excited by the results of this study. Clearly, maintenance treatment was better than no treatment at all. But, for kids, like adults, weight-loss maintenance is challenging and requires continued vigilance," said study author Denise Wilfley, a professor of psychiatry, medicine and pediatrics at Washington University School of Medicine in St. Louis.
Finding effective ways to help children lose weight and keep it off is becoming increasingly important. The number of American children who are overweight has tripled in recent decades, according to background information in the study, which appears in the Oct. 10 issue of the Journal of the American Medical Association. According to government estimates, that means about one in five children in the United States is currently overweight. As in adults, excess weight in children can contribute to a number of illnesses, such as diabetes and high blood pressure.
Because the prevalence of overweight and obesity in children is a relatively recent phenomenon, there haven't been many studies looking at effective ways to help youngsters lose weight and then maintain that weight loss.
In the current study, Wilfley and her colleagues recruited a group of 7- to 12-year-old children from San Diego. Wilfley was working at San Diego State University at the start of this study. All of the 204 youngsters had a BMI between 20 percent and 100 percent above the average BMI for their age and gender, and at least one overweight parent. The average BMI for the group was more than 60 percent higher than their normal-weight peers.
The children, plus at least one parent, participated in a weight-loss program for five months. Once their weight loss had been achieved, 150 children were randomized into one of three treatment groups for four months: no maintenance treatment, social facilitation maintenance (SFM) treatment, or behavioral skills maintenance (BSM) treatment.
SFM focuses on providing a positive social environment for the child. "It's based on the premise that people need a supportive environment for weight control," Wilfley explained. Parents were taught how to guide their children into getting in more physical activity, especially when having play dates. Parents were also taught ways to get kids to eat healthier foods when their peers were present. Wilfley said a lot of parents assumed that kids would balk if they weren't given pizza or burgers on a play date, and that those same parents were pleasantly surprised that kids were generally fine when they were given healthier options, such as fruit. Additionally, SFM helped children improve their body esteem and gave them skills to cope with teasing.
BSM focused on the specific behavior skills that children need to maintain their weight loss. Children were asked to monitor their weight and to immediately return to weight-loss strategies if they found their weight increasing. "It was really about teaching problem-solving skills for weight-loss management," Wilfley explained.
The study found that after two years of follow-up, children in maintenance treatment maintained about a one-quarter point drop in their body mass index (BMI) scores, while those receiving no maintenance treatment maintained an average of less than one-tenth of a point drop in BMI.
The author of an accompanying editorial, Dr. David Ludwig, director of the Optimal Weight for Life program at Children's Hospital Boston, said that while the effect of the maintenance programs was small and diminished when active treatment was over, either maintenance treatment was superior to no treatment at all.
Wilfley said one group in particular -- those treated with SFM who reported few social problems -- did better than the rest of the youngsters.
The bottom line, said Ludwig, is that overweight and obesity needs to be treated as a chronic health problem that needs long-term treatment.
"Overweight is caused by many factors -- a lack of physical activity, the nature of our diets, emotional factors, family dynamics, what's happening in our schools, and larger socioeconomic factors -- so any intervention that focuses on just one factor, such as a new diet, seems unlikely to succeed, said Ludwig, who is also an author of Ending the Food Fight: Guide Your Child to a Healthy Weight in a Fast Food/Fake Food World. "We really need to be viewing obesity as a chronic condition for which long-term attention will be needed."
Wilfley said she'd like combine the best aspects of both types of maintenance treatment and continue the treatment for a longer period of time to see if the children could be more successful at maintaining their weight loss.
For more advice on helping kids lose weight and keep it off, read this information from the National Institute of Diabetes and Digestive and Kidney Disease's Weight-control Information Network.
SOURCES: Denise Wilfley, Ph.D., professor, psychiatry, medicine and pediatrics, Washington University School of Medicine, St. Louis; David Ludwig, M.D., Ph.D., co-author, Ending the Food Fight: Guide Your Child to a Healthy Weight in a Fast Food/Fake Food World, and director, Optimal Weight for Life Program, Children's Hospital Boston, Harvard Medical School, Boston; Oct. 10, 2007, Journal of the American Medical Association
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