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Behavioral changes effective for weight loss
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CHICAGO—Children who lost weight were able to keep it off more effectively by participating in maintenance treatment programs that emphasized behavioral skills or social facilitation, although the effectiveness lessened over time, according to a study in the October 10 issue of JAMA.

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The prevalence of overweight among children in the United States has tripled in recent decades and related health care costs have nearly quadrupled, according to background information in the article. “Lifestyle interventions remain the most well-established interventions for overweight 7- to 12-year-olds. Although some evidence supports long-term efficacy, maintaining weight loss remains a challenge, with most interventions marked by considerable relapse,” the authors write.

Denise E. Wilfley, Ph.D., of Washington University School of Medicine, St. Louis, and colleagues evaluated the effects of two interventions following standard family-based behavioral weight loss treatment: a behavioral skills maintenance (BSM) and a social facilitation maintenance (SFM) intervention, compared to no intervention.

The BSM approach is based on the premise that specific strategies are needed for weight loss maintenance, emphasizing self-regulation behaviors and relapse-prevention strategies. The SFM approach is based on the premise that relapse results from the absence of a social environment supportive of continued weight control. This approach also targets peer (e.g., teasing) and self-perceptual (e.g., body image) factors identified as barriers to overweight children’s physical activity.

The randomized controlled trial, conducted between October 1999 and July 2004 in a university-based weight control clinic, included 204 healthy 7- to 12-year-olds, 20 percent to 100 percent above median (midpoint) body mass index (BMI) for age and sex, with at least one overweight parent. Children enrolled in five months of weight loss treatment and 150 were randomized to one of three maintenance conditions: control group or four months of BSM or SFM treatment. Follow-up assessments occurred immediately following maintenance treatments and 1 and 2 years following randomization.

The researchers found that children receiving either BSM or SFM maintained relative weight significantly better than children assigned to the control group from randomization to postweight maintenance. Active maintenance treatment effectiveness relative to the control group declined during follow-up, but the effects of SFM alone and when analyzed together with BSM were significantly better than the control group when examining certain BMI score outcomes from baseline to 2-year follow-up. Baseline child social problem scores moderated child relative weight change from baseline to 2-year follow-up, with low social problem children in SFM vs. the control group having the best outcomes. There were no significant differences in child weight outcomes between BSM and SFM in either the short-term or long-term.

“The alarming prevalence of child overweight necessitates the development of more effective long-term intervention strategies. Our study demonstrated that extended treatment contact with either a continued BSM focus or a novel SFM focus improves weight loss maintenance in a childhood overweight population in comparison with a weight loss program alone at least in the short-term, with some evidence for sustained long-term efficacy among more socially adept children receiving an SFM treatment,” the researchers write.
(JAMA. 2007;298(14):1661-1673.

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.


In an accompanying editorial, Erinn T. Rhodes, M.D., M.P.H., and David S. Ludwig, M.D., Ph.D., of Children’s Hospital Boston and Harvard Medical School, comment on the study by Wilfley and colleagues.

“Improving outcomes for childhood obesity requires ongoing research to identify optimal dietary and lifestyle strategies, the behavioral interventions necessary to promote them, and their dose-response relationship in different clinical settings. Wilfley et al have provided a useful starting point. Ultimately, the environment in which these interventions are applied also must be considered. For greatest benefit, family-based approaches to obesity should be coupled with interventions in the school and in the community, while even broader efforts focus on the ways in which food marketing can be used to promote rather than jeopardize children’s health.”
(JAMA. 2007;298(14):1695-1696.

Editor's Note: Please see the article for additional information, including financial disclosures, funding and support, etc.

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