For Some Obese Children, Changing Eating Styles Beats Caloric Restriction

One of the greatest public health concerns is the recent upsurge in obesity among children. According to a Belgian psychologist, moderately overweight children can benefit from eating and lifestyle changes rather than using a traditional weight-loss diet (Clin Child Psychol & Psychiatry 1999; 4:1359).

Dr. Caroline Braet recently described a “child-friendly program” for treating moderately obese children, or those above 120% to 180% of normal weight. Dr. Braet and the University of Ghent youth-obesity group believe that one of the reasons dieting fails for children is that too much emphasis is given to slimming and too little to the possible negative effects of dietary restraint, which can be linked to development of eating disorders. Thus, the program stresses normalizing eating habits rather than weight loss.

One essential: Including the entire family

The program uses “a family-friendly” approach. Because the cooperation of the parents or other family members is crucial, and obesity often affects several family members, both parents and the obese child are always seen together during the assessment phase and during one family session before the treatment begins. Family sessions then resume monthly during the follow-up phase, for a year.

The program begins with an evaluation and establishment of a stable caloric balance for the child. Then, using cognitive behavioral techniques, the therapist promotes healthy eating rather than any reduction in calories. Children learn self-regulation skills during 12 once-a-week sessions lasting about an hour.

Good results reported in 1- and 5-year follow-ups

Since 1983, more than 200 obese children have been treated in the program. In a controlled study, at one-year follow-up, the mean weight loss was 9.84% for children treated individually, 13.08% for those treated as a group, and 14.67% for those who were enrolled in a treatment program that included a summer camp. The control group had a weight change in the opposite direction: +2.52%. At the first 5-year follow-up, between 70% and 80% of the children who were treated had not gained weight. In this group, 40% were no longer obese.

Not all excess weight will be lost

One of the more difficult things for family and child to accept is that children will not lose all their excess weight. Instead, a modest amount of weight loss is predicted and the rationale of “weight control” is emphasized. Some of the phrases used in the program are “eat differently, not less,” or “maintain your weight while you are growing; it’s the same as losing weight.”

One limitation of the program is that for some obese children weight stabilization may not be enough. The program seems to work best with young children who are not overly obese and who have a lot of growth potential. Modified programs are necessary for postpubertal children and those who are severely obese (>180% of normal weight). In addition,

Dr. Braet notes that using this approach as the sole treatment for obesity is contraindicated in children with a history of trauma such as physical or sexual abuse or those with internalized problems such as depression.