Seven steps to help kids slim down

By Jeannine Stein
LA Times Blog

Childhood obesity is a thorny issue without simple solutions, but that hasn't daunted healthcare experts who work diligently to come up with viable proposals to help kids lose weight and get in shape.

The most recent strategy is the "Seven Steps to Success: A handout for parents of overweight children and adolescents," designed by physicians and weight-loss experts to be worked in progressive stages: medical management, education, environmental changes, support groups, two forms of cognitive behavior therapy (clinic or short-term, and long-term) and bariatric surgery.

The steps, published in the February issue of the journal Obesity Management, are a reaction to a detailed article published in the journal Pediatrics in 2007. That article also outlined a multi-pronged approach to obesity, including prevention, structured weight management that includes medical screenings, physical activity and diet; a multidisciplinary intervention with food monitoring and structured exercise; and very-low-calorie diets and bariatric surgery (this updated a less comprehensive plan published in that journal in 1998).

But not everyone in the field of childhood obesity was satisfied with all the suggestions outlined in the Pediatrics paper -- some objected to the education-oriented proposals. "An educational approach is very popular in the United States, but it's very ineffective," said Daniel Kirschenbaum, professor of psychiatry and behavioral sciences at Northwestern University Medical School in Chicago and co-author of the Obesity Management article. Providing information about eating more fruits and vegetables may be well-meaning, he added, but it's not so useful for prompting sustainable changes.

The seven steps ratchet up in intensity, requiring more effort and commitment to achieve results. "Try one intervention," he said, "and if in a month you're not making progress, try another one. Science has taught us that you can tell pretty quickly if something isn't working."

The plan presumes that the entire family is involved with the process -- previous studies have shown that better results come from a collaborative effort, not from telling one kid he has to eat chicken breasts and broccoli while the rest of the family gobbles pizza. As children segue into adolescence, he added, they can do more on their own. For behavioral therapy, the plan suggests starting with groups such as Weight Watchers or Take Off Pounds Sensibly that offer support, education and accountability and allow parents and children to work together. "These are very low-cost alternatives where people can come in every week," he said, "but they have to be willing to work." If those don't provide suitable results, parents can opt for more intense group sessions run by trained weight-loss professionals.

Bariatric surgery, Kirschenbaum said, may be a viable option for certain kids and teens, although it's not a decision to enter into lightly. Most clinics require patients to meet parameters such as being quite overweight and providing proof they've tried other weight-loss methods. Support -- before and after surgery -- and behavior modification are also essential components.

How should parents approach the list? Kirschenbaum says they shouldn't go it alone because navigating the steps may prove intimidating and frustrating. "They should take it to their primary care physicians and get some help in making sense of it," he said. It works in reverse, too -- healthcare professionals can show it to their patients to begin a discussion about weight loss. "You should talk about it, see what you think. If you don't set a target for something, you're not going to reach it."