Nurses may help some overweight kids

NEW YORK Thu Apr 7, 2011 5:24pm EDT

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NEW YORK (Reuters Health) - A program including regular follow-ups with nurses and focused attempts to cut back on TV, fast food, and sodas appears to keep some overweight and obese kids from gaining more weight, according to a new study.

Specifically, girls in general and kids from households earning less than $50,000 were less likely to gain weight over the course of a year if they were in the program.

But it appeared to have no effect on boys, or in kids from higher income households.

"We struggled a bit to try to understand" why the program didn't help kids overall, study author Dr. Elsie Taveras of Harvard Medical School told Reuters Health.

"We didn't design it as an intervention specifically for children from low-income populations," but for that population in particular, and for girls, it had a big effect, she said.

Plus, kids who received the intervention cut back on their TV watching by about 30 minutes per day, and they appeared to be less likely to consume soda and fast food. It's possible, with more time, those changes could have an impact on their weight, and the authors plan to follow them for another year to find out, said Taveras.

Other studies have shown a link between TV watching and obesity in kids. Although this program affected TV watching but not weight overall, the two are still likely connected, said the researcher. "I think it's entirely possible the (weight) changes lag behind the changes in behavior."

The intervention revolved around primary care doctors, so integrating the same healthy messages in other aspects of kids' lives - daycare, community centers, schools - may have a larger impact, Taveras added. "The additive effects of consistent messages, and multiple reinforcements, could be much more effective than what we see in just the primary care setting."

The extra effort would be worth it. According to the study, published in the Archives of Pediatrics & Adolescent Medicine, more than 1 in 5 U.S. children between the ages of 2 and 5 are overweight, and another 1 in 10 are obese.

During the study, Taveras and her colleagues randomly assigned overweight and obese kids between the ages of 2 and 6 to either normal care from their primary care doctors or a new program designed to help them lose weight.

The program consisted of frequent check-ins with a nurse practitioner who focused on helping them lose weight, and specially designed ideas to help them cut back on TV, fast food, and sodas.

It required a totally new way of working, said Taveras. For instance, nurses were trained in how to motivate and encourage kids and their parents to make changes. In the clinics, electronic medical records were updated to remind doctors when to order tests and other services.

After one year, neither group of kids, overall, had lost weight - so the program was unsuccessful in that respect. However, girls who received the intervention gained significantly less weight than boys - 0.4 points less on a BMI chart, which factors in weight and height.

Treated kids whose households earned $50,000 or less also gained nearly 1 full BMI point less than kids who simply checked in annually with their primary care doctors.

Interventions designed to help kids lose weight are frequently unsuccessful - but still worth the effort, said Dr. Robert Klesges at the University of Tennessee Health Science Center, who did not participate in the study.

Last year, Klesges and his team found that African-American girls who participated in a program designed to prevent them from becoming obese -- by giving them goals for healthy eating and exercise while teaching their parents about providing healthy foods -- were just as likely to gain weight as girls who participated in a program about general self-esteem.

The trials are expensive, but "also extremely important," he told Reuters Health, because of the frequency of obesity in children, and the damage it can do to their health. "It's such an important public health problem, we can't stop trying."

SOURCE: bit.ly/eNt0lp Archives of Pediatrics & Adolescent Medicine, online April 4, 2011.

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