Experts recommend 25-hour counseling program to treat childhood obesity

Tori Asgard, 11, prepares baked salmon with honey-dijon glaze with her mother, Arlene, on Friday. Tori was not obese, but she completed the Why Weight? program at St. Joseph’s Hospital.

EDMUND D. FOUNTAIN | Times

Tori Asgard, 11, prepares baked salmon with honey-dijon glaze with her mother, Arlene, on Friday. Tori was not obese, but she completed the Why Weight? program at St. Joseph’s Hospital.

For years, parents, doctors and educators heard little but criticism, judgment and conflicting advice on childhood obesity. But now experts can offer hope: medical research that shows focused treatment can help kids slim down.

An independent panel of experts is announcing today that obese children between 6 and 18 years should be steered to weight management programs that provide more than 25 hours of intensive counseling on diet, exercise and behavioral change over six months.

The recommendation, based on a rigorous review of the scientific evidence, comes from the U.S. Preventive Services Task Force, the highly regarded federal panel that recently ignited controversy with its advice that not all women in their 40s need annual mammograms.

On the obesity front, however, its guidance is likely to generate relief rather than protests. Finally, there is a strategy clearly worth pursuing in the fight against the childhood obesity epidemic.

"The good news is we now have things that we know work," said Dr. Ned Calonge, who as chairman of the task force was dissatisfied with the lack of evidence on treatments when the panel last reviewed the issue in 2005.

"Our recommendation is not to say this is easy," he added. "This really takes dedicated work and it takes a comprehensive program in order for us to get these benefits."

That won't surprise South Tampa mother Arlene Asgard, whose 11-year-old daughter, Tori, has struggled with her weight. To fend off a bigger problem down the road, they recently participated in the Why Weight? program at St. Joseph's Children's Hospital.

For six weeks, both mother and daughter attended the weekly two-hour sessions that combined diet and nutrition instruction with physical activity. They left the program resolved to make lasting lifestyle changes.

Tori now participates in a basketball league. Mother and daughter applied what they learned to a recent dinner at Outback Steakhouse, where they decided to split an 8-ounce filet mignon into two diet-friendly portions.

"I learned there was a lot more than just losing weight," Tori said. "You should eat right and exercise, and I learned ways to do that."

The task force's experts in primary care and preventive medicine reviewed 20 studies on childhood obesity treatment. Most involved the behavioral intervention therapy now recommended. Seven studies added drug treatment to behavioral therapies for older children. The task force found benefits and some small risks, but is not advocating drug therapy in today's report.

The report, published today in Pediatrics, the journal of the American Academy of Pediatrics, is geared to obese children, or those with a body mass index at or above the 95th percentile for age and gender. Overweight children, or those between the 85th and 95th percentiles, possibly could benefit, but there wasn't enough evidence for the task force to include them in the recommendation.

The panel found no evidence that weight-management programs had "adverse effects on growth, eating-disorder pathology, or mental health."

Children didn't drop a lot of weight in the studies. But the report said the results still were reason for hope in fighting an epidemic that worries health officials since obese children often become obese adults. For 8-year-olds, the largest loss was about 13 pounds. For 16-year-old boys, it was around 23 pounds.

"A little goes a long way," said Calonge, who is also the chief medical officer of Colorado's public health department. "That's a critical gain in the right direction that if maintained throughout the rest of childhood and into adulthood will translate into real improvements in health."

Still, more research is needed, he noted, including long-term followup. And there's not evidence yet that shorter programs can yield similar benefits.

But he hopes the recommendation will sway more insurers to cover comprehensive weight-loss programs for childhood obesity, now mostly available only to families who can afford them. The St. Joseph's program costs $200 for six weeks. All Children's Hospital in St. Petersburg offers its eight-week program for $75 at locations in Pinellas, Hillsborough and Pasco counties.

The recommendation should also guide pediatricians to refer patients to programs, rather than trying to handle weight-loss issues during brief checkups.

Clinicians often tell parents "your child is overweight, you need to make these changes, and maybe give them a handout on nutrition," said Jana Butler, manager of community health and weight management at St. Joseph's Hospital. "Now it's taking it a step further and saying, 'Your child is really in a risk category for their weight and it's time for a referral to a dietitian or to a program.' "

Parents may worry about a possible stigma attached to seeking weight-loss help, but experts say they can help children deal with bullying and confidence issues.

"The overweight child wants to take our program when another child has noticed that he or she is overweight," said Sarah Krieger, a registered dietitian and instructor at All Children's Fit4AllKids. "It's not because, 'My clothes are too tight.' It's because they are being made fun of."

The new recommendation isn't going to solve the obesity epidemic, the task force chairman acknowledged. But neither will faulting parents and children for becoming overweight, without offering them solutions.

"We try to back off the blaming the patient," said Calonge, describing obesity as a medical problem. "You have this condition, we need to deal with it, and we can help you do that."

Letitia Stein can be reached at lstein@sptimes.com or (813) 226-3322.

Tips on treating childhood obesity

Experts from All Children's Hospital in St. Petersburg and St. Joseph's Hospital in Tampa share tips for treating childhood obesity:

• Involve the family. If everyone's exercising and eating healthy together, the child with a weight problem is more likely to be successful addressing it.

• Parents should lead by example; just telling a child to eat right and exercise isn't enough.

• Involve the child in meal-planning and preparation. And remember that healthy lifestyle choices should be fun, not a chore.

See if your child is overweight or obese with the BMI calculator at apps.nccd.cdc.gov/dnpabmi.

Looking for a weight management program for children? Ask your pediatrician for suggestions. Fit4AllKids, the program offered by All Children's Hospital, is beginning its winter sessions. For more information, call (727) 767-6923.

Experts recommend 25-hour counseling program to treat childhood obesity 01/18/10 [Last modified: Monday, January 18, 2010 10:58am]

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