Children need help to lose weight and keep it off, researchers find

Studying efforts to combat obesity in children, a research team led by School of Medicine investigators has found that children who lose weight are able to keep it off more effectively if they participate in a maintenance-targeted treatment program, although the effectiveness of the maintenance program lessens over time.

The researchers reported their findings in the Oct. 10 issue of the Journal of the American Medical Association.

“Maintenance of weight loss is essential to avoid the physical and psychosocial consequences of chronic obesity,” said principal investigator Denise E. Wilfley, Ph.D., director of the School of Medicine’s Weight Management and Eating Disorders Program. “Active maintenance treatment resulted in significantly better maintenance of weight loss.”

The number of overweight children in the United States has tripled in recent decades, and related health-care costs have nearly quadrupled. Nationwide, 19 percent of children ages 6-11 and 17 percent of those 12-19 are overweight, according to the Centers for Disease Control and Prevention. Those who are overweight during childhood also have an increased risk of obesity in adulthood and are at greater risk for health complications such as diabetes, high blood pressure, heart disease and stroke, as well as psychological and social problems.

“Just as with adults, interventions to help kids lose weight are effective in the short term, but maintaining weight loss remains a challenge, and most interventions are marked by considerable relapse rates,” said Wilfley, a professor of psychiatry, of medicine and of pediatrics and professor of psychology in Arts & Sciences. “This was the first study to examine whether extending treatment contact would help children maintain weight loss, and we found an active, maintenance treatment program did help.”

The researchers studied 150 children in San Diego who were between 7-12 years old and had body mass indices (BMI) that averaged more than 60 percent above the median BMI for their age and sex. For example, an average 8-year-old boy is 4 feet, 2 inches tall, with a BMI of 15.78 and a weight of 57 pounds, but the average 8-year-old boy in this study had a BMI of 25.25 and weighed more than 91 pounds. All of the children in the study also had at least one parent who was overweight.

These children participated in a family based weight-loss treatment program for five months. Then they were randomly assigned to one of three groups: a behavioral skills maintenance (BSM) treatment group, a social facilitation maintenance (SFM) group or a control group that received no active treatment after the initial weight-loss program.

The BSM approach is based on the premise that specific behavioral skills are needed for weight loss maintenance. BSM focuses on enhancing the motivation of parents and children and on behavioral skills needed for long-term weight control — such as learning to monitor body weight and to return to weight-loss strategies when they begin to regain weight.

The SFM approach presumes that people need a social environment that supports continued weight control. The SFM treatment guided parents to encourage their kids to be friends with physically active peers and to ensure that play with existing friends involved physical activity and healthful eating.

Both maintenance programs lasted four months. Researchers then took the height and weight of the children one year and two years after the initial weight-loss program. Most kids had significant decreases in their amounts of weight during the weight-loss intervention, but without a formal maintenance program, they tended to return to their previous overweight levels. In fact, although the weight percentage of children in the control group fell by 11 percent during the weight-loss program, two years later those same children had returned to their previous level of overweight, plus 2.6 percent.

Those children who participated in either the BSM or SFM program maintained their relative weight significantly better than those who did not receive maintenance treatment.

“Our results indicate that when compared to the BSM intervention and the control group, children in the SFM group were significantly more successful in enlisting peers to assist them in increasing physical activity and sticking with healthful eating behaviors,” Wilfley said. “The children in the SFM group also were better able to cope with teasing, and these types of psychosocial changes are associated with positive weight control behaviors.”

While this study did not specifically examine the health benefits of weight loss in these children, Wilfley reasons that losing weight and keeping it off will offer future dividends because more than 80 percent of people who develop type 2 diabetes are overweight.

“The alarming number of overweight children in our society means we need to develop more effective long-term intervention strategies, and we plan to devote more study to the hypothesis that positive peer support can assist children in long-term weight control,” Wilfley said.