Program helps obese kids keep weight off long-term
NEW YORK (Reuters Health) - Kids in an intensive obesity program were able to slim down and maintain a healthier weight a year after it ended, according to a new study.
Obesity programs aimed at youth have generally not shown much long-term success, both in keeping kids involved during the program and still motivated afterwards.
The results are noteworthy for two reasons, according to Dr. Donald Williamson, who studies obesity in youth at Louisiana State University but wasn't involved in the new study.
First, he told Reuters Health, it's important that the kids managed to keep the weight off when they were no longer in the program. Second, the obese kids in the study were from mixed ethnic backgrounds and mostly low-income -- one of the demographics hit the hardest by obesity.
Almost 20 percent of kids and adolescents in the U.S. are obese, according to the Centers for Disease Control and Prevention -- a number that has tripled over the past 30 years. Compared to their slimmer peers, obese youth are more likely to turn into obese adults, setting them up for an increased risk of heart disease and type 2 diabetes, among other conditions.
In the current study, researchers led by Mary Savoye of Yale University in New Haven, Connecticut, signed up about 200 kids aged 8 to 16 for one of two programs. The first was an intensive, family-based obesity program. For six months, kids participated in aerobic exercise sessions twice a week and had classes in nutrition and healthy behavior once a week. For the next six months after that, sessions went down to twice a month. Parents also got coaching on health and nutrition. In the other group, kids had counseling appointments, led by social workers, doctors and dieticians, once every six months.
All of the kids in the study were in the highest five percent of their age and gender for body mass index (BMI), a measure of weight in relation to height. The kids were randomly assigned to the intensive obesity program or the less intensive counseling sessions.
At several points, the researchers measured everyone's height, weight and blood pressure, checked their cholesterol, and looked for signs of diabetes: after six months of the intensive program, after 12 months, and finally one year after the program had ended.
Six months into the intensive program, kids had lost an average of about 5 pounds according to the results, which are published in the journal Pediatrics. After 12 months, they had gained about 1 pound. Another year after the intensive program had ended, they were up 13 pounds from the start of the study. However, their BMI had still dropped because they were growing at the same time.
In contrast, kids in the twice-a-year counseling group gained 10 pounds in the first six months on average, 18 pounds after a year, and 26 pounds after two years -- all equaling increases in BMI from the start of the study.
Kids who had been through the intensive program also had healthier cholesterol levels than kids who only received counseling, and they had fewer warning signs for diabetes than when they started the program.
One of the complicating factors in the study was that more than half of the kids in both groups didn't finish the study. That's not unusual in obesity interventions for youth. In fact it's one of the biggest problems with them, researchers say.
"It's very hard for a family to be involved because lifestyles are busy," Savoye told Reuters Health. "Dropout is always going to be the nature of the beast."
This type of program, involving regular sessions for kids and their parents, is especially prone to having a high dropout rate, Williamson added. But, he said, for kids who are already obese, it's the only real option that has shown success. In terms of preventing kids from becoming obese when they're still at a healthy weight, a more hands-off approach, such as an internet-based program, might help keep more kids involved, Williamson said.
But for the kids who did stick with the program, the finding that they maintained their improvements in BMI compared to the counseling group is promising.
"One of the shortcomings of our current research knowledge is that we really haven't found very effective long-term strategies for childhood obesity or adolescent obesity," Williamson said.
And the program model is one that can be used in other groups of kids, possibly even more successfully than it was here, Savoye said. "If this (program) worked on this most challenging population, it can work really in any population that you put it in," she said.
SOURCE: bit.ly/hcaFuQ Pediatrics, online February 7, 2011.
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