A study published in the December issue of Archives of Pediatric and Adolescent Medicine found that group-based treatments may be effective programs to combat childhood obesity in rural communities. The study, led by researchers at the University of Florida, compared weight loss programs and concluded that children in family-based or parent-only group programs were less overweight than children in a control group.

“Given the scope and seriousness of obesity in America and the limited access to services for children in rural settings, there is a pressing need for programs that help rural families adopt healthy dietary habits and increase physical activity,” said lead investigator David Janicke, Ph.D. (assistant professor, UF College of Public Health and Health Professions).

About 14% of urban children are obese, and over 16% of children in rural area are obese. Rural areas tend to have higher poverty rates and poorer access to medical care, healthful foods, and physical activity facilities due to geographic barriers. This recent study is among the first that was designed to assess the effectiveness of a child weight-management program in a real-world, community-based setting for families in rural areas.

The researchers studied 93 children (age 8 to 14) and their parents, selected from four rural counties in Florida. To be considered for the program, children had to be overweight or obese. That is, they had body mass index (BMI) scores that were above the 85th percentile for age and sex. Random assignment placed each family into one of three four-month treatment groups: family-based, parent-only, or a control group composed of families who were on the wait list for the treatment group. Participants in the weight-management treatment groups received instruction on healthy diet choices, and children were provided with pedometers and instructions to use them. Parents in the parent-only group received training on topics such as nutrition, exercise, and behavior management.

Six months after treatment, children in the weight-management programs presented greater BMI decreases than children in the control group. More specifically, children in the weight-management group were, on average, 4% less overweight and children in the control group were, on average, 3% more overweight at the end of six months. These changes in weight for the children in the weight-management group were consistent with the gradual changes to diet and lifestyle that the researchers recommend. The weight loss was even enough to suggest that lipid and blood sugar levels had improved as well.

Janicke said that, “When working with children it’s important to introduce lifestyle changes slowly and make it fun, otherwise they may become resistant. Making big changes in their diets could lead to unhealthy habits like skipping meals, eating disorders or weight gain.”

The study also took into account cost-effectiveness, finding that the parent-only format offers potential cost benefits even though both treatment plans were effective. In parent-only programs, there are fewer staff, space, material, and other resources required. Similarly, resources are more efficiently used in parent-only programs – there was 74% attendance compared to 63% attendance in the family-based group. Parent-only programs also encourage parents to take more responsibility for teaching good habits and living healthier at home.

Thomas Robinson, M.D. (Irving Schulman, M.D. endowed professor in child health, Stanford University) wrote in an accompanying editorial about the value and rareness of child weight-management studies in real-world settings such as this one led by Janicke.

“We need to focus new energy on finding solutions to childhood obesity, not just documenting the problem,” concludes Robinson. “This is the most direct way to generate the high-quality data needed to establish an evidence base for effectively and efficiently managing pediatric obesity.”

Comparison of Parent-Only vs Family-Based Interventions for Overweight Children in Underserved Rural Settings
David M. Janicke, PhD; Bethany J. Sallinen, PhD; Michael G. Perri, PhD; Lesley D. Lutes, PhD; Milagros Huerta, MD; Janet H. Silverstein, MD; Babette Brumback, PhD
Archives of Pediatric and Adolescent Medicine (2008); 162(12): pp. 1119-1125.
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Written by: Peter M Crosta