A User's Guide to Childhood Obesity Treatment Programs

Child with doctor. Terry Vine/Blend Images/Getty Images

Treating childhood obesity really needs to be a family affair. If the entire family improves its eating and exercise habits, it will be easier for an overweight or obese child to do so. That way, he or she won’t be swimming against the current, tempted by foods that aren’t on “the plan”, or otherwise isolated from the rest of the household. That being said, sometimes upgrading the family’s lifestyle habits isn’t enough by itself to help an obese child lose weight.

Sometimes stronger interventions are necessary.

A 2010 review of the medical literature concluded that for obese kids over age 6, medium-to-high intensity comprehensive behavioral interventions, conducted in specialty health-care settings, were the most effective in producing weight loss over the course of a year; what’s more, they had no adverse effects on kids’ growth, their risk for eating disorders, or their mental health. These behavioral interventions typically include educational sessions on nutrition, physical activity, behavior-change strategies, coping skills, and relapse prevention.

A Behavioral Makeover

Specific behavioral approaches that can help include encouraging parents to avoid having unhealthy foods at home, tracking the foods kids consume, setting goals for their calorie intake and physical activity, and rewarding kids for the successful changes they make to their diet and physical activity habits.

Some programs also offer training to parents to help them develop better problem-solving, limit-setting, and positive-reinforcement skills. 

In a 2012 study involving 96 families, researchers at the University of Buffalo assigned overweight preschool-aged children and their parents to a family-based behavioral approach (where parents learned about healthy dietary and physical activity patterns as well as strategies that would help kids change their habits) or a control group (that received only education about diet and physical activity); both groups had phone contact with a coach between group meetings.

After six months, the preschoolers in the behavioral group lost more weight than their peers in the other group did—and the same was true of the parents! The researchers speculate that it may be easier to reshape habits that lead to obesity if both parent and child are experiencing reductions in body weight.  

Structured Dietary Programs

Some treatments, including many commercial weight-management programs, rely on a reduced-fat, reduced-calorie diet to help kids lose weight; these often require a doctor’s written permission for kids’ participation. Commercial programs that take a moderate approach to cutting calories for obese kids can be healthy and effective. But those that take a more severe approach to reducing calorie intake are potentially worrisome because these diets tend to have high dropout rates as well as higher weight-regain rates. In the case of kids, there’s the added concern about potential long-term effects of these severe diets on adolescent growth and development (particularly their reproductive function).    

In those who are too young to vote, weight-loss medications aren’t the ideal solution. While a combination of pharmacologic and behavioral interventions has been used in adolescents who are severely obese, the long-term safety and efficacy of weight-loss drugs (orlistat is the only one approved for kids ages 12 and older) in this population isn’t known; also, side effects are more of a concern.

Climbing the Treatment Ladder  

Often it makes sense for families to take a stepped approach to addressing a child’s obesity, starting with the lowest intervention and moving up the hierarchy as is necessary. This approach starts with medical management (feedback and evaluations from doctors) and education, then progresses to environmental changes (such as joining a gym or moving TVs and computers out of kids’ bedrooms). If these measures don’t lead to better weight control, the next step is to join a local self-help group (such as Weight Watchers or TOPS); after that, outpatient cognitive behavioral therapy (CBT) with a local therapist may be in order.

If these interventions don’t succeed, the next step up the ladder is immersion cognitive behavioral therapy where the child goes to a residential program (such as MindStream Academy, where I am senior medical advisor, or Wellspring Camps); these programs remove the child from an obesity-promoting environment and intensify the process of reshaping his or her eating habits, physical activity patterns, and cognitive/emotional issues related to obesity in a setting that’s free of potentially corrupting influences. If previous interventions fail, the last stop at the top of the ladder: Bariatric surgery

Ultimately, your best bet is to discuss various treatment options with your child’s doctor. This way, you can choose an approach that will take into account your child’s age and weight, health and developmental status, and your family environment. Just as there isn’t a single cause for the childhood obesity epidemic, there isn’t a one-size-fits-all remedy, either. Treatment should be tailored to an individual child’s needs.


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