Efficacy of maintenance treatment approaches for childhood overweight: a randomized controlled trial.

CONTEXT: No trials for childhood overweight have examined maintenance interventions to augment the effects of initial weight loss programs. OBJECTIVES: To determine the short-term and long-term efficacy of 2 distinct weight maintenance approaches vs no continued treatment control following standard family-based behavioral weight loss treatment for childhood overweight, and to examine children's social functioning as a moderator of outcome. DESIGN, SETTING, AND PARTICIPANTS: A parallel-group, randomized controlled trial conducted between October 1999 and July 2004 in a university-based weight control clinic. Participants were 204 healthy 7- to 12-year-olds, 20% to 100% above median body mass index (BMI) for age and sex, with at least 1 overweight parent. Children enrolled in 5 months of weight loss treatment and 150 were randomized to 1 of 3 maintenance conditions. Follow-up assessments occurred immediately following maintenance treatments and 1 and 2 years following randomization. INTERVENTIONS: Maintenance conditions included the control group or 4 months of behavioral skills maintenance (BSM) or social facilitation maintenance (SFM) treatment. MAIN OUTCOME MEASURES: BMI z score and percentage overweight. RESULTS: Children receiving either BSM or SFM maintained relative weight significantly better than children assigned to the control group from randomization to postweight maintenance (P< or =.01 for all; effect sizes d = 0.72-0.96; mean changes in BMI z scores = -0.04, -0.04, -0.05, and 0.05 for BSM alone, SFM alone, BSM and SFM together, and the control group, respectively). Active maintenance treatment efficacy relative to the control group declined during follow-up, but the effects of SFM alone (P = .03; d = 0.45; mean change in BMI z score = -0.24) and when analyzed together with BSM (P = .04; d = 0.38; mean change in BMI z score = -0.22) were significantly better than the control group (mean change in BMI z score = -0.06) when examining BMI z score outcomes from baseline to 2-year follow-up. Baseline child social problem scores moderated child relative weight change from baseline to 2-year follow-up, with low social problem children in SFM vs the control group having the best outcomes. CONCLUSIONS: The addition of maintenance-targeted treatment improves short-term efficacy of weight loss treatment for children relative to no maintenance treatment. However, the waning of effects over follow-up, although moderated by child initial social problems, suggests the need for the bolstering of future maintenance treatments to sustain effects. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00301197.

Prevalence, characteristics, and correlates of teasing experiences among overweight children vs. non-overweight peers.

OBJECTIVE: Information regarding the prevalence, nature, sources, and psychosocial correlates of teasing was obtained for overweight (OV) children (10 to 14 years of age) vs. non-overweight (non-OV) peers. It was hypothesized that weight-related teasing would be negatively correlated with self-esteem in specific domains and with enjoyment of physical/social activities and positively correlated with loneliness, bulimic behaviors, body dissatisfaction, and enjoyment of sedentary/isolative activities. RESEARCH METHODS AND PROCEDURES: Teasing experiences and psychosocial correlates were assessed among OV children from a fitness camp and a demographically similar school sample of non-OV children. RESULTS: Among the OV children, appearance-related teasing was more prevalent, frequent, and upsetting, involved disparaging nicknames focusing more on weight rather than less stigmatized aspects of appearance, and more often perpetrated by peers in general rather than a specific peer. Degree of teasing within the full sample was significantly associated with higher weight concerns, more loneliness, poorer self-perception of one's physical appearance, higher preference for sedentary/isolative activities, and lower preference for active/social activities, all but the latter association holding up above and beyond actual weight status and demographics. Among OV children, teasing was associated with bulimic behaviors. Associations with type of teasing showed specificity, with weight-related teasing predicting weight and appearance variables and competency-related teasing related to social domain factors. DISCUSSION: When frequency, intensity, emotional impact, and stigmatized content are examined, findings indicate that teasing is more severe for OV children. Effective interventions are needed to help victims cope with and prevent further weight-related teasing, which may improve peer functioning, enhance weight control efforts, and reduce risk for future eating disturbance.

Validation of the telephone and in-person interview versions of the 7-day PAR.

PURPOSE: To validate the 7-d Physical Activity Recall (PAR) telephone interview version and its activity intensity categories. METHODS: Seventy-four adults (47 women, 27 men), ranging in age (18-67) and activity levels, were interviewed by phone and in-person using the same PAR protocol. Each participant wore a TriTrac-R3D accelerometer for 10 d. Validity was assessed by comparing the phone and in-person PAR interviews with the TriTrac-R3D data. RESULTS: Sixty-nine adults (44 women, 25 men) were used for all statistical analyses. Intraclass correlations between the two PAR interviews for total minutes per week of activity were r = 0.96, and r = 0.94 for moderate, r = 0.97 for hard, and r = 0.97 for very hard intensity activities. Pearson product moment correlations between the phone PAR and TriTrac-R3D for total minutes per week of physical activity were r = 0.43, and r = 0.31 for moderate, r = 0.39 for hard, and r = 0.78 for very hard intensity activities. Pearson correlations between the in-person PAR and TriTrac-R3D for total minutes per week of physical activity were r = 0.41, and r = 0.33 for moderate, r = 0.43 for hard, and r = 0.74 for very hard intensity activities. Participants overestimated the amount of physical activity in both interviews as compared with the TriTrac-R3D. CONCLUSION: The phone and in-person versions of the PAR are equivalent measures for self-reported physical activity. Regardless of age, body mass index, or physical activity level both interview methods had similar estimates for total minutes per week of moderate, hard, and very hard activity. Correlations between each interview method and the TriTrac-R3D were lower for moderate and hard activities as compared with very hard activities.

Overweight children's barriers to and support for physical activity.

OBJECTIVE: As the epidemic of overweight increases among youth, research needs to examine factors that may influence children's participation in weight-related health behaviors. This study examined overweight children's perceived barriers to and support for physical activity compared with nonoverweight children. RESEARCH METHODS AND PROCEDURES: Barriers to and support for physical activity were examined among 84 overweight children attending a summer fitness camp or a university-based weight loss clinic. Barriers and support levels were then compared with those of 80 nonoverweight children of a similar age range. RESULTS: Body-related barriers were the most predominant barrier type among overweight youth, especially among overweight girls. Overweight children, particularly girls, reported significantly higher body-related, resource, and social barriers to physical activity compared with nonoverweight children and lower levels of adult support for physical activity. DISCUSSION: Overweight children may be particularly vulnerable to body-related barriers to physical activity, and reducing such barriers may serve as physical activity intervention points most relevant for overweight youth. Future interventions may also benefit from enhancing support for physical activity from adults and peers.