Background: The prevalence of overweight in U.S. children and its associated costs have increased over the past few decades, placing this population at a greater risk of adult obesity. Maintaining weight loss is a particular challenge because of high relapse rates. Wilfley and colleagues assessed two weight maintenance programs (behavioral skills maintenance [BSM] and social facilitation maintenance [SFM]) implemented after the completion of a family-based behavioral weight loss program.
The Study: The randomized controlled trial included children seven to 12 years of age who were 20 to 100 percent overweight and who had at least one overweight parent. Exclusion criteria were participation in a concurrent weight loss program, use of weight loss medications, or psychiatric conditions. Patients participated in a five-month state-of-the-art weight loss program that included diet and physical exercise and were randomly assigned to the BSM program, SFM program, or no maintenance program. The weight loss and maintenance programs included family-based and individual treatment.
The weight maintenance programs involved 16 individually tailored weekly sessions targeted at achieving a three-pound weight maintenance range. The BSM program focused on motivation, identifying and avoiding risks, and developing family-based habits geared toward permanent change. The SFM program encouraged parents to match their children with active peers, addressed self-image issues and teasing, and focused on building social support. Outcome measures were body mass index (BMI) z scores and the percentage over median BMI (i.e., percentage overweight). Various scales were also administered to assess self-efficacy in choosing healthy foods, responding to teasing, and self-image issues. In all three groups, assessments were conducted at baseline, five months, nine months, 17 months, and 29 months.
Results: Of the 204 enrollees, 150 were randomly assigned to a maintenance group or the control group (most of the other 54 participants withdrew from treatment). Regardless of intervention, patients attended 17 out of 20 weight loss sessions, and the two active intervention groups did not differ in median number of maintenance sessions attended. In the initial weight loss phase, most children achieved lower BMI z scores and percentages overweight. In the maintenance phase, the individual BSM and SFM groups and the two groups combined (pooled active groups) had better short-term results than the control group. After two years, the SFM group and pooled active groups had significantly lower BMI z scores than the control group, but the BSM group did not. Regarding percentage overweight, the SFM group did better than the control group, but the difference was not significant; the BSM and pooled active groups did not do better than the control group.
There was no significant difference in BSM psychosocial targets (perceived self-efficacy in choosing healthy foods and perceived ability to overcome barriers to physical activity) between the BSM and SFM groups. Each active group demonstrated better BSM psychosocial targets than the control group, although short- and long-term results differed. Regarding SFM psychosocial targets, children in the SFM group coped better with teasing, received more peer encouragement to eat healthy, and enlisted more friends to support them in physical activity than those in the control group. The BSM group did not demonstrate better SFM psychosocial targets than the control group. Evaluation of the relationship between social problems and body weight showed that, compared with the control group, children in the SFM group who had a low level of social problems had greater decreases in percentage overweight and BMI z scores.
Conclusion: Children who received SFM treatment had less weight regain (as measured by BMI z score) than controls. There were no significant short- or long-term differences between intervention groups. Weight loss maintenance was especially effective in patients in the SFM group who had a low level of social problems. Because this study focused on weight loss parameters rather than health outcomes and because the effectiveness of the initial weight loss intervention was lost in the control group, the authors conclude that more efforts should be focused on weight loss maintenance in children.