Behavioural modification programs help obese children manage their weight

Obese school-age kids and teens can lose weight or prevent further weight gain if they participate in medium- to high-intensity behavioural management programs, according to a new report released by US Health and Human Services’ Agency for Healthcare Research and Quality (AHRQ).

Children in the medium- to high-intensity behavioural management programs studied met for more than 25 hours, usually once or twice a week, for 6 months to 12 months. Effective programs included techniques to improve dietary and physical activity habits, with some featuring strategies such as goal setting, problem solving and relapse prevention.

Researchers found that after completing weight management programs, obese children would weigh between 3 pounds and 23 pounds less, on average, than obese children not involved in such programs. Among those enrolled, the weight difference would be greatest among heavier children as well as in those enrolled in more intensive programs. Researchers also found that weight improvements could be maintained for up to a year after the program ended.

"Effective prevention is the best way to stem the childhood obesity epidemic, but we also have to find effective and healthy ways of helping our children and teens who already are obese get to a healthier weight," said AHRQ Director Carolyn M Clancy, MD. "AHRQ’s new evidence report helps identify possible solutions."

About 17 percent of US children and teenagers are obese, meaning they have a body mass index (a measure of weight adjusted for the height, age and sex of a child) at or above the 95th percentile for their age and sex. For example, a 16-year-old girl who is 5 feet 4 inches (1.62 metres) tall and weighs 168 pounds (76 kilograms) or more is considered obese. Obese children and adolescents are at higher risk for asthma, type 2 diabetes, fatty liver disease, sleep apnoea and other weight-related medical problems. They may also suffer psychological harm from being stigmatised because of their appearance.

"Obese children and their families may be discouraged about their weight, but our review found there are programs out there that can help kids to either gain weight more slowly as they grow or, where appropriate, lose weight," said Evelyn Whitlock, MD, MPH, Associate Director of the AHRQ-supported Oregon Evidence-based Practice Center at Kaiser Permanente’s Center for Health Research in Portland that produced the report.

In a study of one high-intensity, 12-month program reviewed by the researchers, obese children 8 to 16 years old gained less than 1 pound on average, compared with obese kids the same age who gained nearly 17 pounds during the same time period. AHRQ’s report found that intensive, health care-based programs generally had greater effects than school-based programs. For example, the report found that obese 12-year-olds in a medium- to high-intensity health care program would weigh 17 to 18 pounds (8 kg) less than their obese peers. In contrast, children enrolled in school-based programs would end up weighing only 4 pounds (2 kg) less than their obese peers.

The report also showed that adding prescription drugs to a behavioural weight management program helped extremely obese adolescents lose weight. However, no studies evaluated maintenance of weight loss after drug treatment ended.

The two primary drugs reviewed were sibutramine (Meridia), which is an appetite suppressant, and orlistat (Xenical), which helps block fat absorption. In one 12-month study, adolescents taking sibutramine as part of a weight management program lost an average of 14 pounds (6 kg), compared with a 4.2-pound weight gain among those who took a placebo. In another trial, adolescents who took orlistat as part of their weight management program gained an average of 1.2 pounds (0.5 kg), compared with their peers who took a placebo and gained nearly 7 pounds.

While there were no reported harms from behavioural intervention alone, there were side effects from prescription drugs. These included mild increases in heart rate or blood pressure from the use of sibutramine. Among those taking orlistat, up to one-third reported abdominal pain, oily spotting or fecal urgency; 9 percent reported fecal incontinence.

The researchers also reviewed the effectiveness of weight-reduction surgery on morbidly obese adolescents who had a BMI of 41 or greater. Although the evidence is limited, results suggest moderate to substantial weight loss. The surgery can resolve weight-related medical problems such as sleep apnoea and asthma. However, greater short-term risks are associated with surgery, and few cases have been followed more than 1 year.

(Source: Behavioral Modification Programs Help Obese Children Manage Their Weight: Agency for Healthcare Research and Quality: October 2008)