Family focus may help obese kids to succeed in treatment

Parents should be involved in treatment programs for their obese children, according to a new scientific statement published in Circulation: Journal of the American Heart Association.

"In many cases, the adults in a family may be the most effective change agents to help obese children attain and maintain a healthier weight," said Myles S. Faith, Ph.D., chair of the American Heart Association's statement writing group and associate professor of Nutrition at the Gillings School of Global Public Health, University of North Carolina – Chapel Hill. "To do so, the adults may need to modify their own behavior and try some research-based strategies."

The authors evaluated research on the outcomes of behavioral change strategies that included high involvement by parents and other adult caregivers of obese children in the context of treatment programs. The treatment programs were typically multi-disciplinary ― implemented by a team of psychologists, medical staff and dieticians in a university or hospital clinic setting.

Access to such intensive treatment programs is limited for many families across the country.

"While these strategies were implemented by healthcare professionals in a treatment program, the psychological principles on which they are based provide sound guidance for families of obese children as well," Faith said.

Strategies that have been linked to better outcomes include:

• As a family, identify specific behaviors that should be changed.
• Set goals and monitor progress. The goals should be clearly defined, such as reducing or limiting television screen time to no more than two hours per day.
• Provide a home environment that encourages healthier choices. For example, limit temptations at home, such as higher calorie desserts, while providing access to a variety of fruits from which children can choose.
• Parents should praise their children's progress and, instead of criticizing, use "slips" as an opportunity to help children identify ways to make different choices if the same situation arises again.
• Food shouldn't be a reward or withheld as punishment.
• Keep track of progress toward goals, using a written or online tracker.

Faith noted that not all types of parental involvement is helpful, which could explain inconsistent findings across studies.

More research is needed to identify specific parenting strategies that will help children be successful with weight control in the short and long term, and the studies should include more ethnic diversity, the statement authors wrote.

Other research gaps include the need for better data on improving the accuracy of parental perception of their child's overweight/obese status, the involvement of grandparents or other caregivers in implementing/reinforcing desired diet/lifestyle behaviors, and quantifying the impact of technology-based strategies (e.g., internet, smart phones) for different age/gender/socio-demographic groups.