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Clinical efficacy of group-based treatment for childhood obesity compared with routinely given individual counseling

International Journal of Obesity volume 31, pages 1500–1508 (2007)Cite this article

Abstract

Objective:

The aim of the study was to compare the efficacy of group treatment stressing a health-promoting lifestyle with routine counseling in the treatment of childhood obesity.

Design and subjects:

Seventy obese children (weight for height 115–182%) aged 7–9 years were randomized either to routine counseling (two appointments for children) or to family-based group treatment (15 separate sessions for parents and children). These sessions included nutrition education, physical activity education and behavioral therapy.

Outcome measures:

Children's weights and heights were measured at baseline, after the 6-month intervention and after the 6-month follow-up. The change of weight for height based on Finnish growth charts was used as the primary, and changes in body mass index (BMI) and BMI standard deviation scores (BMI-SDS) as secondary outcome measures.

Results:

Children attending the group treatment lost more weight for height (6.8%) than children receiving routine counseling (1.8%) (P=0.001). The difference was significant when the data were analyzed in four groups by the cut-off limits of 0, −5 and −10% for the change in weight for height. The respective decreases in BMI were 0.8 vs 0.0 (P=0.003) and in BMI-SDS 0.3 vs 0.2 (P=0.022). The results remained similar in adjusted analyses. Both group and routine programs were feasible with a high, 87–99%, participation rate in sessions and appointments and very low, 3% or less, attrition rate from the programs. Six months after the intervention, beneficial effects were partly lost, but for changes in weight for height and BMI, the differences between the two treatment programs still were significant, and for BMI-SDS, there was a trend.

Conclusions:

Family-based group treatment that stresses a health-promoting lifestyle and is given separately for parents and children, offers an effective mode of therapy to treat obese school-aged children.

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References

  1. Lobstein T, Frelut ML . Prevalence of overweight among children in Europe. Obes Rev 2003; 4: 195–200.

    Article  CAS  Google Scholar 

  2. Hedley AA, Ogden CL, Johnson CL, Carroll MD, Curtin LR, Flegal KM . Prevalence of overweight and obesity among US children, adolescents, and adults, 1999–2002. JAMA 2004; 291: 2847–2850.

    Article  CAS  Google Scholar 

  3. Lissau I, Overpeck MD, Ruan WJ, Due P, Holstein BE, Hediger ML et al. Body mass index and overweight in adolescents in 13 European countries, Israel, and the United States. Arch Pediatr Adolesc Med 2004; 158: 27–33.

    Article  Google Scholar 

  4. Lobstein T, Baur L, Uauy R, IASO International Obesity TaskForce. Obesity in children and young people: a crisis in public health. Obes Rev 2004; 5: S4–S104.

    Article  Google Scholar 

  5. Williams J, Wake M, Hesketh K, Maher E, Waters E . Health-related quality of life of overweight and obese children. JAMA 2005; 293: 70–76.

    Article  CAS  Google Scholar 

  6. Reilly JJ, Methven E, McDowell ZC, Hacking B, Alexander D, Stewart L et al. Health consequences of obesity. Arch Dis Child 2003; 88: 748–752.

    Article  CAS  Google Scholar 

  7. Ebbeling CB, Pawlak DB, Ludwig DS . Childhood obesity: public-health crisis, common sense cure. Lancet 2002; 360: 473–482.

    Article  Google Scholar 

  8. Dietz WH . Childhood weight affects adult morbidity and mortality. J Nutr 1998; 128: S411–S414.

    Article  Google Scholar 

  9. Epstein LH, Valoski AM, Vara LS, McCurley J, Wisniewski L, Kalarchian MA et al. Effects of decreasing sedentary behavior and increasing activity on weight change in obese children. Health Psychol 1995; 14: 109–115.

    Article  CAS  Google Scholar 

  10. Golan M, Fainaru M, Weizman A . Role of behaviour modification in the treatment of childhood obesity with the parents as the exclusive agents of change. Int J Obes Relat Metab Disord 1998; 22: 1217–1224.

    Article  CAS  Google Scholar 

  11. Summerbell CD, Ashton V, Campbell KJ, Edmunds L, Kelly S, Waters E . Interventions for treating obesity in children. Cochrane Database Syst Rev 2003. pp 1–57, Issue 3, Art. No.: CD001872.

  12. Whitlock EP, Williams SB, Gold R, Smith PR, Shipman SA . Screening and interventions for childhood overweight: a summary of evidence for the US preventive services task force. Pediatrics 2005; 116: e125–e144.

    Article  Google Scholar 

  13. Korhonen A, Kalavainen M, Ihanainen M, Nuutinen O . Mahtavat muksut – ratkaisuja lihavan lapsen hoitoon (in Finnish). Ravitsemusterapeuttien yhdistys ry: Helsinki, 1999.

    Google Scholar 

  14. Stallard P . Think Good – Feel Good. A Cognitive Behaviour Therapy Workbook for Children and Young People. John Wiley & Sons, Ltd: Chichester, 2002.

    Google Scholar 

  15. Brownell KD, Kramer FM . Behavioral management of obesity. Med Clin North Am 1989; 73: 185–201.

    Article  CAS  Google Scholar 

  16. Robinson TN . Behavioral treatment of childhood and adolescent obesity. Int J Obes Relat Metab Disord 1999; 23: S52–S57.

    Article  Google Scholar 

  17. Sharry J . Solution-Focused Groupwork, 1st edn. Sage Publications Ltd: London, 2001.

    Google Scholar 

  18. Hasunen K, Kalavainen M, Keinonen H, Lagström H, Lyytikäinen A, Nurttila A et al. The Child, Family and Food. Nutrition Recommendations for Infants and Young Children as well as Pregnant and Breastfeeding Mothers (in Finnish, English Summary). Publications of the Ministry of Social Affairs and Health: Helsinki, 2004.

    Google Scholar 

  19. Nykänen E, Kalavainen M, Ihanainen M, Nuutinen O . Suurenmoinen nuori – ratkaisuja liikapainoisen nuoren painonhallintaan. (in Finnish). Ravitsemusterapeuttien yhdistys ry: Helsinki, 2000.

    Google Scholar 

  20. Tilator Oy Ltd. Pediator Software for Growth Data (Computer Program). Version Release 6.7.4. Säkylä, Finland: Tilator Oy Ltd. Author: 2004.

  21. Northwest Institute for Bio-Health Informatics. Child obesity calculator using British 1990 growth reference data. Available at: http://www.phsim.man.ac.uk/ Accessed January 18, 2007.

  22. Cole TJ, Freeman JV, Preece MA . Body mass index reference curves for the UK, 1990. Arch Dis Child 1995; 73: 25–29.

    Article  CAS  Google Scholar 

  23. Freeman JV, Cole TJ, Chinn S, Jones PR, White EM, Preece MA . Cross sectional stature and weight reference curves for the UK, 1990. Arch Dis Child 1995; 73: 17–24.

    Article  CAS  Google Scholar 

  24. Cole TJ, Freeman JV, Preece MA . British 1990 growth reference centiles for weight, height, body mass index and head circumference fitted by maximum penalized likelihood. Stat Med 1998; 17: 407–429.

    Article  CAS  Google Scholar 

  25. Cole TJ . The LMS method for constructing normalized growth standards. Eur J Clin Nutr 1990; 44: 45–60.

    CAS  Google Scholar 

  26. Sorva R, Lankinen S, Tolppanen EM, Perheentupa J . Variation of growth in height and weight of children. II. After infancy. Acta Paediatr Scand 1990; 79: 498–506.

    Article  CAS  Google Scholar 

  27. Pere A . Comparison of two methods for transforming height and weight to normality. Ann Hum Biol 2000; 27: 35–45.

    Article  CAS  Google Scholar 

  28. Daniels SR, Arnett DK, Eckel RH, Gidding SS, Hayman LL, Kumanyika S et al. Overweight in children and adolescents: pathophysiology, consequences, prevention, and treatment. Circulation 2005; 111: 1999–2012.

    Article  Google Scholar 

  29. Speiser PW, Rudolf MC, Anhalt H, Camacho-Hubner C, Chiarelli F, Eliakim A et al. Childhood obesity. J Clin Endocrinol Metab 2005; 90: 1871–1887.

    Article  CAS  Google Scholar 

  30. Sihvola S . A health dialogue in the school entrance health examination (academic dissertation, in Finnish, English summary). Acta Universitatis Tamperensis 751 University of Tampere, Tampere, 2000.

  31. Jain A, Sherman SN, Chamberlin LA, Carter Y, Powers SW, Whitaker RC . Why don't low-income mothers worry about their preschoolers being overweight? Pediatrics 2001; 107: 1138–1146.

    Article  CAS  Google Scholar 

  32. Jeffery AN, Voss LD, Metcalf BS, Alba S, Wilkin TJ . Parents' awareness of overweight in themselves and their children: cross sectional study within a cohort (EarlyBird 21). BMJ 2005; 330: 23–24.

    Article  CAS  Google Scholar 

  33. Eckstein KC, Mikhail LM, Ariza AJ, Thomson JS, Millard SC, Binns HJ et al. Parents' perceptions of their child's weight and health. Pediatrics 2006; 117: 681–690.

    Article  Google Scholar 

  34. Barlow SE, Dietz WH . Obesity evaluation and treatment: Expert Committee recommendations. The Maternal and Child Health Bureau, Health Resources and Services Administration and the Department of Health and Human Services. Pediatrics 1998; 102: e29.

    Article  CAS  Google Scholar 

  35. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH . Establishing a standard definition for child overweight and obesity worldwide: International survey. BMJ 2000; 320: 1240–1243.

    Article  CAS  Google Scholar 

  36. Voss LD, Bailey BJ . Diurnal variation in stature: is stretching the answer? Arch Dis Child 1997; 77: 319–322.

    Article  CAS  Google Scholar 

  37. Tillmann V, Clayton PE . Diurnal variation in height and the reliability of height measurements using stretched and unstretched techniques in the evaluation of short-term growth. Ann Hum Biol 2001; 28: 195–206.

    Article  CAS  Google Scholar 

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Acknowledgements

We thank all the families who participated in this study, and the students and staff members who assisted with data collection. We also thank Anne Tuovinen, MSc, RD for leading part of the parents' group sessions and our enthusiastic student group Satu Haukijärvi, Merja Kiviranta, Heli Lehtimäki, Mirva Nieminen and Kati Seppänen for leading children's group sessions. We are also grateful for Senja Karjalainen, MSc for help with statistical analysis, for Maarit Korhonen, PhD, RD, Merja Ihanainen, MSc, RD and Terttu Peltola, MSc, RD for thoughtful comments on a draft of this manuscript.

This work was supported in part by grants from Kuopio University Hospital, the Scientific Foundation of Finnish Association of Academic Agronomists, Finnish Cultural Foundation of Northern Savo, Juho Vainio Foundation, Ministry of Social Affairs and Health and Social Insurance Institution.

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Authors and Affiliations

  1. Departments of Pediatrics and Clinical Nutrition, Kuopio University Hospital, Kuopio, Finland

    M P Kalavainen

  2. Department of Pediatrics, Kuopio University and University Hospital and Pediatric Research Center, Tampere University and University Hospital, Tampere, Finland

    M O Korppi

  3. Department of Public Health and Clinical Nutrition, University of Kuopio, Kuopio, Finland

    O M Nuutinen

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  1. M P Kalavainen
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  2. M O Korppi
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  3. O M Nuutinen
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Correspondence to M P Kalavainen.

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Kalavainen, M., Korppi, M. & Nuutinen, O. Clinical efficacy of group-based treatment for childhood obesity compared with routinely given individual counseling. Int J Obes 31, 1500–1508 (2007). https://doi.org/10.1038/sj.ijo.0803628

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