Objective: Aim of this study is to examine the 5-year follow-up results of MI PIACE PIACERMI (I like to like and please myself), a cognitive-behavioural programme intended to obtain a weight growth regulation over an extended period. Design: Longitudinal observational clinical study. Setting: Hospital-based programme, through outpatient activities. Subjects: Thirty-one simple obese children, 13 boys and 18 girls, 6-12 years of age on admission. Intervention: The intervention was carried out by a multidisciplinary team (paediatrician, cognitive-behavioural psychologist, physical therapist). It employed cognitive-behavioural techniques, nutrition education, promotion of physical activity, setting a high value on free play in motion. The programme actively involves parents. The following measurements were taken on admission and at 5-year follow-up: height, weight, waist circumference, body mass index (BMI), BMI standardized (BMI-SDS), and adjusted BMI (a-BMI) as actual BMI/BMI (50th percentile) * 100. Dietary habits were investigated by interview and 24-h recall. Parents completed the Family Habit Inventory and the Child Behaviour Checklist (CBCL). Motor skills were assessed by using Frostig's test. Results: The dropout rate was 35.5 %. In subjects who completed the 5-year follow-up, the mean and s.d. of BMI-SDS and a-BMI were, respectively, 4.2370.71 and 54.7%79.0 at baseline and 2.7470.85 and 43.2%717.3 at the last visit. Waist circumference decreased. Family habits improved significantly. Total energy intake was significantly reduced. Emotional and social aspects of obesity-related behaviours showed positive changes. Motor skills globally improved. Conclusions: The study provides further evidence that positive persistent results may be obtained in obese children with treatment programmes combining a lifestyle centred approach, parental involvement, nutrition education and cognitivebehavioural strategies.

The physiotherapist was able to start or to continue assistance at home or in the hospital, and to keep up the programme based on the child's needs. Integrated home/hospital physiotherapy for children suffering from cancer is feasible and is useful for maintaining continuity of treatment without lengthening hospitalisation.

Overweight is the most frequent nutritional disease in patients affected by MMC. Since in our experience on correlation with MID was found, we can speculate that childhood and adolescent obesity in patients with MMC occurs as a result of complex interactive factors, not strictly related to energy intake and MID. Nutritional surveillance and specific treatment programs for overweight MMC patients are essential to enhance their quality of life.

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