Journal Article•
Long-term effects of dietary counselling on nutrient intake and weight loss in obese children.
TL;DR: Intensive treatment of obese children with intensive treatment resulted in decreased fat intake and also led to a reduction in relative weight, whereas a conventional approach appeared to be ineffective with regard to nutrient intake and weight loss.
Abstract: The effects of dietary counselling on food and nutrient intake and weight loss were studied over a two-year period in 32 obese children (relative weight greater than 120%) with intensive treatment (Group I) and in 16 obese children treated in a school health-care setting (Group II). The control group (Group III) comprised 29 normal-weight children (relative weight less than 120%). The children were 6-16 years old. The obese children were treated for one year and observed for another year. Food consumption data were collected by a four-day food record method. At baseline there were no differences in food consumption or nutrient intake between obese and normal-weight children. During treatment the children in Group I reduced their mean daily fat intake (P less than 0.001) and this reduction was maintained throughout the observation period. In Groups II and III no change was observed in mean daily fat intake. The relative body weight decreased by 16.2% in Group I (P less than 0.001) during the first year and the lower body weight was maintained during the observation year. No significant weight reduction was observed in Group II. The decrease in energy intake was significantly correlated with the reduction in body fat mass over the first year (rs = 0.50; P = 0.05, n = 16) in obese children passing through their pubertal growth spurt and to the reduction in relative weight over the first year (rs = 0.90; P less than 0.05, n = 5), as well as to the decrease in fat mass over the second year (rs = 0.70; P less than 0.05, n = 11) in adolescents beyond their growth spurt. In conclusion, intensive treatment resulted in decreased fat intake and also led to a reduction in relative weight, whereas a conventional approach appeared to be ineffective with regard to nutrient intake and weight loss.
Citations
More filters
TL;DR: The writing group has drawn from the available evidence to propose a comprehensive 4-step or staged-care approach for weight management that includes the following stages: Prevention Plus; structured weight management; comprehensive multidisciplinary intervention; and tertiary care intervention.
Abstract: In this article, we review evidence about the treatment of obesity that may have applications in primary care, community, and tertiary care settings. We examine current information about eating behaviors, physical activity behaviors, and sedentary behaviors that may affect weight in children and adolescents. We also review studies of multidisciplinary behavior-based obesity treatment programs and information about more aggressive forms of treatment. The writing group has drawn from the available evidence to propose a comprehensive 4-step or stagedcare approach for weight management that includes the following stages: (1) Prevention Plus; (2) structured weight management; (3) comprehensive multidisciplinary intervention; and (4) tertiary care intervention. We suggest that providers encourage healthy behaviors while using techniques to motivate patients and families, and interventions should be tailored to the individual child and family. Although more intense treatment stages will generally occur outside the typical office setting, offices can implement less intense intervention strategies. We not ony address specific patient behavior goals but also encourage practices to modify office systems to streamline office-based care and to prepare to coordinate with professionals and programs outside the office for more intensive interventions.
853 citations
TL;DR: There is strong evidence for the short- and long-term efficacy of multicomponential behavioral treatment for decreasing weight among children relative to both placebo and education-only treatments.
Abstract: Objective: To review the efficacy of existing interventions for pediatric obesity with reference to the Chambless criteria. Methods: Chambless criteria for determining treatment efficacy were applied to 42 randomized studies involving nonschool-based programs targeting childhood and adolescent weight loss. Results: We summarize the following dimensions of the pediatric obesity treatment literature: description of participants, diagnostic criteria for study participation, experimental design, treatment protocol, treatment outcome, and follow-up. Conclusions: There is strong evidence for the short- and long-term efficacy of multicomponential behavioral treatment for decreasing weight among children relative to both placebo and education-only treatments. Conclusions about adolescent obesity treatment programs are more tentative as they have been less frequently examined, less rigorously controlled, and usually have not conducted long-term follow-up. Current research appears to be working to identify more efficacious treatments for pediatric obesity by exploring the specific behavioral strategies that will be most effective in modifying children’s eating and physical activity habits.
297 citations
TL;DR: In this article, the authors identified controlled interventions that treated childhood overweight or obesity in either a primary care setting or with the involvement of a primary healthcare professional and examined components of those interventions associated with effective outcomes.
Abstract: The primary care setting presents an opportunity for intervention of overweight and obese children but is in need of a feasible model-of-care with demonstrated effectiveness. The aims were to (i) identify controlled interventions that treated childhood overweight or obesity in either a primary care setting or with the involvement of a primary healthcare professional and (ii) examine components of those interventions associated with effective outcomes in order to inform future intervention trials in primary care settings. Major health and medicine databases were searched: MEDLINE, CINAHL, EMBASE, Cochrane Reviews, CENTRAL, DARE, PsychINFO and ERIC. Articles were excluded if they described primary prevention interventions, involved surgical or pharmacological treatment, were published before 1990 or not published in English. Twenty-two papers describing 17 studies were included. Twelve studies reported at least one significant intervention effect. Comparison of these 12 interventions provides evidence for: training for health professionals before intervention delivery; behaviour change options (including healthy diet, activity and sedentary behaviour); effecting behaviour change via a combination of counselling, education, written resources, support and motivation; and tailoring intensity according to whether behavioural, anthropometric or metabolic changes are the priority. These components are practicable to future intervention studies in primary care.
87 citations
TL;DR: The most successful treatment of pre-adolescent obesity may be in preschool children with frequent visits, and a randomized trial is warranted to test this possibility.
Abstract: Objective: To determine if timing and frequency of interventions affect the outcome of treatment of obesity in pediatric patients. Design: Retrospective chart review; comparison of subgroups defined by age and frequency of visits. Setting: A nutrition evaluation clinic, an outpatient referred care clinic at a metropolitan hospital. Participants: All 93 obese children, aged 1 to 10 years, seen within 1 year and with one or more subsequent visits in the next year. Obesity was defined as greater than 120% ideal body weight for height age (IBWH). Mean percent IBWH was 171% (median, 199%; range, 127% to 251%). Interventions: (1) Initial visit. Comprehensive history and physical examination, by physician, registered dietician, and licensed clinical social worker; design of individualized care plan, including prescribed frequency and size of meals and snacks; and type, frequency, and duration of exercise. (2) Subsequent visits (after 1 month, then with frequency tailored to need). Review of progress, adjustment of energy intake and expenditure; management of biopsychosocial obstacles to needed changes. Measurements/Main Results: Four patient groups were defined by two variables: age (preschool vs school-age children) and frequency of visits in 1 year (two to three vs four or more). Groups were compared on change in mean percent IBWH and on mean change in percent IBWH. All groups showed significant change in percent IBWH ( P ≤.040 for school-age children, P ≤.012 for preschool children). For all visits, the mean change was more than twice as great for preschool as for school-age children (4.7±5.4 vs 1.9±4.8, P =.027). Conclusions: (1) The most successful treatment of preadolescent obesity may be in preschool children with frequent visits. (2) A randomized trial is warranted to test this possibility. (3) Many of the techniques used to treat early obesity can be adapted for prevention and intervention in early obesity during the preschool years, and this is the preferred approach. (Arch Pediatr Adolesc Med. 1994;148:1257-1261)
85 citations
TL;DR: Enhanced reporting of relevant and pragmatic information in behavioral investigations of childhood obesity interventions is needed to improve the ability to evaluate the applicability of results to practice implementation.
46 citations