Dietary glycaemic index has also been implicated in weight reduction.123 Two small, short-term studies of obese adolescents reported increased weight loss on a diet with reduced glycaemic load, but the numbers were small and long-term effects are unknown.124,125
Strategies to change dietary habits to a more calorie-reduced intake are based on behavioural principles, of which Bandura’s social cognitive model126 is the most widely used. The model is based on the notion that lifestyle changes succeed through cognitively driven, intentional behaviours such as self-monitoring, goal setting, and rewarding of successful change. A widely adopted approach in children uses the trafic light system, which was developed by Epstein and colleagues.127 Motivational interviewing has been advocated as an especially useful technique for patients who might not feel ready for change.128 It is a so-called empathetic way of being, including reffective listening, shared decision making, and agenda setting.129 American Heart Association guidelines recommend motivational interviewing for paediatric weight management.130 However, the effectiveness of this approach versus other behavioural approaches is not known.
Most weight reduction programmes are provided by outpatient clinics. In one study, investigators examined an inpatient intervention and showed some evidence of effectiveness.131,132 Although the school setting has not been regarded as a site for treatment of childhood obesity (as opposed to prevention), promising results from a randomised trial of classroom-based weight reduction in obese Mexican-American children suggest that this venue needs further examination.133 Residential summer camps for obese adolescents have short-term effectiveness,134 but long-term effects remain unknown.
Internet intervention for obese adolescents has been examined, without promising results.135
Better research into non-pharmacological treatment is urgently needed, especially into extent of caloric restriction and effectiveness of increasing energy expenditure.
Consensus guidelines for age-appropriate safety monitoring of weight-reducing regimens are also needed to ensure appropriate height growth and biological and social development. Since randomised clinical trials are costly, multicentre collaborative research with common protocols might be the most cost-effective and generalisable approach. In view of ageing populations worldwide and increasing use of technology-intensive medical treatments, allocation of increasingly scarce medical resources will demand more evidence-based information for treatment of childhood obesity. Questions such as how often an obese child should have dietary counselling will not be readily answered unless improved evidence is made available.
Joan C Han, Debbie A Lawlor, Sue Y S Kimm
Lancet 2010; 375 - 1737-48
Published Online May 6, 2010 DOI - 10.1016/ S0140- 6736(10)60171-7
Unit on Growth and Obesity, Program on Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, DHHS, Bethesda, MD, USA (J C Han MD); MRC Centre for Causal Analyses in Translational Epidemiology, Department of Social Medicine, University of Bristol, Bristol, UK (Prof D A Lawlor PhD); and Department of Internal Medicine/Epidemiology, University of New Mexico School of Medicine, Albuquerque, NM, USA (S Y S Kimm MD)
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