Weight Gain: Managment and Treatment

Managment and Treatment

Some treatments involving children and adolescents have produced substantial short-term improvements in percent overweight, blood pressure, and lipid profiles. However, longer-term effects of treatment generally have been disappointing. The most successful interventions have been family based and behaviorally oriented. Such treatments include parents in the treatment process, usually as a target of treatment along with the child; a diet program that promotes adherence and provides sufficient nutrition for growth; modification of the child's food environment at home and in school; a physical activity program emphasizing life-style activities instead of a specific exercise regimen; specific strategies to reduce sedentary time; behavior modification techniques, including self-monitoring of diet and activity behaviors; identification of potential barriers and problem-solving; cognitive restructuring techniques to help the child cope with difficult situations, stressful times, and dietary lapses; parental skills training and role modeling; and a contracting and reward system emphasizing positive reinforcement for both proximal and distal goals.

State-of-the-art programs incorporating these elements in research settings have produced 10-year success in up to about one-third of participating children. These are much better results than those from adult treatment programs.

Perhaps the most important factor in weight control treatment is the readiness of the child and the family. Although the clinician participates in treatment, the family has the primary role. A clinician can provide the requisite knowledge and methods, but until a family is ready to change, the necessary changes will not occur. Therefore, when there is a lack of agreement between parent and child, or between two parents, it is appropriate to defer treatment until a consensus is reached. In some cases, participation of a family therapist may facilitate treatment. Although family therapy-based interventions for obesity have yet to be proven effective, a child's weight problem is often a focus of family conflict within treatment-seeking families. Consequently, changes made as part of a treatment program may substantially alter family dynamics.

In children without complications of obesity that require immediate weight reduction, the initial goal of treatment should be to maintain weight or to slow the rate of gain. Once weight maintenance is achieved, progression to a weight loss goal of about 1 pound per month is appropriate for most children and adolescents. This strategy allows children to "grow into" their weight over time without risking adverse health effects from more rapid weight loss. In such cases, a combination of increased activity levels and moderate calorie restriction can be effective. Reductions in total dietary fat content and calorically dense foods, through substitutions and eliminations alone, can produce a sufficient caloric deficit without changing the general pattern of food consumption for the child or family. Diets that are low in calories and fats and high in complex carbohydrates and fiber are not associated with complications in older children and adolescents, and such diets lead to loss of body fat without significantly compromising growth in height. However, frequent monitoring of growth and intermittent assessment by a nutritionist is recommended to ensure that the diet is nutritionally adequate.