We report 10-year treatment outcomes for obese children in 4 randomized treatment studies. At 10 years, 34% decreased percentage overweight by 20% or more, and 30% were not obese. Significant effects were observed when parents and children were targeted and reinforced for weight loss in comparison with nontargeted controls and for children given lifestyle or aerobic exercise in comparison with a calisthenics control. Thirty-four percent of the variance in change in percentage overweight was predicted from sex, baseline percentage overweight, self-monitoring weight, meals eaten at home, and family and friends' support for eating and exercise. Results show long-term changes in children depend on the treatment, and evidence converges on the importance of the family and other sources of support for eating and activity change.

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Obese children 8-12 years old from 61 families were randomized to treatment groups that targeted increased exercise, decreased sedentary behaviors, or both (combined group) to test the influence of reinforcing children to be more active or less sedentary on child weight change. Significant decreases in percentage overweight were observed after 4 months between the sedentary and the exercise groups (-19.9 vs. -13.2). At 1 year, the sedentary group had a greater decrease in percentage overweight than did the combined and the exercise groups (-18.7 vs. -10.3 and -8.7) and greater decrease in percentage of body fat (-4.7 vs. -1.3). All groups improved fitness during treatment and follow-up. Children in the sedentary group increased their liking for high-intensity activity and reported lower caloric intake than did children in the exercise group. These results support the goal of reducing time spent in sedentary activities to improve weight loss.

Considering obesity as a body mass index of 30 or higher may lead to misinterpretation of individual and population risks. Escalating extreme obesity may exacerbate health effects and costs of the obesity epidemic.

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EPSTEIN, LEONARD H, ALICE M VALOSKI, MELISSA A KALARCHIAN AND JAMES MCCURLEY. Do children lose and maintain weight easier than adults: a comparison of child and parent weight changes from six months to ten years. Obes Res. 1995;3:411-417. Recent research has shown weight maintenance for obese preadolescent children over 60 and 120 month intervals, while studies on adults consistently show they fail to maintain weight loss. This paper is designed to examine differences in percent overweight changes at 6,60 and 120 months in obese parents and children from 113 families who participated in randomized controlled outcome studies evaluating family-based behavioral treatment. Analyses showed children had significantly greater changes in percent overweight than their parents at each time point. Chi-square and Logistic Regression analyses showed children were more likely than their parents a t each time point to have percent overweight decreases greater than 20%, with over 20% of the children and less than 1% of the parents showing changes this large. The implications of these results for weight control are discussed. These results suggest there may be differences in the efficacy of treating obesity in children versus adults.

Obese children and parents from 53 families were randomly assigned to three groups: diet, diet plus exercise, and no treatment control. At 6 months, parents and children in both treatment groups had equal and significantly better weight change than members of the control group. At 1 year, however, parents given diet plus exercise showed better weight losses than parents given diet alone. No treatment group differences were found for children after 1 year. Parent and child weight changes during the first 6 months of treatment were highly correlated, but those during months 6 to 12 were uncorrelated. Discriminant analyses showed that initial relative weight was the best predictor of 12-month relative weight for both parents and children and that exposure to the exercise program during treatment was a predictor of maintenance of nonobesity.

This article presents the 5-year outcome of family-based behavioral treatment of obesity for 6- to 12-year-old children in 162 families across 4 treatment outcome studies. Results suggest that treatments that use (a) conjoint targeting and reinforcement of child and parent behavior or (b) reciprocal targeting and reinforcement of children and parents are associated with the best child outcomes. Predictors of child success include self-monitoring, changing eating behavior, praise, and change in parent percent overweight. Parental outcome is predicted by self-monitoring weight, baseline parent percent overweight, and participation in fewer subsequent weight control programs.