A randomized, controlled trial that followed overweight children who had successfully participated in a university-based weight control clinic found that two different family-based maintenance programs were significantly more effective than the use of no maintenance program at helping sustain their weight loss.
However, the positive effects of the interventions waned over a 2-year follow-up, Denise E. Wilfley, Ph.D., of the department of psychiatry, Washington University, St. Louis, and her associates wrote.
The authors stated that, to the best of their knowledge, this was the first large-scale study to examine the effect of weight loss interventions in overweight children (JAMA 2007;298:1661–73).
A total of 204 healthy 7- to 12-year-olds (mean age of about 10 years), who were 20%–100% above the median body mass index (BMI) for age and sex and had at least one parent with a BMI (kg/m
At the program's completion, 150 of the children and at least one of their parents or a guardian were randomized to one of three groups: a control group (n=49), which involved no follow-up, or one of two maintenance programs. The behavioral skills maintenance (BSM) program (n=51) has a cognitive-behavioral approach that emphasizes self-regulation behaviors and relapse-prevention strategies; the social-facilitation maintenance (SFM) program (n=50) involves using techniques to help parents “facilitate child peer networks that support healthy eating and physical activity” and targets factors, such as teasing from peers or body image, that may impede children from engaging in physical activity. The programs lasted for 4 months, for a total of 16 weekly sessions.
At the end of the 4 months, the children in the two maintenance programs had maintained their weight significantly better than did children in the control group, based on the two outcome measures in the study: BMI z score (determined using age-specific and sex-specific median BMI), and the percentage overweight (percentage above median BMI).
The results of children in the BSM group, of those in the SFM group, and of these two groups combined indicated that these participants maintained their BMI z score and percentage overweight significantly better than did those in the control group.
Over the 2-year follow-up, which was initiated after completion of the active weight-loss program, both outcome measures were significantly higher among participants in the SFM group, and also when the SFM and BSM groups were combined, compared with controls, but the results for the BSM group alone were not significantly different than were those of the controls.
At 2 years, for the percentage overweight measure, the SFM group had better results than did the control group, and these results approached statistical significance. But there were no significant differences between the results of the BSM group or the pooled results, compared with those of controls.
The results in the BSM or the SFM groups were not significantly different for either of the outcomes measures at any of the time points.
Among participants with a lower level of social problems, long-term weight maintenance was better among those in the two maintenance programs, compared with those in the control group.
Although the investigators acknowledged some limitations to the study, their results indicate that extended contact with either the BSM or SFM approach in a maintenance program “improves weight loss maintenance in a childhood overweight population in comparison with a weight loss program at least in the short-term, with some evidence for sustained long-term efficacy among more socially adept children receiving an SFM treatment,” they concluded.
“The general decline in effects following extended treatment suggests the need for the development of continuous care models for children, as in the adult weight loss field, which finds that longer ongoing contact helps maintain initial weight loss and improves health outcomes.”