Friday, April 1, 2011

Targeting Parents’ Diet To Tackle Childhood Obesity

Regular readers may recall a previous post calling for treating the parents to tackle childhood obesity. Indeed, there is little evidence that trying to address childhood obesity without involving the whole family is likely to have any success.

Thus, it may not be all that surprising that Clare Collins and colleagues from the University of Newcastle, NSW, Australia, in a randomised controlled study just published in PEDIATRICS, find that targeting the parents’ diets appears far more likely to affect the weight of their overweight offspring than trying to getting the kids to be more active.

This study included 165 overweight prepubertal children (68 boys, aged 5.5-9.9 years) who were randomised to either a child-centered physical-activity program to either a child-centered physical-activity program, a parent-centered dietary-modification program, or both in an assessor-blinded 6-month intervention.

All group interventions weekly 2-hour face-to-face session for 10 weeks that included homework activities followed by a relapse-prevention program that reviewed short- to medium-term goals set by parents, by telephone, monthly for 3 months.

The diet program, which was delivered exclusively to the parents, focused on goal setting, problem solving, role modeling, and positive reinforcement.

The activity program, consisted of weekly face-to-face sessions aimed to improve child fundamental movement-skill proficiency, with parents participating in the first session and being encouraged to complete the homework activities weekly with their child.

The combined intervention consisted of both the dietary intervention for the parents and the activity intervention for the kids.

At 24 months after the start of the intervention, BMI z scores showed the greatest reduction in the parent-centred diet-modification group (-0.35), followed by the activity and diet group: -0.24, and the activity-only group -0.19.

Thus, the greatest effects were achieved through inclusion of a parent-centered diet program, indicating the importance of targeting parents within treatment. In fact the authors even suggest the possibility that exclusively targeting parents diet may be a viable option for treating obese prepubertal children.

“The implication for health service providers, and parents who seek effective treatment options, is that parental involvement is essential for program effectiveness. In addition, parents can participate in intervention programs that will benefit their child without their child being required to participate.”

In any case, it is probably safe to say that (perhaps contrary to popular belief) programs that exclusively focus on trying to address childhood obesity by getting kids to be more active are probably the least effective strategies.

In contrast, leaving the kids alone and focussing on the parents, may be best, unless of course one has the resources and capacity to do both.

AMS
Edmonton, Alberta

Collins CE, Okely AD, Morgan PJ, Jones RA, Burrows TL, Cliff DP, Colyvas K, Warren JM, Steele JR, & Baur LA (2011). Parent Diet Modification, Child Activity, or Both in Obese Children: An RCT. Pediatrics PMID: 21444600

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11 Responses to “Targeting Parents’ Diet To Tackle Childhood Obesity”

  1. NewMe says:

    I just returned from a conference held by a Canadian company at a popular resort in the US. Many of the participants brought their children. I was appalled by what I saw.

    Many of both the adults and children seemed to be frightened by the food that was served. They shunned the vegetables (what little there were), eating mostly bread, some meat and lots of desserts. It was sad to see how people develop such bad eating habits before my very eyes.

  2. vesta44 says:

    Was any follow-up done to see how long the results lasted? We know how successful long-term weight loss maintenance is in adults (not very), so what makes anyone think it will be any more successful in children? Do you really want to set children up for a life-time of yo-yo dieting, with all the shame and physiological harm that causes? Isn’t it better to educate parents and their children about nutrition and moving their bodies in ways that they enjoy? Those things alone will bring about the health improvements wanted without necessarily dragging weight loss into the picture and shaming children when they don’t lose weight, even though their health improves. Why does it always have to be about weight = health? It ain’t necessarily so, ya know?

  3. Lauren says:

    This is an interesting study. I do some work with a program that offers education to parents and kids/teens in North Carolina. We have seen a tremendous change in the lab profile, BMI, and blood pressure for those children whose parents are committed to making healthy changes for the entire family. Not surprisingly, the parents greatest influence comes in the form of dietary changes. After all, parents are usually the ones doing the grocery shopping and cooking. One of the interesting changes we have observed is that during the course of the 12-week program, many of the children are the driving force for increased physical activity in the family. Many times, the parents report not feeling like going to the gym or want to skip the evening walk but the kids insist!

  4. Susan says:

    To NewMe: Snobby, moralizing and condescending judgements toward obese people, especially children, are very hurtful.

  5. Rosemary Dinsdale says:

    This is a very interesting study indeed.

    I have always thought that the lifestyles of the parents, in particular their dealings with food and exercise, and attitudes towards being a “perfect” body weight/size, are directly related to eating disorders. I speculate that the same results may be true if a study was done on the parents of eating disordered individuals. Perhaps the parents unknowingly exacerbate the child’s tendency towards an eating disorder.

    I would welcome a study on this subject.

    Thanks for your time,
    Rosemary in Edmonton

  6. Rosemary Dinsdale says:

    I would like to add that the parents are doing the best they can with the knowledge they have to help their children but perhaps unwittingly add to the problem.

    “Perhaps the parents unknowingly exacerbate the child’s tendency towards an eating disorder.”

    Thanks again,
    Rosemary in Edmonton

  7. DeeLeigh says:

    To NewMe: Snobby, moralizing and condescending judgements toward obese people, especially children, are very hurtful.

    That’s weird. She never mentioned the size of the people she was talking about. I didn’t assume that they were fat. I thought she was just taking a shot at people with poor eating habits in general.

    I went on a cruise once (never again! It was incredibly boring.) and I noticed the same thing. However, I’m fat and the people who were eating a lot of bland, unappetizing food were all different sizes. I was bigger than a lot of them, but that’s not the kind of food I like – nor do I enjoy sitting around and eating all day.

  8. Susan says:

    DeeLeigh: Not really weird at all actually. He or she didn’t have to mention the size of the people, given this is a blog about obesity and this article is about obese children. I think its very unlikely ‘NewMe’ was thinking about skinny people when he/she used the term “appalled” to describe his/her feelings.

  9. Linda says:

    It’s an interesting study and I’m not surprised by the findings.

    One of my big concerns reading about something like this is that there seems to be no awareness of the need for caution about the potential for development disordered eating or eating disorders – as Rosemary alludes to, parental attitudes towards food and body are known to have an impact on the development of eating disorders, anorexia in particular. So where is the safeguard here that the pendulum won’t swing in that direction? Are the parents in the two hours a week being coached about focusing on health and activity and learning how to avoid making disparaging comments about their own weight/shape, at least in front of their children?

    So, on the one hand, great to find out what helps (at least as one person noted, in the short term – definitely long term follow up needed) with one set of problems, as long as we’re not implicitly increasing other risks by how the study and the information is delivered – in other words the coaching should include not only eating and activity but psychological and emotional coaching/counselling as well.

    Last thought – if I were designing a follow-up piece of research, I would also want, based on what I’ve said here, to know what the long-term outcome differences and similarities were for the boy and girl children of the parents in the study.

  10. Rosemary Dinsdale says:

    RE: Susan’s comment

    “in other words the coaching should include not only eating and activity but psychological and emotional coaching/counseling as well.”

    Bingo on that. I was thinking that as well.

    Thanks,
    Rosemary

  11. AcceptanceWoman says:

    My read on “NewMe’s” comment was the same as DeeLeigh’s — I didn’t assume she was talking about the size of people, more about their eating habits. I think the point she was making was that people (she didn’t mention anything about size) at the conference she attended were not drawn to the “healthier” options.
    Not eating your vegetables or fruits isn’t limited to larger people — I’ve known plenty of people who were not fat who didn’t eat a varied diet with a wide range of nutrients.

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