A family-based education program for obesity: a three-year study

Abstract

BackgroundThe epidemic of obesity is increasing in all countries. However, the number of controlled studies focusing on childhood obesity, with a long follow-up is still limited. Even though Behavioral Therapy shows some efficacy, it requires a prolonged teamwork that is not always available in public health settings. In addition, Behavioral Therapy is not always accepted. We describe a new intensive and sustainable family-based, Therapeutic Education program for childhood obesity.MethodsControlled clinical study: a family-based Therapeutic Education program without dietetic prescription involving overweight and obese children/adolescents, without evident psychological troubles, and their families. The program consisted of three clinical and therapeutic education sessions, carried out by a single physician. Further sessions were carried out every six months in the first year and then every year.Study population: 190 overweight children, 85 treated with a therapeutic education program (45 males and 40 females, mean age of 10.43 ± 3) with an average BMI% of 154.72 ± 19.6% and 105 matched children, treated with traditional dietary approach.Children's Body Mass Index (BMI) % and BMI Standard Deviation Score measured at baseline and after a three year-follow-up, were compared. Statistical tests: ANOVA-RM (repeated measures) controlled for distribution by Kolmogorov-Smirnov, Bartlett's test or correspondent non-parametric procedures, X2 tests or Fisher's exact test and simple linear regression.ResultsAfter a follow-up of 2.7 ± 1.1 years, 72.9% of the children who followed the Therapeutic Education Program obtained a BMI% reduction, compared to 42.8% of children who followed the traditional dietary treatment. Weight reduction was good in moderately obese children and in the severely obese. In addition, a smaller proportion of children treated with therapeutic education had negative results (BMI increase of >10%) compared to those treated with dietary approach (11.8% vs. 25.7%); finally, periodic phone calls reduced the drop-out rate in the therapeutic education group.ConclusionThese results indicate the efficacy and sustainability of the Therapeutic Education program, that was completely carried out by a single pediatrician; in addition, it met with an elevated participant acceptance, suggesting a convenient therapeutic solution for skilled pediatricians and selected obese children, when Behavioral Therapy is not available or teamwork is poor.

Family involvement in the treatment of childhood obesity: the Copenhagen approach

“…A new study from Italy is interesting because the follow-up period was 3 years. Children (n=85) and their parents followed a Therapeutic Education Program resulting in a significant 0.44 decrease in BMI SDS over the 3-year period [41]. However, the change we found was not as large as that of a small study from the USA with severely obese children lasting for 3 months.…”

Treatment of Childhood Obesity: A Systematic Review

“…Craeynest et al 2008;Fennig and Fennig 2006;Lazzer et al 2005), and/or education on healthy eating/nutrition (e.g. Reinehr et al 2007;Rice et al 2008;Sacher et al 2005;Tanas et al 2007) with the traffic light diet representing the most commonly prescribed diet featured in studies (e.g. Epstein et al 2001Epstein et al , 2004Jiang et al 2005;Levine et al 2001).…”

Pediatrician-led Motivational Interviewing to Treat Overweight Children: An RCT

“…14 They have also shown that a behavioral approach to changing lifestyle in children 15 or multisetting strategies 7 can produce significant and clinically meaningful weight reduction in children compared with standard care or self-help. 16 Some studies also highlight the need to pay attention to parental influence, 17 especially for younger children, 18 as parents are sometimes unconcerned about their child' s weight status 19 and they may not believe that excess weight gain can negatively affect their child' s health. 4 Expert Committee recommendations 15 suggest the use of patient-centered counseling techniques such as motivational interviewing, which helps families identify their own motivation for making changes.…”