Lifestyle Changes Help Reduce Child Obesity

Ruzanna Harutyunyan's picture
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A new review of studies spread over five continents finds that overweight or obese children and teens can lose weight with lifestyle changes — sometimes coupled with medication.

Lead reviewer Hiltje Oude Luttikhuis, M.D., with the Beatrix Children’s Hospital in Groningen, the Netherlands, and her colleagues analyzed 64 randomized controlled trials of lifestyle therapy and drug interventions.

Behavioral lifestyle therapy aims to change thinking patterns and actions. For example, children and adolescents were encouraged to have breakfast and to eat regular meals, while controlling portions. They were also encouraged to reduce sedentary behaviors — like watching TV — and to increase physical activity. Techniques used to change these thinking patterns included self-awareness, self-monitoring and goal setting for eating and physical activity. Participants also learned cognitive behavior strategies that included ways to deal with stress.

Studies took place in North America, Europe, Australia, Asia and South America (Brazil).

The new review appears in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews like this one draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Although this research cannot pinpoint the ultimate treatment for childhood obesity, the reviewers found several studies that highlighted the importance of combined dietary, physical activity and behavioral components. Parental involvement was an important feature of behavioral programs, particularly in pre-adolescent children.

Citing increasing rates of overweight and obesity worldwide, Oude Luttikhuis said, “More than 30 percent of children and adolescents in the Americas, for example, are overweight or obese. Even in the Netherlands, this prevalence in childhood obesity is going up. We conducted this study because we wanted to understand how best to intervene.”

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Review studies comprised 5,230 participants. Fifty-four lifestyle studies focused on some aspect of diet, physical activity or other behavior changes for 3,806 participants. Ten studies focused on drug intervention in addition to lifestyle changes for 1,424 participants. Only 18 of 54 lifestyle studies reported measures of harm; of these, no adverse effects occurred.

Drug interventions included orlistat and sibutramine, which researchers tested with moderately to severely obese adolescents. Orlistat works by inhibiting the absorption of dietary fats. In contrast, sibutramine is an appetite suppressant that works by making people feel full, so they want to eat less.

A range of side effects occurred, depending on the drugs. From the meta-analysis, Oude Luttikhuis could not discern whether one medication was more efficient than another, but both drugs significantly reduced obesity. However, she said that it is important to weigh the beneficial effects against the side effects. What is clear, she said, is that when drug therapy is used, it should be given in combination with lifestyle interventions.

She said she especially was surprised to find a lack of studies in preschool age children: “Ideally, the treatment — and prevention — of obesity should begin before children go to school, where they might be subjected to discrimination, because of their weight.”

She added, “Doctors should not despair and feel drugs are vital, if a teen has become obese. Already, we have seen large effects in weight loss from lifestyle changes alone. It is disappointing that we have to consider drug or surgical interventions with problems that might have been altered by lifestyle changes earlier on.”

The clinical studies were quite varied in how they were conducted, making it difficult to synthesize the results. Interventions in children under 12, for instance, were often different from studies for adolescents. Further, most clinical studies used small samples of children and adolescents.

“This evidence review does an excellent job of reviewing current treatment options for obesity in children and adolescents,” said Alice Ammerman, director of the Center for Health Promotion and Disease Prevention at the University of North Carolina at Chapel Hill. She added, however, that while it is beyond the scope of this review, it is critical to consider the policy, environmental and systems changes needed to create a situation where children and their families can make healthful choices.

“This includes improved opportunities for walking and bicycling within communities, better access to high quality fruits and vegetables for families of all income levels, and improved nutrition and physical activity environments within schools,” Ammerman said. “Until we address these broader issues, individual level obesity treatment programs for children are unlikely to have a long-term impact.”

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Thoughts about Obesity Obesity is when excess body fat accumulates in one to where this overgrowth makes the person unhealthy to varying degrees. Obesity is different than being overweight, as it is of a more serious concern. As measured by one’s body mass index (BMI), one’s BMI of 25 to 30 kg/m is considered overweight. If their BMI is 30 to 35 kg/m, they are class I obese, 35 to 40 BMI would be class II obese, and any BMI above 40 is class III obesity. Presently, with obesity affecting children progressively more, the issue of obesity has become a serious public health concern. Approximately half of all children under the age of 12 are either obese are overweight. About twenty percent of children ages 2 to 5 years old are either obese are overweight. Worldwide, nearly one and a half billion people are either obese or overweight. In the United States, about one third of adults are either obese or overweight. It is now predicted that, for the first time in about 150 years, our life expectancy is suppose to decline. Morbid obesity is defined as one who has a body mass index of 30 kg/m or greater, and this surgery, along with the three other types of surgery for morbid obesity, should be considered a last resort after all other methods to reduce the patient’s weight have chronically failed. Morbid obesity greatly affects the health of the patient in a very negative way. It has about 10 co-morbidities that can develop if the situation is not corrected. Some if not most of these co-morbidities are life-threatening. One solution beneficial in many cases of morbid obesity if one’s obesity is not eventually controlled or corrected is what is known as gastric bypass surgery. This is a type of bariatric surgery that essentially reduces the volume of the human stomach in order to correct and treat morbid obesity by surgical re-construction of the stomach and small intestine. Patients for such surgeries are those with a BMI of greater than 40, or a BMI greater than 35 if the patient has comorbidities aside from obesity. This surgery should be considered for the severely obese when other treatment options have failed. There are three surgical variations of gastric bypass surgery, and one is chosen by the surgeon based on their experience and success from the variation they will utilize. Generally, these surgeries are either gastric restrictive operations or malabsorptive operations. Over 200,000 gastric bypass surgeries are performed each year, and this surgery being performed continues to progress as a suitable option for the morbidly obese. There is evidence that this surgery is particularly beneficial for those obese patients that have non-insulin dependent Diabetes Mellitus as well. So the surgery to correct morbid obesity greatly limits or prevents such co-morbidities associated with those who are obese. Two percent of those who undergo this surgery die as a result from about a half a dozen complications that could occur. However, the surgery reduces the overall mortality of the patient by 40 percent or so, yet this percentage is debatable due to conflicting clinical studies. Age of the patient should be taken into consideration, as to whether or not the risks of this surgery outweigh any potential benefits for the patient who may have existing co-morbidities that have already caused physiological damage to the patient. Also what should be determined by the surgeon is the amount of safety, effectiveness, and rationale for a particular patient regarding those patients who are elderly, for example. Many feel bariatric surgery such as this should be considered as a last resort when exercise and diet have failed for a great length of time. If a person or a doctor is considering this type of surgery, there is a website dedicated to bariatric surgery, which is: www.asmbs.org, Dan Abshear