Family-Based Lifestyle Interventions May Help Obese Children Lose Weight

Family-Based Lifestyle Interventions May Help Obese Children Lose Weight

Laurie Barclay, MD From Medscape Today

January 26, 2009 — Family-based lifestyle interventions that modify diet and physical activity and that include behavioral therapy can help obese children lose weight and maintain that loss for at least 6 months, according to the results of a Cochrane systematic review posted online January 21 in the Cochrane Database of Systematic Reviews.

"Child and adolescent obesity is increasingly prevalent, and can be associated with significant short- and long-term health consequences," write Hiltje Oude Luttikhuis, from Beatrix Children's Hospital and University Medical Center Groningen, in Groningen, the Netherlands, and colleagues. "In order to support clinicians in determining the most appropriate form of treatment, paediatric weight management guidelines exist in many countries to promote best practice, but at present many of these recommendations are based on low grade scientific evidence."

The goal of this systematic review was to evaluate the efficacy of lifestyle, drug, and surgical interventions to treat obesity in childhood. The reviewers searched CENTRAL on The Cochrane Library Issue 2 2008, MEDLINE, EMBASE, CINAHL, PsycINFO, ISI Web of Science, DARE, and NHS EED from 1985 to May 2008 without language restrictions. Bibliographies of retrieved articles were also consulted.

Inclusion criteria for the review were randomized controlled trials of lifestyle interventions (eg, dietary, physical activity, and/or behavioral therapy interventions) and drug and surgical interventions to treat obesity in children younger than 18 years. The interventions could have been conducted with or without the support of family members. A minimum of 6 months of follow-up was required or 3 months for actual drug therapy.

Exclusion criteria were interventions that specifically addressed the treatment of eating disorders or of type 2 diabetes or that included participants with a secondary or syndromic cause of obesity. Using criteria in the Cochrane Handbook, 2 reviewers independently evaluated trial quality and extracted data, and they also contacted study authors for additional information when needed.

The 64 randomized controlled trials identified that met criteria enrolled a total of 5230 participants. In 12 studies, lifestyle interventions were directed at physical activity and sedentary behavior, whereas 6 studies addressed diet and 36 evaluated behaviorally oriented treatment programs. Ten studies looked at drug interventions with metformin, orlistat, or sibutramine. None of the identified studies of surgical intervention met inclusion criteria. Intervention design, outcome measurements, and methodologic quality varied considerably in the included studies.

Meta-analyses showed that lifestyle interventions involving children and lifestyle interventions in adolescents with or without the addition of orlistat or sibutramine were associated with a reduction in overweight at 6 and 12 months of follow-up. Randomized controlled trials of drugs showed a range of adverse effects.

Limitations of this review include those of the reviewed studies, such as insufficient power, publication bias, failure to account for missing data in analyses, analysis not based on intent-to-treat, variations in the definitions of fatness in children, and limited duration of follow-up.

"While there is limited quality data to recommend one treatment program to be favoured over another, this review shows that combined behavioural lifestyle interventions compared to standard care or self-help can produce a significant and clinically meaningful reduction in overweight in children and adolescents," the study authors conclude. "In obese adolescents, consideration should be given to the use of either orlistat or sibutramine, as an adjunct to lifestyle interventions, although this approach needs to be carefully weighed up against the potential for adverse effects. Furthermore, high quality research that considers psychosocial determinants for behaviour change, strategies to improve clinician family interaction, and cost-effective programs for primary and community care is required."

The University Medical Center, Groningen, Netherlands; The Children's Hospital at Westmead, Sydney, Australia; the Centre for Food Physical Activity and Obesity Research, University of Teesside, United Kingdom; the Wolfson Research Institute, University of Durham, United Kingdom; and the Australian National Health & Medical Research Council, Australia, supported this study. One of the review authors is a coauthor on 3 of the studies included in the Cochrane Review. Two other authors are involved in the design and conduct of a potentially eligible study for this review.

Cochrane Database Syst Rev. Published online January 21, 2009.