• By Dartington SRU
  • Posted on Wednesday 01st August, 2012

No fad diet: family-based program promises long-lasting weight loss for obese children

Any dieter knows that the real challenge isn’t losing the weight – it’s keeping it off. More than quick fix diets are needed to reverse the growing epidemic of obesity, especially in children and young people. A family-based program developed for urban black and Hispanic children in the US shows how this can be done.Bright Bodies, a program created by researchers from the Yale School of Medicine, boasts impressive evidence of its effectiveness. In a two-year-long randomized controlled trial (RCT) of 209 obese children from New Haven, Connecticut, Bright Bodies was more effective than standard clinical care in reducing the children’s weight gain, body fat, and body mass index (BMI, calculated as the proportion of weight to height). It also had a positive impact on cholesterol levels and insulin sensitivity, which are known risk factors for developing diabetes. And whereas most weight loss interventions offer good results only during or straight after the program, the effects of the Bright Bodies program were still visible a year after the intervention was finished. So what is the secret of the program that has helped sustain these health improvements? The simple combination offered by Bright Bodies is based on four common-sense principles: 1. Good nutrition Dieting is a no-no since it only encourages short-term changes and would be counter-productive in the long term. Instead, children and teens are taught about better food choices and appropriate portion sizes to encourage long-lasting weight management. Both parents and children take part in the nutrition classes, since it is the parents who choose what foods are bought and cooked for the family. Parents are taught, for example, how to read labels of food products, how to choose balanced meals and healthy recipes, and how to pack healthy lunches for school.2. Regular exerciseIncreasing children's physical activity levels promotes weight loss and helps maintain weight in the long term. The program offers children cardiovascular exercise twice a week for 50 minutes, supervised by exercise physiologists. A wide variety of activities are offered to keep children interested, such as flag football, dancing, basketball, races, and interactive video games. The children are also encouraged to exercise three additional days at home a week in order to achieve the recommended 30-40 minutes of physical activity five times a week.3. Change behavior permanently Behavior modification techniques are used to help change behavior permanently. Children are taught to become more aware of overeating triggers and ways to cope with such triggers. Other topics taught include how to manage difficult situations, self-monitoring behavior, how to handle relapses and keep up the motivation, as well as dealing with teasing and improving self-esteem. The program is a full year in duration, meaning the behavioral changes taught have adequate time to become embedded in the lifestyle of the children.4. Involve the whole family Most important, the program involves the whole family, which is key to sustaining the lifestyle changes needed to keep weight under control [See Diet and lifestyle change begins at home]. The program developers recognize that children alone cannot keep up the behavioral changes without changes in the family environment. The program gets parents involved by offering them weekly group sessions, where they are taught how to be role models for their children and how to promote healthy behavior changes in the family environment. The classes also give the parents an opportunity to meet other parents in the same situation and offers social support in overcoming the challenges on the way.Bright Bodies successes and challengesThe above four components of the program offer the children tools that help them achieve a healthier lifestyle, which the research suggests leads to both children and parents adopting healthier behaviors in the long term. However, no program works for every child or family, and Bright Bodies is no exception. The drop-out rate from this trial was very high. For instance, the study originally included a group of children assigned to a structured meal plan, but this part of the study was discontinued when more than four-fifths dropped out in the first six months. Overall, of the 209 children who started the study, only 76 – just over a third – were still in the study after two years. Children and families dropped out because they lost interest, moved and left no forwarding address, or had family issues, transportation problems, or schedule conflicts. For future work on the Bright Bodies program, anything that keeps participants engaged will improve the quality of the research – and more important, it is likely to improve the outcomes for children and families. This study, unlike most previous research on weight management programs, focused on urban black and Hispanic families. While more research is needed to confirm the effectiveness of the program in other locations and with other demographic groups, the diversity of the participants in this study is encouraging. As the authors of the study put it: “This gives us hope that behavior change is possible, even in the most challenging populations.” **********References:Savoye, M., Nowicka, P., Shaw, M., Yu, S., Dziura, J., Chavent, G., O'Malley, G., Serrecchia, J.B., Tamborlane, W.V., & Caprio, S. (2011). Long-term results of an obesity program in an ethnically diverse pediatric population. Pediatrics, 127(3), 402-410.LinksBright Bodies Program websitePA story: Diet and lifestyle change begins at home

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