Children respond to ‘active’ programs for getting fit, eating balanced diet

A little health information is not enough to help obese children get into better shape, according to a recent analysis.

However, programs specifically aimed at changing eating and exercise habits are helpful, according to a new review of evidence in the September issue of the journal Health Psychology.

Denise Wifley

Moreover, children who do not receive an offer for intervention or who receive information only tend to experience weight gains. Children given guidance that is more direct get into better shape, according to the review.

“Providers make the assumption that providing information leads to changes,” said Denise Wilfley, Ph.D., lead author and professor of psychiatry, medicine and pediatrics at the School of Medicine and professor of psychology in Arts & Sciences. “Providing information is a necessary component, but it’s not sufficient.”

Children need interventions that provide more guidance that is active and strategies to help them make behavioral changes, Wilfley said. An “active” treatment, according to the review, involved “any combination of diet, physical activity or behavioral treatment recommendations.” Sessions varied widely — from family counseling sessions on diet to child-only physical training sessions to diet and exercise combinations.

The researchers looked at 14 studies involving 527 young children, adolescents and teenagers. Some children participated in active treatment programs with an average of about 18 sessions. Others had no treatment or were offered educational sessions only.

The children who participated in treatment programs experienced an 8 percent to 9 percent reduction in weight status, which is the child’s weight in relation to various factors such as age and height. Without treatment or with education only, there was a 2.1 percent increase in weight status.

Measuring progress can be tricky when it comes to obese children. Wilfley is cautious about using the term weight loss. For example, if a child does not gain or lose weight but grows taller, he still is making strides toward getting into better shape.

Getting into shape is a matter of eating less and exercising more, Wilfley said, but the tough part is that children are drawn to food such as hamburgers, fried chicken and pizzas — frequent lunchtime offerings in school cafeterias. “The cultural context is not supportive of managing your weight.”

The fact that children actually get worse if given only a little information worries Brian Saelens, associate professor of pediatrics at the University of Washington and Seattle Children’s Hospital Research Institute.

“Five minutes during a doctor’s visit is all a lot of kids get,” he said. “They (doctors) wish they had more time and more resources, but that’s what they’re given.”

With little information in hand, children sometimes try to make changes in eating habits on their own, but their efforts can backfire.

“My guess is that they try something, but they don’t get the support,” he said.

Parents buy food for the home, and they’re the ones who decide to bring home fried chicken and french fries for dinner instead of making baked chicken.

Unless parents change what is in the pantry, the child must independently resist poor food choices.

“That’s hard to do,” Saelens said. Ultimately, kids “feel like they’ve failed at something. The way they cope with failure is to eat.”

“Data suggests (that) intervening with a parent and child concurrently can have a marked impact,” Wilfley said.