Behavioural Modification Programs Help Obese Children Manage Their Weight

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Title: Behavioural Modification Programs Help Obese Children Manage Their Weight
URL: http://www.pslgroup.com/dg/22DE96.htm
Doctor's Guide
September 30, 2008

ROCKVILLE, Md -- September 30, 2008 -- Obese children and teens can lose weight or prevent further weight gain if they participate in medium- to high-intensity behavioural management programs, according to a new report released today by the Agency for Healthcare Research and Quality (AHRQ).

"Effective prevention is the best way to stem the childhood obesity epidemic, but we also have to find effective and healthy ways of helping our children and teens who already are obese get to a healthier weight," Carolyn M. Clancy, MD, AHRQ, Rockville, Maryland. "AHRQ's new evidence report helps identify possible solutions."

Children in the medium- to high-intensity behavioural management programs studied met for more than 25 hours, usually once or twice a week, for 6 to 12 months. Effective programs included techniques to improve dietary and physical activity habits, with some featuring strategies such as goal setting, problem solving, and relapse prevention.

Researchers found that after completing weight management programs, obese children would weigh between 3 pounds and 23 pounds less, on average, than obese children not involved in such programs.

Among those enrolled, the weight difference would be greatest among heavier children as well as in those enrolled in more intensive programs. Researchers also found that weight improvements could be maintained for up to 1 year after the program ended.

"Obese children and their families may be discouraged about their weight, but our review found there are programs out there that can help kids to either gain weight more slowly as they grow or, where appropriate, lose weight," said Evelyn Whitlock, MD, Kaiser Permanente's Center for Health Research, Portland, Oregon.

In a study of 1 high-intensity, 12-month program reviewed by the researchers, obese children aged 8 to 16 years gained less than 1 pound on average, compared with obese kids the same age who gained nearly 17 pounds during the same time period.

AHRQ's report found that intensive, healthcare-based programs generally had greater effects than school-based programs. For example, the report found that obese children aged 12 years in a medium- to high-intensity healthcare program would weigh 17 to 18 pounds less than their obese peers. In contrast, children enrolled in school-based programs would end up weighing only 4 pounds less than their obese peers.

The report also showed that adding prescription drugs to a behavioural weight management program helped extremely obese adolescents lose weight. However, no studies evaluated maintenance of weight loss after drug treatment ended.

The 2 primary drugs reviewed were sibutramine (Meridia) and orlistat (Xenical). In one 12-month study, adolescents taking sibutramine as part of a weight management program lost an average of 14 pounds, compared with a 4.2-pound weight gain among those who took a placebo. In another trial, adolescents who took orlistat as part of their weight management program gained an average of 1.2 pounds, compared with their peers who took a placebo and gained nearly 7 pounds.

While there were no reported harms from behavioural intervention alone, there were side effects from prescription drugs. These included mild increases in heart rate or blood pressure from the use of sibutramine. Among those taking orlistat, up to one-third reported abdominal pain, oily spotting, or faecal urgency, and 9% reported faecal incontinence.

The new report, Effectiveness of Weight Management Programs in Children and Adolescents, is available at:

http://www.ahrq.gov/clinic/tp/chwghttp.htm

SOURCE: Agency for Healthcare Research and Quality

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