• By Kevin Mount
  • Posted on Thursday 26th August, 2010

Diet and lifestyle change begins at home

Schools can help, but the only sure way to combat childhood obesity is to get parents involved in the challenge and encourage them to change family diet and lifestyle.This is the message from two separate UK Cochrane collaboration reviews just published. Maureen Dobbins and a team of researchers from McMaster University in Canada investigated the impact of school-based physical activity programs on children’s fitness and health outcomes. From the wealth of literature on the subject, the team selected 26 studies based on criteria related to study design, methods and measurement of outcomes. Most involved efforts to encourage children to exercise more by explaining the health benefits of being more active. Some involved changing the format of the school day to include more rigorous physical activity and better access to fitness equipment. Most included educational materials for teachers and students.After reviewing the effects, Dobbins’s team concluded that school programs had very little effect on children’s body mass index (BMI); or on their propensity to be physically active outside school hours. They had no effect either on children’s blood pressure or pulse rate. “Physical activity classes may be too closely associated with school work, so for some students this makes them feel like they are being made to do more work,” she writes.There were some positive effects, however. School-based programs did reduce cholesterol and the amount of time that children spent watching television. They also successfully increased “VO2 max” – also known as maximal oxygen uptake or aerobic capacity – a general indicator of individual fitness level.“Given that there are some beneficial effects, we would recommend that schools continue their health promotion programs. These activities should also be supported by public health unit staff, and parents and teachers as positive role models,” says Dobbins.A second Cochrane review, led by Hiltje Oude Luttikhuis, supports the bias toward home-based strategies.

Lifestyle interventions should target whole family

“It is now clear that family-based lifestyle interventions that include a behavioral program aimed at changing diet and physical activity provide significant and clinically meaningful decreases in overweight and obesity in both children and adolescents compared with standard care of self-help regimes,” says Oude Luttikhuis, a physician researcher at the Beatrix Children’s Hospital in Groningen, the Netherlands. She found that lifestyle interventions that improved diet and physical activity and included some behavior therapy had positive effects when the target was not just an obese child but the whole family. Weight loss was sustained for at least six months and, in the case of adolescents, for a whole year.The review team also discovered that, for moderate to severely obese adolescents, weight loss drugs prescribed in addition to the lifestyle program were effective (although in some cases they had adverse side effects).Sixty-four randomized controlled trials involving 5,230 participants from North America, Europe, Australia, Asia and South America were included in the Oude Luttikhuis review. “(These figures) highlight the importance of effective treatment strategies for children and young people already affected by the problem of obesity,” says Louise Baur, Oude Luttikhuis’s chief collaborator and Professor at the University of Sydney.Oude Luttikhuis adds that there is still work to be done to find out what types of aspects of different interventions work better for different groups of children.• Childhood obesity is on the increase. In America, approximately 30% of children are obese and in Europe 20%. The worldwide figure for 5-17 year olds is 10% according to the International Obesity Taskforce. See: Dobbins M, De Corby K, Robeson P, Husson H, Tirilis D. “School-based phsyical activity programs for promoting physical activity and fitness in children and adolescents aged 6-18.” and Oude Luttikhuis H, Baur L, Jansen H, Shrewsbury V A, O’Malley C, Stolk R P, Summerbell C D “Interventions for treating obesity in children” Cochrane Database of Systematic Reviews 2009, Issue 1.

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