Child obesity interventions
Ncbi web site requires javascript to tionresourceshow toabout ncbi accesskeysmy ncbisign in to ncbisign l listchild obes. Berge, phd, lmft, department of family medicine and community health, university of minnesota, phillips wangensteen building, 516 delaware street se, minneapolis, mn 55455, email:email: @9000lhomauthor information ► copyright and license information ►copyright 2011, mary ann liebert, article has been cited by other articles in ctbackground: with the rising prevalence of childhood obesity over the last several decades, and the call for more family-based intervention research to combat childhood obesity, it is important to examine the extant research on family-based interventions in order to make recommendations and improve future ive: to conduct a meta-analysis of family-based interventions targeting childhood obesity in the last decade in order to inform the research in the next s: a literature review was conducted between december 2009-april 2010. Studies published between the years 2000–2009 that used family-based interventions to treat childhood obesity were included. A total of 20 studies met inclusionary s: although results varied by study design, the majority of studies had a moderate to large effect size for change in the target child's bmi (bmi percentile, zbmi, percent overweight) after participating in a family-based intervention. Long-term change varied by study, but the majority of studies produced sustainable change in child bmi, although smaller effect sizes. Change in secondary variables (dietary intake, sugar-sweetened beverage intake, physical activity) were substantially different between studies and are reported as sion: to date, there is preliminary evidence suggesting that family-based interventions targeting childhood obesity are successful in producing weight loss in the short and long-term. Limitations with the research, recommendations for future research, and implications for practitioners working with overweight/obese children are uctionover the last two decades obesity prevalence in children has more than doubled,1–3 childhood overweight and obesity are associated with increased risk for adverse health problems, including hypertension, cardiovascular disease, metabolic syndrome, and type ii diabetes. These expert panels and committees, along with other researchers, have identified family involvement in the treatment of childhood obesity as a neglected area of research and have called for more family-based interventions. 10 specifically, experts suggest that intervening in the family system may provide greater change and longer sustainability of change in the child because of the ability of the family to shape child behaviors on a daily basis. 10 thus, the purpose of this meta-analysis is to assess the state of the science on family-based interventions targeting childhood obesity in the last decade, in order to determine the success of these interventions and inform research in the next systems theoryfamily systems theory indicates that families live in complex systems in which multiple interactions occur simultaneously. These mutually influencing patterns within the family are important to consider when designing childhood obesity interventions because targeting child health behaviors may be contingent on family interactions and modeling. Thus, this meta-analysis uses family systems theory to guide the understanding of findings from family-based interventions used in treating childhood obesity in the last of the researchprior to the year 2000there have been very few family-based interventions to treat childhood obesity prior to the year 2000. 14,15 family-based interventions include the target children and one or more family member(s) directly involved in the treatment intervention. Typically a parent, most commonly the mother, participates in the intervention with the target child. The most successful family-based obesity treatment interventions have been conducted by epstein and his colleagues in a clinical setting using the stoplight diet. Epstein has shown that using the stoplight diet with children and their parent(s) produces significantly more weight loss than control groups.
Thus, this meta-analysis focuses on studies conducted in the last decade in order to identify the state of the research on family-based interventions during the time when calls for family-based interventions were sstudy abstractionwe followed the recommendations of lipsey and wilson for study abstraction. Searches were performed on pubmed, medline, psycinfo, cochrane library, cinahl and social science abstracts search engines using various combinations of the following key terms: child, childhood, obesity, overweight, family, family-based, parent, treatment, weight-loss, interventions. Second, the tables of content for journals that commonly publish in childhood obesity studies were reviewed (e. Journal of pediatrics, preventive medicine, journal of pediatric psychology, journal of family psychology, american journal of public health, journal of the american dietetic association, obesity). Fourth, established researchers in the field of childhood obesity treatment were contacted and asked for copies of unpublished articles (under review or in press). Based intervention studies to reduce childhood overweight/obesity included in the meta-analysisinclusion/exclusion criteriastudies were selected for inclusion in the meta-analysis if they met the following criteria: 1) published in peer-reviewed journals between 2000 and 2009; 2) written in english; 3) studies were childhood obesity interventions (treatment not prevention). Studies were not required to be randomized control trials (rct's) because this is a relatively new area of research and there were few rct's that included family members directly in interventions; 4) included a member or members of the target child's family in the intervention; the parent or family member component was defined as an intervention strategy that directly engaged parent or family member support or assistance in child health behavior change; 5) recruited children between the ages 5–18; and 6) included pre- and post- measurements of body mass index (bmi) (e. Due to the relatively small amount of studies using family-based interventions, we included all available studies in the meta-analysis as a first step in understanding the existing literature on family-based treatment extractiondata from the studies were extracted using standardized forms developed by the authors. School, home, health care center), study design, theoretical framework used to guide intervention design, recruitment methods, subject participation/attendance in intervention, primary and secondary outcomes, bmi measurement, description of intervention, intervention frequency and duration, main findings, methods of parent/family involvement in intervention, and any analysis that assessed whether subsequent changes in child or parent behavior could be attributed to involvement in the intervention. These studies are discussed under both sections, in order to show effect sizes for change in child weight for both components of the study. 31 the positive effect size between treatment groups indicates that the first group (parent-focused) decreased bmi more than did the second group (child-focused); however, these results were not significant. 35,36,40,41 group 1 was defined as “parents only targeted,” while group 2 was “parents and children” for golan et al. 41 all participants received the same intervention, but group 1 was comprised of same-sex parent-child dyads, while group 2 was opposite-sex dyads. More than did the second group (“parents and children”); however, the change reported for the “parents and children” group was not significant. The difference between treatment conditions (“same-sex” and “opposite-sex” parent-child dyads) was not significant at 24-month follow-up. Indicating support for parent-only versus parent-child treatment modalities, parenting skills training in combination with lifestyle education versus parenting skills training alone, and opposite-sex parent-child dyads versus same-sex dyads.
Only one study examined differences in effects on %ow between treatment groups, and found sizeable but questionably significant support for a parents-only group versus a parent-child treatment. Follow-up studies found that most differences between treatment groups were insignificant at follow-up, except for differences between a parents-only group and a parent-child group for zbmi and %ow in one study. Variablesa number of studies examined links between family-based interventions for child obesity and secondary health outcomes for the target child(ren), such as fruit/vegetable intake, consumption of water and sugar-sweetened beverages, physical activity and sedentary behaviors. None of the reviewed articles compared changes in secondary health variables between two treatment sionthe main aim of this meta-analysis was to identify the state of the research on family-based interventions targeting childhood obesity in the last decade, in order to inform research in the next decade. The majority of the studies, 70%, showed statistically significant moderate to large effect size changes in child bmi, after participating in a family-based intervention for weight loss. Of these, 50% showed statistically significant child weight loss change at 6-month, 1-year and 2-year follow-up, although effect sizes were more modest (small to moderate). Thus, the scientific evidence suggests the usefulness of using family-based interventions in childhood obesity treatment. Overall, there has been movement to respond to the calls by expert panels and committees to include the family in childhood obesity interventions. Family members were involved in various degrees, ranging from being a part of education components, helping to encourage and monitor weight loss efforts of the target child, being directly involved with the target child's weight loss through participating in own weight loss, and targeting parents only in weight loss efforts. Results from the analysis indicate the importance of including a parent in child weight loss efforts. There are still unanswered questions regarding whether it is important if the involved parent is the same-sex or opposite-sex of the target child, or whether the intervention should target only the parent in treating childhood obesity. Long term follow-up studies are important for establishing the success of family-based interventions in producing sustainable weight loss over time in children. With the issue of childhood obesity especially, it is important to be able to show continued weight loss or maintenance in order to counteract the devastating outcomes of adult obesity such as: hypertension, cardiovascular disease, metabolic syndrome, and type ii diabetes. The curriculum used in the family-based interventions included three main components: (1) nutritional and physical activity education, (2) psychoeducational parenting groups, and (3) behavioral control/monitoring of diet and exercise. The interventions that targeted both parenting skills and nutrition/physical activity education showed more statistically significant results with larger effect sizes compared to interventions that used education only or education plus behavioral control/monitoring. This implies the importance of teaching parents both structure/setting limits skills and empathic/caring skills in treating childhood n and colleagues' stoplight diet was used in 40% (8 of 20) of the studies.
This family-based curriculum has been shown to produce significant weight loss in children and their family members at 6 month, -2 year and -10 year follow-up time points. This is a limitation of the current research on family-based interventions that needs to be addressed. It is well known that ethnic/racial minorities are at highest risk for overweight/obesity. 3 thus, it is crucial to identify family-based interventions that are suitable for children from diverse ethnic/racial and low socioeconomic backgrounds. 48 based on the results of this meta-analysis, and the importance of “family” to many ethnic/racial groups, family-based interventions targeting minority children need to be developed and ement of bmi. All studies in the meta-analysis used bmi percentile, bmiz or percent overweight to measure the primary outcome of change in child bmi. For instance, the majority of studies using bmi percentile showed larger effect size changes in child weight loss compared to bmiz and % overweight. Because children are growing, analyzing the z-transformation of bmi, which uses the centers for disease control (cdc) growth charts19 to compare the child's bmi against gender- and age(month)-specific standards, is preferred. Although a few (n=4) studies examined links between family-based childhood obesity interventions and secondary health outcomes (e. Child fruit/vegetable intake, consumption of water and sweetened beverages, physical activity and sedentary behaviors), the current study did not report effect sizes because only single studies looked at secondary outcome variables or because change in the variable was not quantified. These significant findings suggest that it would be important to measure secondary outcomes in childhood obesity intervention research. This is important because it is likely that there are multiple pathways to child weight change, rather than a magic variable or program that will solve the childhood obesity problem. Thus, measuring secondary outcomes will allow for identifying variables that are upstream from child weight loss in order to identify targets for intervention (e. Dietary intake, physical activity) as primary study outcomes, rather than secondary, in childhood obesity treatment studies. As family-based intervention research continues to show significant results for treating childhood obesity, it will be important to use theory in conceptualizing study designs that will allow for sustainability of weight loss in children. Several studies have identified an association between opposite sex parent/child dyads in regards to authoritative parenting style and child bmi, dietary intake and frequency of family meals.
53–55 taken together, these results suggest that the opposite sex parent may play a unique role in influencing child weight loss and sustainability of weight loss. Studies that reported differences between participants who stayed in treatment versus dropped out identified that the target children in these families were typically more overweight/obese, from lower ses households, and were ethnically/racially diverse. Although the last decade has shown an increase in family-based interventions for childhood obesity, more is needed. More studies, conducted by more researchers, are necessary in order to firmly establish the evidence in favor of family-based interventions. This would help confirm the evidence supporting family-based interventions to target childhood ations for clinical practiceresults from the current meta-analysis provide implications for practitioners who treat children with overweight and obesity issues. First, results suggest that referring children with overweight or obesity concerns to family-based interventions is a good option for practitioners. The current meta-analysis showed moderate to large effect sizes for effectiveness of family-based interventions in reducing child weight. This means that the change in child weight was more likely due to the family-based intervention versus another factor. Interventions that include one parent visit, or only send home materials for parents, are not considered family-based interventions. The current meta-analysis showed that including at least one parent in the childhood obesity intervention was important and that the sex of the parent may also be important. In addition, family-based interventions that showed child weight loss in the short and long term were more likely to target weight change/management in the child, as well as, the parent/family. Thus, identifying family-based interventions that include both individual level change and system level change (e. Epstein's stop light diet) would be important in order for practitioners to have resources to provide referrals to families with children who are overweight/gh findings from the met-analysis show positive results for using family-based interventions to combat childhood obesity, family-based interventions or treatment centers are not always readily available to providers. Many pediatric specialty clinics, or clinics located at research universities have family-based obesity treatment programs. In addition, many community mental health clinics are beginning to include obesity treatment options, but it is important to identify whether they are individually-based treatments or family-based treatments. Further, there is likely to be more childhood obesity intervention options available in the near future as the topic has become one of national and international importance.
Is preliminary evidence suggesting that family-based interventions treating childhood obesity are successful in producing weight loss in the short and long term. Including families in weight loss treatment of overweight/obese children warrants further implementation and ledgementsresearch is supported by a building interdisciplinary research careers in women's health grant administered by the deborah e. The project described is supported by grant number k12hd055887 from the national institutes of child health and human development. The content is solely the responsibility of the authors and does not necessarily represent the official views of the national institute of child health and human development or the national institutes of disclosure statementno competing financial interests nces1. Ogden c, carroll m, curtin l, lamb m, flegal ence of high body mass index in us children and adolescents, 2007–2008. Ogden cl, carroll md, flegal body mass index for age among us children and adolescents, 2003–2006. Ogden cl, carroll md, curtin lr, mcdowell ma, tabak cj, flegal ence of overweight and obesity in the united states, 1999–2004. Review of familial correlates of child and adolescent obesity: what has the 21st century taught us so far? Kitzmann km, beech -based interventions for pediatric obesity: methodological and conceptual challenges from family psychology. Epstein lh, paluch ra, roemmich jn, beecher -based obesity treatment, then and now: twenty-five years of pediatric obesity treatment. Rhee ke, de lago cw, arscott-mills t, mehta sd, davis s associated with parental readiness to make changes for overweight children. Epstein lh, valoski a, wing rr, mccurley -year outcomes of behavioral family-based treatment for childhood obesity. Bermudez de la vega ja, vazquez ma, bernal s, gentil fj, gonzalez-hachero j, montoya pometric, bone age, and bone mineral density changes after a family-based treatment for obese children. Germann jn, kischenbaum d, rich and parental self-monitoring as determinants of success in the treatment of morbid obesity in low-income minority children. Levine md, ringham rm, kalarchian ma, wisniewski l, marcus family-based behavioral weight control appropriate for severe pediatric obesity? Reinehr t, brylak k, alexy u, kersting m, andler tors to success in outpatient training in obese children and adolescents.
Goldfield gs, epstein lh, kilanowski ck, paluch ra, kogut-bossler -effectiveness of group and mixed family-based treatment for childhood obesity. Epstein lh, paluch ra, saelens be, ernst mm, wilfley s in eating disorder symptoms with pediatric obesity treatment. Beech bm, klesges r, kumanyika sk, murray dm, klesges l, mcclanahan b, slawson d, nunnally c, rochon j, mclain-allen b, pree-cary - and parent-targeted interventions: the memphis gems pilot study. Epstein lh, paluch ra, raynor differences in obese children and siblings in family-based obesity treatment. Kalavainen mp, korppi mo, nuutinen al efficacy of group-based treatment for childhood obesity compared with routinely given individual counseling. Janicke dm, sallinen bj, perri mg, lutes ld, huerta m, silverstein jh, brumback ison of parent-only vs family-based interventions for overweight children in underserved rural settings: outcomes from project story. Epstein lh, gordy cc, raynor ha, beddome m, kilanowski ck, paluch sing fruit and vegetable intake and decreasing fat and sugar intake in families at risk for childhood obesity. Temple jl, wrotniak bh, paluch ra, roemmich jn, epstein onship between sex of parent and child on weight loss and maintenance in a family-based obesity treatment program. Mcgarvey e, keller a, forrester m, williams e, seward d, suttle ility and benefits of a parent-focused preschool child obesity intervention. Danielzik s, pust s, muller -based interventions to prevent overweight and obesity in prepubertal children: process and 4-years outcome evaluation of the kiel obesity prevention study (kops). School-based intervention to reduce overweight and inactivity in children aged 6–12 years: study design of a randomized controlled trial. Barlow committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Katz -based interventions for health promotion and weight control: not just waiting on the world to change. In press [pmc free article] [pubmed]articles from childhood obesity are provided here courtesy of mary ann liebert, s:article | pubreader | epub (beta) | pdf (1. Findings may be used for research purposes, but should not be considered ood obesity is a serious health problem in the united states and worldwide. We assessed the effectiveness of childhood obesity prevention programs by reviewing all interventional studies that aimed to improve diet, physical activity, or both and that were conducted in schools, homes, primary care clinics, childcare settings, the community, or combinations of these settings in high-income countries.
Body mass index [bmi], waist circumference, percent body fat, skinfold thickness, prevalence of obesity and overweight); intermediate outcomes (e. Together, the reviewers graded the strength of the evidence (soe) supporting interventions--diet, physical activity, or both--in each setting for the outcomes of interest. The majority of the interventions (104 studies) were school based, although many of them included components delivered in other settings. Other studies tested interventions delivered at home (n=6), in primary care (n=1), in childcare (n=4), and in the community (n=9). For obesity prevention, the following settings and interventions showed benefit: school-based--diet or physical activity interventions (soe moderate); school-based with a home component--physical activity interventions (soe high) and both diet and physical activity (soe moderate); school-based with home and community components--diet and physical activity interventions (soe high); school-based with a community component--diet and physical activity interventions (soe moderate); community with a school component--diet and physical activity interventions (soe moderate). The strength of the evidence is either low or insufficient for the remainder of the interventions and evidence is moderate about the effectiveness of school-based interventions for childhood obesity prevention. Physical activity interventions in a school-based setting with a family component or diet and physical activity interventions in a school-based setting with home and community components have the most evidence for effectiveness. More research is needed to test interventions in other settings, such as those testing policy, environmental, and consumer health informatics l, wu y, wilson rf, et al. Pmid: ch protocol december 20, ood obesity prevention programs: a comparative effectiveness review and y: three interventions that reduce childhood obesity are projected to save more than they cost to implement. Choices paper identifying cost-effective nutrition interventions with broad population reach highlights the importance of primary prevention for policy makers aiming to reduce childhood interventions that reduce childhood obesity are projected to save more than they cost to ker sl, claire wang y, long mw, giles cm, ward zj, barrett jl, kenney el, sonneville kr, afzal as, resch sc, cradock affairs, 34, no. 11 (2015): united states will not be able to treat its way out of the obesity epidemic with current clinical practice. Instead, reversing the tide of obesity will require expanded investment in primary prevention, focusing on a combination of interventions with broad population reach, proven individual effectiveness, and low cost of study is the first of its kind to estimate the cost effectiveness of a wide variety of nutrition interventions high on the obesity policy agenda—documenting their potential reach, comparative effectiveness, implementation cost, and cost-effectiveness. Researchers identified three interventions that would more than pay for themselves by reducing healthcare costs related to obesity: an excise tax on sugar-sweetened beverages; elimination of the tax subsidy for advertising unhealthy food to children; and nutrition standards for food and drinks sold in schools outside of school meals. The projected net savings to society in obesity-related health care costs for each dollar spent would be $30. Onal interventions modeled include restaurant menu calorie labeling, increased access to adolescent bariatric surgery, improved early care and education, and nutrition standards for school meals. The study points out that the improvements in nutrition standards for both school meals and foods and beverages sold outside of meals through current smart snacks in school regulation make the healthy, hunger-free kids act of 2010 one of the most important national obesity prevention policy achievements in recent researchers analyzed interventions separately, no strategy on its own would be sufficient to reverse the obesity epidemic.
The study also emphasizes the importance of obesity prevention that spans across multiple settings throughout the life course. While childhood interventions are necessary to reduce obesity during the early years of life and ensure that children enter into adulthood at a healthy weight, it is critical that environments spanning the life course continue to support healthy eating and drinking behaviors. Policy makers looking to reverse the childhood obesity epidemic and reduce long-term obesity prevalence need to focus on implementing cost-effective preventive interventions that reach a large percentage of our nation’s children,” says lead investigator of the choices project, dr. Chan school of public study notes that interventions affecting both children and adults are particularly attractive, since near-term health care cost savings can be achieved by reducing adult obesity, while laying the ground work for long-term cost savings by reducing childhood obesity. Billion in net costs over the course of the decade, primarily due to reductions in adult health care entions that can achieve near-term health cost savings among adults and reduce childhood obesity offer policy makers an opportunity to make long-term investments in children’s health while generating short-term y: three interventions that reduce childhood obesity are projected to save more than they cost to implement. Billion in net costs over the course of the decade, primarily due to reductions in adult health care entions that can achieve near-term health cost savings among adults and reduce childhood obesity offer policy makers an opportunity to make long-term investments in children’s health while generating short-term returns.