Effectiveness of lifestyle intervention in overweight children

Abstract

Therapy of choice in obese children and adolescents is lifestyle intervention based on nutrition education, behavioural treatment and exercise treatment. Its efficacy even after the end of intervention has been proven by several randomised-controlled trials and meta-analyses including a recent Cochrane review. However, randomised-controlled trials are likely to overestimate the effectiveness. Studies under normal day-to-day circumstances demonstrated only a very moderate effect on weight loss (<10% success rate 2 years after the onset of intervention). A reduction of >0·5 SDS-BMI (which means a stable weight over 1 year in growing children) is associated with an improvement of cardiovascular risk factors, while improvements of quality of life seem independent of the degree of weight loss. Younger children and less overweight children particularly profit from lifestyle interventions in contrast to extremely obese adolescents. Recent studies demonstrated that involving parents is crucial for success, suggesting that parents and children and not children alone should be the primary target of interventions. Failures in weight reduction are attributed not only to a lack of motivation but also to other aspects particular to the genetic background. The techniques, more than the contents, of an intervention influence the treatment outcome. Besides behavioural therapy, systemic and solution-focused treatments are important. Future longitudinal research should focus on the identification of which children and adolescents profit from which kind of intervention, in order to be able to tailor specific treatment approaches. Studies under normal day-to-day circumstances are necessary to prove the benefit of this kind of intervention.

Development and evaluation of the lifestyle intervention “Obeldicks light” for overweight children and adolescents

“…The success rate defined by reduction of BMI-SDS was 94% in the intervention group. Given the observed values of the difference and standard deviations of BMI-SDS change the power of this study was >0.999 at a random error level of 0.05 (Reinehr et al 2010c). …”

“…Our first preliminary findings may point towards an effectiveness of the new lifestyle intervention "Obeldicks light" for overweight children and adolescents as well as towards the usefulness of our study protocol and the accurateness of our study sample estimation (Reinehr et al 2010c): Our intervention and evaluation protocol was suitable for the participants of the study as demonstrated by a very low drop-out rate (3% in intervention and 16% in the control group). Furthermore, we have demonstrated in a previous study that our study population did not differ from a general population in Germany concerning social status or ethnicity (Finne et al 2009) also supporting the generalizability of our results and demonstrating that all social classes were addressed by our intervention.…”

“…(Reinehr et al 2010c). Additionally, waist circumference was reduced significantly only in the intervention group (Reinehr et al 2010c).…”

“…The reduction of overweight was independent of age and gender of the children (Reinehr et al 2010c) assuming that the materials and methods of the intervention "Obeldicks light" are applicable to boys and girls in the age range of 8 to 16 years. (Reinehr et al 2010c).…”

“…Based on a preceding phase-II feasibility cross-over trial in 19 overweight children (at baseline 10.7 ±2.1 years, 68% female, mean BMI-SDS 1.58 ±0.19, mean BMI 22.6 ±1.8 kg/m²) the required sample size for the RCT was estimated (Reinehr et al 2010c). The 19 overweight children in the pilot study increased their degree of overweight significantly in the six-months waiting period before intervention (mean increase of BMI-SDS 0.15 ±0.19 and mean increase of BMI 1.1 ±0.9 kg/m²).…”