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.

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Holiday Tips with Peggy Porter

Each year around this time, my girlfriends and I go on our annual shopping trip to the US. This is usually the time for me when I start my shopping and Christmas preparations.

Although for some, it may seem a bit premature, I always like to remind my readers in early November of how they can begin to implement a few tips now that can save them holiday stress later.

Being a busy, working mom is usually demanding enough, however, throw in a holiday and your stress level can go through the roof if you are not organized.

Each year some of us make the promise to ourselves that we will not be so unprepared or disorganized next Christmas. Somehow though, the year creeps up quickly and we are left with the same frantic schedule.

This year make a commitment to fully embrace and enjoy all that this wonderful time of year has to offer. Don't allow another year to go by feeling pressured, stressed and overwhelmed. You have complete control over what your holiday season will consist of.

Following are a few tips that may be helpful in getting a head start so when the season is in full swing, you can relax and enjoy all the festivities.

* Make your Christmas list now and start shopping. Write down who you have to buy for, any suggestions you have for gifts and approximate amount you want to spend on each person. Knowing how much you want to spend will eliminate a lot of needless shopping for items that are out of your price range. With the help of the computer, you can make a master list and save it so you can reuse each year, adding or changing as necessary. Use the convenience of gift certificates and online as well as catalogue shopping. It can make the whole process so much less demanding (unless you get a big rush being in the stores on the Saturday before Christmas!).

* Organize your gift wrapping essentials. Buy a container to house all your wrapping paper, scissors, ribbons and tags. Have it all ready in a convenient place such as a closet or under the bed. As you buy a gift, bring it home and wrap it. Having all the items together makes it easy to wrap as you buy. I have done this for the last few years and it makes my wrapping effortless, or almost effortless!

* Eliminate clutter now. In order to get ready for the new, get rid of the old. Go through your kids' toy boxes and throw out any broken or incomplete toys. Donate any others that your kids have outgrown and are still in good condition. If your kids are old enough, have them organize their own clothing or toys - a great way to teach them responsibility.

* Take care of your health. With the hectic schedule that many of us have during the season, it is a necessity to eat well and exercise regularly if we want to be energized and able to effectively manage holiday stress.

* Put yourself at the top of your Christmas to-do list. Remember that sacrificing your health and sanity does nothing for you or your family's Christmas spirit. Nourish and renew your own spirit this holiday season and I guarantee it will be the best gift your family will receive. Visit www.peggyporter.com for more great ideas from Canada's Finest Mom Coach!

Think Positive

Practice Positive Thinking

Research shows that your viewpoint and perspective affect your health. People who think positively live more healthful and happy lives.

You can shift your thoughts, first take inventory. What kind of thinker are you?

Keep a journal of your thoughts for 72 hours and reflect on whether your thoughts benefit your well-being or distract from your health. Carry the journal in your pocket, when you drop your children off at school, order lunch, or interact with a colleague, write down what you are thinking on the left side of the page and how you are feeling on the right. In the following 72 hours do the same activity but make a third column for thought replacement, write down alternate positive thoughts to replace your negative thoughts.

When you are late for an appointment and think, "This darn traffic." Replace the thought with "It's so nice to have some peace and quiet in the car for a few minutes."

When your children won't listen and you are thinking, "I am so tired of these squirts." Replace the thought with "I am raising such independent thinkers."

Come on, don't laugh just do it!

Live On The Bright Side In Your Relationship

Business is competitive, we all work hard, drive hard and live hard, BUT maybe it all doesn’t have to be this hard.

Having a successful career, successful relationships and an extraordinary life are complementary - All can be achieved. Get out of damage control and back into thriving relationships at work and at home with practical solutions that will change your life.

a. What Harvard says you can do to increase longevity and happiness
b. Three essential steps to successful relationships at work and home
c. The 5 Factor Makeover

Successful Relationships Lesson #1 – Live on the bright side.
Research shows that your viewpoint and attitude may impact your health, happiness and career success more than your genetics.

Successful Relationships Lesson #2– Choose your shoes. You choose what shoes you walk in, what path you take and who you take it with, be proactive not reactive and choose your shoes, don’t just wear any shoes someone offers you.

Successful Relationships Lesson #3– Learn how to push the STOP Button. Know when to stop yourself from making critical, demeaning, contemptuous and sarcastic comments. Edit yourself. People who avoid saying every critical thought when discussing touchy topics are consistently the happiest and most successful in their relationships.

Successful Relationships Lesson #4– Bored people are boring people.
If you aren’t sure what is interesting and intriguing about you, it’s time to find out. If you hear yourself say, I am tired of this job, life, relationship etc. it’s time to take charge, take a risk and make a change.

Successful Relationships Lesson #5– Forgiveness fosters health.
People often think that if they harbor anger it hurts the person they are angry with but anger only hurts you. People who let anger go and experience forgiveness experience less heart disease, anxiety and depression.

Protein and Children

Yesterday at the Dietary Conference of the Arizona Department of Health Services we had a great discussion on how much protein our children need each day.

As a general rule, between 10 percent and 15 percent of your total calories should come from protein. So, as an adult, if you consume 2,000 calories per day, at least 200 should come from protein, or about 50 grams.

You should try to eat around one gram of protein per one kilogram of body weight, or around 0.4 grams per pound. An easier way to figure this out in your head is to take your weight, divide it in half, and subtract 10.

How does this apply to children. Protein requirements depend on a child's age and weight. For example, the average 4-6 year old preschooler requires about 22 grams of protein a day, while an older 7-10 year old requires about 28 grams of protein a day.

Many children eat sugary foods such as cereal and pop tarts for breakfast when they really would benefit better from a serving of protein with a complex carbohydrate for breakfast. Good Sources of protein include:

Milk
Soy Milk
Eggs
Cheese
Yogurt
Peanut Butter
Lean Meats, Fish, and Poultry
Beans, Tofu, Lentils, and other Legumes
Whole grains, including bread and pasta
Nuts and Seeds

So for breakfast consider serving:

Peanut butter on sliced apples or Asian pears
Almond butter on whole grain toast
whole grain cereal with organic skim milk
Chicken and brown rice with small pieces of cooked vegetables such as carrots or asparagus
Mixed berries with organic yogurt
Buckwheat pancakes with bananas or berries
Melted cheese on whole grain toast
Organic macaroni and cheese
Turkey meatballs with organic tomato sauce

It's easy and fun to feed children protein to fuel their school days, consider reading:

Lunch Lessons: Changing the Way We Feed Our Children by Ann Cooper, Lisa M. Holmes, Mehmet C. Oz.
The Healthy Lunchbox by American Diabetes Association, Marie McClendon, Cristy Shauck, Marie McClendon, Cristy Shauck

http://www.chefann.com/blog/
http://www.eatwellbewell.org/
http://www.angrymoms.org/

Low Glycemic Carbohydrates

We had a great talk last night at the Picky Eaters Class at North Scottsdale Pediatrics. You parents really are amazing!

Here is list of low glycemic carbohydrates to serve with protein in the morning to get your children off to a healthy start. Combing two ounces of protein with one serving of complex carbohydrates is just what your kids need to study and thrive in school all day. Add a few slices of Asian Pear or 1/2 cup fresh berries to the plate. Happy eating for health and wellness!

Beans (Garbanzo, Pinto, Kidney, White), 1/3 cup
Bread (Whole-wheat, Multi-grain, Pumpernickel, Rye, Sourdough, Oatmeal), 1 slice
Corn, 1/2 cup
Couscous (cooked), 1/3 cup
Crackers (whole-grain), 3/4 oz
Oatmeal (cooked), 1/2 cup
Pasta (cooked al dente), 1/2 cup
Peas (green), 1/2 cup
Peas (split, black-eyed), 1/3 cup
Pita (whole-grain, 6 inch), 1/2
Rice (cooked, brown), 1/3 cup
Roll (whole-grain, small), 1
Sweet Potatoes, Yams, 1/3 cup

Chef Ann's nutrition report card is a must hang...

Eating well is an important part of family health and wellness. As an innovator in children's health, Chef Ann, has changed the food delivery patterns in schools across America.

Improve your kids habits in a matter of days.

Check this out, print out Chef Ann's report card and hang it on your fridge. Notice how your kids seek out healthier foods, almost immediately.

http://www.lunchlessons.org/html_v2/ChefAnn_ReportCard.pdf