Treating obesity in children and adolescents: a review

"You Don't Look Anorexic": Atypical anorexia patient experiences of weight stigma in medical care

Eating disorders (ED) and weight stigma pose significant healthcare challenges. Patients at higher weights, like some with atypical anorexia (AAN), may face increased challenges due to weight stigma. This study analyzed patients' lived experiences with weight stigma in healthcare. Thirty-eight adult patients with AAN completed in-depth, semi-structured interviews regarding healthcare experiences. Guided by narrative inquiry approaches, transcripts were thematically coded. Across the illness trajectory (ED development, pre-treatment, treatment, post-treatment), patients reported that weight stigma in healthcare contributed to initiation and persistence of ED behaviors. Themes included "providers pathologizing patient weight," which patients reported triggered ED behaviors and relapse, "provider minimization and denial" of patients' EDs, which contributed to delays in screening and care, and "overt forms of weight discrimination," leading to healthcare avoidance. Participants reported that weight stigma prolonged ED behaviors, delayed care, created suboptimal treatment environments, deterred help-seeking, and lowered healthcare utilization. This suggests that many providers (pediatricians, primary care providers, ED treatment specialists, other healthcare specialists) may inadvertently reinforce patients' EDs. Increasing training, screening for EDs across the weight spectrum, and targeting health behavior promotion rather than universal weight loss, could enhance quality of care and improve healthcare engagement for patients with EDs, particularly those at higher weights.

Heart Smart: A Multifaceted Cardiovascular Risk Reduction Program for Grade School Students

Heart Smart Program is a health education intervention for grades kindergarten through six which encourages the acquisition and maintenance of health-enhancing behaviors. These include nutritious eating habits; physical fitness and exercise; saying “no” to cigarette smoking, alcohol, and drugs; and control of stress. Social Cognitive Theory is used to derive the necessary training concepts for children with reinforcement of these concepts occurring in six areas: the curriculum, school lunch, staff development, physical activity, environment, and parental support. The necessary training mechanisms provide mastery experiences, knowledge transfer, role modeling, and emotional and physiological feedback. The program incorporates the influence of the social environment on learning and builds support from parents, teachers and school staff.

Estimates of the Prevalence of Obesity in Canadian Children

Childhood obesity is becoming a topic of great con cern due to the rising prevalence of this condition in North America. Studies conducted in the United States have indicated that the prevalence of obesity has increased dramatically over the past few decades. The purpose of this study was to estimate the prevalence of obesity in Canadian children between the ages of 5 and 12 years by examining data from two national and two regional surveys The 85th percentiles of each of four anthropometric indices derived from large normative populations were used as diagnostic criteria for obesity. As expected, the resulting prevalences varied according to the criteria used. A significant increase in childhood obesity between the 1981 to 1988 national surveys was observed when the three indices which used skinfolds were applied Weight-for-height percentiles did not indicate an increase in obesity in these samples. Regional samples showed a less than expected prevalence of obesity among the middle-class children and a higher than expected rate among the inner city boys. It can be concluded that there is a need for a defined criteria for identifying obesity in children in order to avoid confusion resulting from the wide variation in estimates of prevalence resulting from different standards and measurements. Using adiposity-based criteria for obesity it was clearly evident that the prevalence of obesity has increased in Canadian children.

Rapid versus Gradual Scheduling of Therapeutic Contact in a Family Based Behavioural Weight Control Programme for Children

Forty-five overweight children aged 6 to 13 were randomly assigned to one of four conditions: a behavioural programme occurring on a rapid schedule, the same behavioural programme presented on a schedule of gradually decreasing frequency, a non-specific control procedure and a waiting list control group. Experimental procedures required subjects to attend eight sessions, accompanied by a parent. The behavioural approach was found to lead to significantly greater reductions in obese status as measured by absolute weight loss and percentage overweight for age, sex and height, in comparison to both the non-specific control procedure and the waiting list group during treatment. This difference was maintained at the 11 week follow-up. Comparison between the rapid and gradual scheduling of behavioural sessions revealed little difference in outcome in the long term, other than effects which reflected differences in duration since the onset of treatment. Skinfold measures were found to be less sensitive to change, with differences between groups being evident only in the longer term assessments.

A meta-analysis of family-behavioral weight-loss treatments for children

Childhood obesity is a major concern in the United States. Because children's diets can be significantly influenced by parental behavior (e.g., food purchases, meal preparation), researchers have included family intervention components in some childhood weight-loss programs. The relative benefits of adding the family component have not been well-established. This meta-analysis compared the mean effect sizes of family-behavioral, other treatment, and control weight-loss groups for children. A comprehensive literature review identified 16 studies with a total of 44 treatment groups. Results indicated that interventions containing a family-behavioral component produced larger effect sizes than the alternative treatment groups. This demonstrates that the inclusion of a family component may be advantageous to a child's weight-loss treatment.

Efficacy of exercise for treating overweight in children and adolescents: a systematic review

BACKGROUND

Overweight prevalence among children/adolescents is increasing, while adult obesity may potentially cause a decline in life expectancy. More exercise is uniformly recommended, although treatment efficacy remains unclear.

OBJECTIVE

To determine the efficacy of exercise alone for treating overweight in children/adolescents.

DESIGN

A systematic review and meta-analysis of randomized trials published in English were completed following multiple database searches performed on December 10, 2004. Studies of isolated or adjunctive exercise/physical activity treatment in overweight/obese children or adolescents which reported any overweight outcome were included. Literature searches identified 645 papers which were manually searched, of which 45 were considered for inclusion, of which 13 papers which reported 14 studies were included (N=481 overweight boys and girls, aged approximately 12 years). Two reviewers independently identified relevant papers for potential inclusion and assessed methodological quality. Principal measures of effects included the mean difference (MD) (between treatment and control groups), the weighted MD (WMD), and the standardized MD (SMD).

RESULTS

Few studies were of robust design. The pooled SMD was -0.4 (-0.7, -0.1, P=0.006) for percent body fat, and -0.2 (-0.6, 0.1, P=0.07) for central obesity outcomes, whereas the pooled WMD was -2.7 kg (-6.1 kg, 0.8 kg, P=0.07) for body weight, all of which favored exercise. Pooled effects on body weight were significant and larger for studies of higher doses, whereas nonsignificant and smaller effects were seen for studies of lower doses of exercise (155-180 min/weeks vs 120-150 min/weeks).

CONCLUSIONS

Based on the small number of short-term randomized trials currently available, an aerobic exercise prescription of 155-180 min/weeks at moderate-to-high intensity is effective for reducing body fat in overweight children/adolescents, but effects on body weight and central obesity are inconclusive. Recommendations for future study designs are discussed.

Percentage fat in overweight and obese children: comparison of DXA and air displacement plethysmography

OBJECTIVE

To compare percentage body fat (percentage fat) estimates from DXA and air displacement plethysmography (ADP) in overweight and obese children.

RESEARCH METHODS AND PROCEDURES

Sixty-nine children (49 boys and 20 girls) 14.0+/-1.65 years of age, with a BMI of 31.3+/-5.6 kg/m2 and a percentage fat (DXA) of 42.5+/-8.4%, participated in the study. ADP body fat content was estimated from body density (Db) using equations devised by Siri (ADP(Siri)) and Lohman (ADP(Loh)).

RESULTS

ADP estimates of percentage fat were highly correlated with those of DXA in both male and female subjects (r=0.90 to 0.93, all p<0.001; standard error of estimate=2.50% to 3.39%). Compared with DXA estimates, ADP(Siri) and ADP(Loh) produced significantly (p<0.01) lower estimates of mean body fat content in boys (-2.85% and -4.64%, respectively) and girls (-2.95% and -5.15%, respectively). Agreement between ADP and DXA methods was further examined using the total error and methods of Bland and Altman. Total error ranged from 4.46% to 6.38% in both male and female subjects. The 95% limits of agreement were relatively similar for all percentage fat estimates, ranging from +/-6.73% to +/-7.94%.

DISCUSSION

In this study, conversion of Db using the Siri equation led to mean percentage fat estimates that agreed better with those determined by DXA compared with the Lohman equations. However, relatively high limits of agreement using either equation resulted in percentage fat estimates that were not interchangeable with percentage fat determined by DXA.

Overweight children and adolescents: a clinical report of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition

Childhood overweight and obesity are major health problems with immediate and long-term consequences of staggering magnitude. Despite this, there are few preventive and therapeutic strategies of proven effectiveness available to public health and clinical practitioners. Accruing such evidence is currently and appropriately a health policy priority, but there is an urgent need to intervene even before comprehensive solutions are fully established. The aim of this Clinical Report on Overweight Children and Adolescents is to present information on current understanding of pathogenesis and treatment of overweight and obesity. We report on the epidemiology, molecular biology and medical conditions associated with overweight; on dietary, exercise, behavioral, pharmacological and surgical treatments; and on the primary prevention of overweight in children and adolescents.

Childhood obesity

The pediatrician's approach to overweight was best summarized by Bruch 25 years ago: The pediatrician plays an important role in the prevention of obesity. From birth on, feeding a child always involves a dual task--namely, offering food in appropriate amounts and gearing it to the child's expression of his needs. Only in this way can he develop discriminating awareness and become active in establishing self-regulation.... If a child is fed when he is hungry, played with when he needs attention, and encouraged to be active when he is restless, he is not likely to grow up inhibited and passive or overstuffed and helpless, unable to control his eating because every discomfort is misinterpreted as a need to eat.

Childhood obesity

Approximately 10% of children are obese. Twin and adoption studies demonstrate a large genetic component to obesity, especially in adults. However, the increasing prevalence of obesity over the last 20 years can only be explained by environmental factors. In most obese individuals, no measurable differences in metabolism can be detected. Few children engage in regular physical activity. Obese children and adults uniformly underreport the amount of food they eat. Obesity is particularly related to increased consumption of high-fat foods. BMI is a quick and easy way to screen for childhood obesity. Treating childhood obesity relies on positive family support and lifestyle changes involving the whole family. Food preferences are influenced early by parental eating habits, and when developed in childhood, they tend to remain fairly constant into adulthood. Children learn to be active or inactive from their parents. In addition, physical activity (or more commonly, physical inactivity) habits that are established in childhood tend to persist into adulthood. Weight loss is usually followed by changes in appetite and metabolism, predisposing individuals to regain their weight. However, when the right family dynamics exist--a motivated child with supportive parents--long-term success is possible.

Management of childhood obesity in pediatric practice

Evaluation of obese children and adolescents in the pediatric office or clinic should include baseline assessment of weight for height and body fatness; rule out endocrine and genetic causes of obesity; and evaluate other health-risk factors, such as those for cardiovascular disease, cancer, diabetes, and hypertension. Treatment of obesity is most successful if realistic goals are set; a balanced low-fat/high-fiber diet is stressed; a safe rate of weight loss of 1 to 2 pounds per week is achieved through a moderate reduction of caloric intake (approximately 20-25% decrease); increased physical activity is stressed as much as diet; parental support is strong; and behavior therapy is provided during the course of treatment to help both child and parent achieve the diet, exercise, and behavior goals.

Follow-up results of different treatment programs for obese children

OBJECTIVE

Many approaches have been tried in order to tackle the problem of obesity in children, but most of them have failed to achieve long-term weight loss. Cognitive behaviour therapy tends to predict good prospects. So far, no studies have investigated the surplus value of introducing a "healthy-eating" lifestyle program instead of a strict diet prescription, in combination with the principles of cognitive behaviour therapy. Therefore, a new program was designed. The second aim of the study was to evaluate the impact of different forms of therapeutic contact.

SUBJECTS AND METHODS

The obese group consisted of 205 children seeking treatment, and a control group of 54 obese school children. The effects of the program were evaluated by means of a pre-test/post-test design with a 1-y follow-up. Subjects were assigned to different therapeutic conditions: group therapy, individual therapy, summer camp or "advice in one session".

RESULTS

A progressive and significant loss of weight for all therapeutic conditions was noticeable. The reduction continued at least 6 months after completing therapy. The control group, however, showed weight evolution in the opposite sense.

CONCLUSIONS

A replication of the positive effect of CBT was found in a broad sample of clinically obese children, even without strict diet prescription. Our hypothesis that group approach will result in a better outcome is borne out.

Guidelines for school health programs to promote lifelong healthy eating

Healthy eating patterns in childhood and adolescence promote optimal childhood health, growth, and intellectual development; prevent immediate health problems, such as iron deficiency anemia, obesity, eating disorders, and dental caries; and may prevent long-term health problems, such as coronary heart disease, cancer, and stroke. School health programs can help children and adolescents attain full educational potential and good health by providing them with the skills, social support, and environmental reinforcement they need to adopt long-term, healthy eating behaviors. This report summarizes strategies most likely to be effective in promoting healthy eating among school-age youths and provides nutrition education guidelines for a comprehensive school health program. These guidelines are based on a review of research, theory, and current practice, and they were developed by CDC in collaboration with experts from universities and from national, federal, and voluntary agencies. The guidelines include recommendations on seven aspects of a school-based program to promote healthy eating: school policy on nutrition, a sequential, coordinated curriculum, appropriate instruction for students, integration of school food service and nutrition education, staff training, family and community involvement, and program evaluation.

Treatment of childhood obesity in pediatric practice

Evaluation of obese children and adolescents in the pediatric office or clinic should include baseline assessment of weight for height, and body fatness; should rule out endocrine and genetic causes of obesity; and should evaluate other cardiovascular risk factors. Treatment of obesity is most successful if realistic goals are set; if a safe rate of weight loss of one to two pounds per week can be achieved through a reduction of caloric intake that amounts to 500 calories less per day; if increased physical activity is stressed as much as diet; if parental support is strong; and if behavior therapy is provided during the course of treatment to help both child and parent achieve the diet, exercise, and behavior goals.

Defining obesity in children and adolescents: clinical approaches

For clinical utility, obesity should be defined as a condition of excess adipose tissue associated with adverse health outcomes. Based on a number of criteria, body mass index (BMI) (weight/height) is the most appropriate measure for clinical assessment of adiposity in children and adolescents. However, sufficient information regarding associations between adiposity and current or future morbidity is lacking. Available data suggest a definition of obesity based on adiposity alone would perform poorly as a clinical screening test for adverse health outcomes. In addition, labeling and attempted weight control therapy may produce more harm than benefit. Therefore, until better information regarding the risks of adiposity and risks of treatment are available, recommendations for weight control therapy should be focused primarily on those children and adolescents who currently manifest adiposity-related morbidity, those with a BMI above the 95th percentile, or those above the 85th percentile who perceive their adiposity to be a significant psychosocial problem. To produce a clinically useful definition of obesity, longitudinal data should be used to determine the sensitivities, specificities, and predictive values of comparative measures of childhood and adolescent adiposity for predicting current and future morbidity, and to evaluate the utilities of including characteristics such as age, age of adiposity rebound, persistence of increased adiposity, family adiposity, family morbidities, and fat distribution to improve predictive values and minimize misclassification. Weight control research should attempt to identify patient characteristics that predict long-term treatment success, treatment failure, and treatment side effects.

Child and adolescent obesity: the nurse practitioner's use of the SHAPEDOWN method

The prevalence of obesity in children and adolescents has increased approximately 50% in the last 20 years and now affects more than one in four young people. Although family-based approaches to the problem recently have shown weight losses maintained at 5-year and 10-year follow-up, this care is unavailable in many communities because of an insufficient availability of trained providers. Nurse practitioners are uniquely appropriate for providing child and adolescent obesity services yet appear to be underrepresented among pediatric obesity care providers. This article describes a method of preventive and therapeutic care that nurse practitioners can use in clinical practice.

Management of obesity in adolescence

A great deal of the discouragement about treating adolescents who are obese is related to the traditional treatment approaches. Obesity is a complex problem needing comprehensive treatment. Focusing on weight loss as a short-term goal is unreasonable because of individual variation in the physiologic potential to lose weight. Short-term goals and rewards are related to adopting daily habits that will lead to a decrease in energy storage in the long term. Support for changing habits and improving psychosocial adjustment is a necessary component of effective treatment, enabling patients and their families to make changes.

Childhood obesity. Medical and familial correlates and age of onset

The prevalence of obesity in U.S. children is rising. Etiologic studies have focused on infants and school age children but little is known about obesity in early childhood. To study the development of childhood obesity and its medical correlates, the authors reviewed 175 charts of obese children seen in a nutrition clinic. The 61 study subjects (37% of charts reviewed) had growth records for ages 7 years and less and were without developmental delay syndromes. Thirty-nine (64%) of 61, were girls; ages at presentation were 1 to 14 years. Data collection included previous and presenting weights, heights, medical problems, and evidence of parental and sibling obesity. Study subjects' mean percent of ideal body weight for height (% IBWH) at presentation was 160 percent. Many study subjects had medical problems considered to be related to obesity: 30 percent had asthma, 25 percent elevated blood pressure, and 28 percent hyperlipidemia. Thirty (63%) of 48, study subjects with data on maternal weight and height, had obese mothers and 14 (31%) of 45 had obese fathers. Fourteen (50%) of 28 had one or more obese siblings. Among all study subjects, the proportion of obese (% IBWH greater than 120%) and severely obese children (% IBWH greater than 140%) increased between ages 1 and 7 years. For example, the proportion greater than 140% IBWH was zero percent at 1 year and 3 years; 0.1 at 2 years; 0.2 at 4 years; 0.5 at 5 to 6 years; and 0.6 at 7 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Childhood obesity

More effort should be invested in preventing obesity than is currently practiced, because prevention is much more successful than treatment, in either children or adults. Most obese children or adults. Most obese children have exogenous obesity, which is caused by increased caloric intake, reduced energy output, or overly efficient calorie utilization. These children are often tall for their age and have advanced bone age. Obesity in childhood is strongly associated with obesity in adulthood. The relationship between infantile obesity and obesity in childhood is less clear. Preventive measures in infants may include promotion of breastfeeding and delay in introduction of solid foods. Treatment in children includes abolition of junk foods and reduction in saturated fat in the diet and encouragement of regular physical exercise.

Combined low-dose medication and primary intervention over a 30-month period for sustained high blood pressure in childhood

Studies of the pathobiologic consequences of high blood pressure in childhood, as well as those following blood pressure levels into young adulthood, indicate that early intervention in the natural history of essential hypertension is warranted. In an exploratory study of the concept, 95 children out of 1604 (aged 8 to 18 years), who persistently scored higher than the 90th percentile for blood pressure over a 4-month period, considering the race, sex, and height of the children, were studied. Five series of replicate measurements with 30 total observations were obtained. Children with evidence of secondary hypertension were excluded. The study children were randomly divided into treatment (n = 48) and high-comparison (n = 47) groups. Treatment consisted of low-dose combined drug therapy (propranolol and chlorthalidone) with an educational program directed towards hypertension and dietary and exercise modification. Monthly follow-up was continued for 30 months. Significant systolic (-3.59 mm Hg) and diastolic (-1.73 mm Hg) changes were noted up to 30 months (p less than 0.05) with minimal side effects. Furthermore, analyses suggested that the blood pressure change, at least in the first month, was mostly attributable to drug therapy. Moreover, the mechanism of blood pressure change appeared to be race-specific, with whites having pulse rate changes and blacks having significant weight changes, which were associated with blood pressure change. This trial shows further research is warranted to determine optimum approaches for early treatment of essential hypertension to prevent future hypertensive disease.

Family-oriented prevention of cardiovascular disease: a social epidemiological approach

A social epidemiological approach has been used to study social factors associated with chronic disease, as well as to promote community-oriented intervention programs to modify risk for cardiovascular disease. The present review suggests using a social epidemiological approach in a third way; to promote efforts directed toward family-oriented primary prevention of cardiovascular disease. Evidence is presented which shows an association between three family social factors (marital status, family socioeconomic status, family size) and risk for cardiovascular disease. The real determinants of risk, however, may be the underlying health-related behaviors indicated by each of these factors. Evidence is also presented which shows the importance of a fourth family social factor (family age) in promoting effective health education efforts to modify risk. Thus, a social epidemiological approach is more valuable than a single discipline-based approach in identifying, understanding, and modifying family social influences on cardiovascular risk.

Treatment and follow-up of obesity in adolescent girls

An intervention program was conducted for 12 postmenarche, 12-15-year-old obese girls. Weight Winners, a multicomponent and multidisciplinary after-school intervention program, was developed in which behavior modification, aerobic exercise, and modeling appropriate behaviors for weight control were emphasized. Evaluation made before and immediately after the intervention and at a nine-month follow-up suggested that the after-school treatment program was successful in: 1) reducing the rate of gain and decreasing body weight by 11% while maintaining lean tissue and resting energy expenditure (REE), and 2) improving eating and exercise behaviors. Significant changes in eating behaviors (p less than 0.05) were: more low-calorie, nutritionally dense foods were consumed; the frequency and amount eaten decreased; and the speed of eating slowed. Implementing a fee contingent on attendance and on record keeping appeared to reduce attrition. Subjects cited the Weight Winners program, aerobic exercise, changes in eating behaviors, group and family support, and encouragement and praise from the group leaders as important contributions to their success in weight control. Barriers to change were reported by participants as boredom, hunger, lack of family and peer support, and having food in sight. An increase in lean tissue was associated with both improved self-esteem (p less than 0.05) and improved self-control (p less than 0.05). Subjects who had been obese the longest were the most responsive to hunger cues (p less than 0.05).

Metabolic effects of a very low calorie diet in obese children and adolescents with special reference to nitrogen balance

Eight obese children and adolescents, mean age (+/- SD) 12.0 +/- 2.5 years, were treated for 3 weeks with a liquid formula very low calorie diet (VLCD), containing 320 kcal/1339 kj (44 g protein, 33 g carbohydrate, 0.9 g fat). Weight loss after 3 weeks was 8.0 +/- 1.8 kg resulting in 15.3 +/- 4.6% reduction of body overweight. During the dietary period no patient complained of hunger and no serious side effects were observed. Four patients achieved positive N-balance during the second week, all but one in the third week. Mean cumulative N-balance after 3 weeks was calculated to be -23.2 +/- 31.6 gN. Great interindividual variances were observed in the rate of N-loss during the course of the study. No significant correlation was found between cumulative N-balance and weight loss or initial body weight. Blood parameters remained unaffected, except for glucose and urea, which decreased slightly from 74.6 +/- 13.6 to 50.4 +/- 20.1 mg/dl and from 14.1 +/- 4.3 to 8.6 +/- 7.4 mg/dl, respectively. Uric acid concentrations increased slightly, three of eight patients had levels higher than 8 mg/dl and therefore were treated with allopurinol. Total serum protein decreased; serum albumin values did not change. The type of VLCD used in this study proved therapeutically useful in achieving rapid weight loss. Compared with VLCD containing 30% less protein and carbohydrate, a marked improvement of N-balance in 3 weeks could be achieved with the VLCD containing 1 g protein/kg IBW/day. This amount of protein seems to be necessary to obtain the nitrogen sparing effect in children and adolescents undergoing weight reduction with VLCDs.

Potential life-threatening cardiac arrhythmias associated with a conventional hypocaloric diet

Nine obese children (mean age 12.7 years, mean overweight 74.2%) were treated for 3 weeks with a very low calorie diet containing high quality protein. Eight patients (patients A) received a commercially available diet (240 kcal/1004 kJ/day) and 1 patient (patient B) a homemade dietary regimen (500 kcal/2100 kJ/day). Both preparations were supplemented with micronutrients; however, the daily intake of minerals was significantly less in patient B. All patients were monitored for the appearance of cardiac arrhythmias by frequent 24-hour Holter recordings. In patients A the mean loss of body weight was 9.4 +/- 2.4 kg, patient B lost 8.7 kg. The mean daily nitrogen balance was negative (patients A: 10.2 g/day, patient B: 6.8 g/day). Frequent blood chemistry evaluations were unremarkable. On the 14th day of treatment patient B developed arrhythmias (ventricular couplets, non-sustained ventricular tachycardias); in patients A no ventricular dysrhythmias were observed. Our data suggest that very low calorie diets containing protein of high biologic value can be associated with potentially dangerous arrhythmias.

Prevention of atherosclerosis in childhood

Atherosclerosis begins in infancy, with fatty streaks appearing at the age of 3 years and fibrous plaques appearing during adolescence. Fatty streaks and fibrous plaques are related to serum total cholesterol, LDL-C, and systolic blood pressure levels. Children with elevated levels of cholesterol and blood pressure track (i.e., maintain elevated levels over time) and are candidates for premature coronary artery and cerebrovascular disease, especially if there is a positive family history of premature CVD. Screening for CVD risk factors in children is rapid, simple, inexpensive, and effective, with tremendous potential to prevent future adult CVD. At their annual physical examinations, children 5 years of age or older should have careful blood pressure measurements by two observers, and determinations of serum total cholesterol levels. Levels should be plotted on standard percentile grids (Figs. 5-7) in the child's permanent medical record. Those with persistently elevated levels of blood pressure and/or serum LDL-C require nonpharmacologic intervention initially, but may require antihypertensive or antilipid medication if unresponsive to behavioral modification for diet, physical activity, and cigarette smoking. Pediatric health professionals can play vital roles in primary prevention and reduction of adult CVD.

Parental weight and its relation to infant feeding patterns and infant obesity

Mother-infant feeding behaviour as a possible determinant of obesity was studied. Seventy-eight healthy primiparous couples and their newborn children were divided into three groups according to parents' weight status (normal weight parents; one overweight and one normal weight parent; both parents overweight). Infants' weight and length measurements were obtained at birth and at 6 months of age. Mother-infant dyads were observed during feeding sessions at 55-77 hr after birth, at 2 weeks, 1, 2, 4 and 6 months postpartum. Feeding behaviour of mother and infant did not differ, nor did mother-infant interaction differ between the three groups throughout the observation period. However, infant weight status, although not different at birth, differed significantly at 6 months of age. Bartholomew's test showed the proportion of infants greater than or equal to 90%il increased significantly from infants of normal weight parents to infants of one overweight and one normal weight parent, to infants both parents of whom were overweight (chi 2 = 6.904, c = 0.44, P less than or equal to 0.01). While data of this study do not show any behavioural differences between overweight and normal weight parents and their offspring, they confirm results reported by other researchers showing children of overweight parents at risk of becoming overweight at 6 months of age as well.

Family life and cardiovascular risk: implications for the prevention of chronic disease

While individual life style has been related to increased risk for cardiovascular disease, as well as other chronic diseases, little attempt has been made to explore the influence of family life style upon risk factor development. This review examines findings from behavioral and epidemiological studies which suggest a relationship between family environmental factors and levels of risk characteristics. Concepts provided by a Family Systems Approach are used to direct attention to crucial family issues which influence this relationship in light of the potential for prevention of cardiovascular disease. We conclude that preventive approaches could be improved in three ways: by directing primary prevention efforts toward pre-school children within the context of their family, by directing adult intervention efforts toward consideration of their marital life style in relation to each risk factor, and by directing future research efforts toward clarifying the currently elusive relationship between family psychosocial factors and cardiovascular risk.

Drew program for obesity treatment

Obesity affects about 30 percent of adult Americans, causing significant morbidity. Contributing problems of poor self-concept and oral gratification may require intense therapy. This study was designed to see whether a multidisciplinary approach combining diet, exercise, and behavioral therapy, and run by a clinic staff would be effective.Patients were Afro-American women at least 20 percent above ideal body weight. Attrition reduced sample size, making statistical analysis difficult; however, some general trends were observed. One half of those who completed the program lost one pound per week and maintained the loss during a two-month follow-up. Those who succeeded showed a higher level of dissatisfaction and greater ability to respond to external motivation in psychological tests. Weight loss was comparable to that achieved in behavioral groups described in the literature.

Childhood obesity

Several conclusions can be drawn on the basis of the research reviewed: Obese children are more likely to become obese adults than are their thinner peers. Parent weight may interact with child weight status in the etiology of adult obesity. Obese children with obese parents are more likely to become obese adults than are obese children with thin parents. The prediction of adult obesity from childhood obesity improves with the age of the child. As the obese child gets older, he or she is more likely to become an obese adult. The inclusion of parents in the treatment process is important for the success of childhood weight control. It may be best to see the parent and child separately in treatment meetings rather than together. Children with thin parents may do better in weight control than children of obese parents. Adherence to exercise is likely to be a problem with obese children, and the choice or design of an exercise program should take these adherence problems into account. Nutritional adequacy of the child's diet should be evaluated both in terms of what the child is eating as well as in terms of the prescribed diet. Likewise, growth of the obese child during dieting should be monitored and should be related to expected height, which can be based on parent height. In summary, childhood obesity is a problem that places a child at great risk for becoming an obese adult. However, a growing body of research has emerged that has identified important risk factors for the development of obesity in children. Likewise, treatment methods have been developed that produce significant and long-lasting effects on childhood weight status. Continued development of treatment methods would be of great potential importance in the prevention and treatment of this prevalent problem.

Lipids, lipoproteins and fatty acid composition in obese adolescents undergoing a very low calorie diet

Sixteen obese adolescents (mean +/- SD age: group I 12.5 +/- 2.1 and group II 12.0 +/- 2.5 years) were treated at least 3 weeks with two different very low calorie diet (VLCD) regimens. The VLCD in group I contained 33g proteins, 25.5g carbohydrates and 0.7g fat (240 kcal, 1004KJ) and in group II 44g protein, 33g carbohydrates and 0.9g fat (320 kcal, 1339KJ). After the 3 weeks treatment total serum cholesterol decreased from 180 +/- 34 mg/dl in group I and 184 +/- 34 mg/dl in group II respectively, to 125 + 16 mg/dl and 120 + 22 mg/dl. This fall was mainly due to the highly significant decrease of LDL-cholesterol. VLDL-cholesterol, HDL-cholesterol and triglycerides in group I remained almost unchanged. In group II triglycerides increased significantly from 81 +/- 19 mg/dl to 104 +/- 19 mg/dl and HDL-cholesterol decreased slightly. The LDL-C HDL-C- ratio in both groups improved considerably. Fatty acid composition of the serum lipids changed only slightly: In total serum linoleic acid levels declined slightly in group I and remained constant in group II. Linoleic acid content in cholesterylesters declined moderately in group I from 37.5 +/- 5.6% to 34.8 +/- 5.6% whereas arachidonic acid increased slightly in both groups. In phospholipids, oleic acid declined in both groups significantly, linoleic acid declined significantly in group I and arachidonic acid increased in group I significantly. Similar changes occurred in triglycerides. After 3 weeks treatment with a practically fat free alimentation no biochemical signs of essential fatty acid deficiency could be detected.

Weight control in adolescent girls: a comparison of the effectiveness of three approaches to follow-up

The purpose of the project was to compare the effectiveness of three different types of follow-up of a weight control program in assisting adolescent girls to achieve and maintain ideal body weight. During the initial phase of the weight control program, subjects attended two sessions of approximately one hour each for eight weeks. One session each week included theory and practice of physical exercise. The other session was devoted to behavioral control of eating and diet therapy. After eight weeks, 18 subjects were divided randomly into three groups for follow-up: Group 1--monthly measurements and reinforcement of behavioral, diet, and exercise components of the weight control program; Group 2--monthly measurements; and Group 3--annual measurements. Fifteen subjects completed the 12-month follow-up program. Mean weight loss during follow-up of Group 1 was 3.65 kg, Group 2 was 1.90 kg, while Group 3 had a mean weight gain of 3.44 kg. The results suggest that regular follow-up may be a critical element in successful weight control programs for adolescent girls.

Obesity: prevention is the treatment

Prevention of obesity at all ages is a matter of considerable concern for health professionals. A review of current theories of the etiology of obesity provides the basis for discussion of preventive measures at critical developmental stages throughout the life cycle. Good nutrition during pregnancy, breast feeding, and avoiding early introduction of solid foods are advocated to avoid obesity during infancy. For the young child, healthy eating habits and sufficient physical exercise are prescribed to prevent the accumulation of excess weight. Psychological and social difficulties make weight loss difficult for obese adolescents. The advantages and disadvantages of diet, anorectic drugs, exercise, and behavior modification are discussed. Adult-onset obesity is often easier to prevent and treat than is juvenile-onset obesity. Intervention is basically the same as that for adolescents. The role of health professionals is clear: encouragement of behavior consistent with sound nutrition and good health before excess weight is gained, early recognition of overweight individuals, and assistance in the choice of corrective measures.