University of Michigan
Department of Pediatrics
Evidence-Based Pediatrics Web Site

Question

• What diet and exercise programs have been found to be effective long-term treatments for childhood obesity?

Clinical Bottom Lines

1. The earlier the intervention, the better.
   
2. Diet, activity, and behavior all important.
   
3. Effective: balanced reduced calorie diet.
   
4. Ineffective: hypocaloric diets, protein modified fasts, fibre supplements, Fenfluramine.
   
5. Diet with "Healthy physical activities" as opposed to "exercise" or "calisthenics."
   
6. Enforcing a decrease in sedentary behaviors had greater effect than encouraging increase in activity (1 study).
   
7. Exercise is more effective than no exercise!! (with 3 studies to prove it!).
   
8. Behavior modification is an important component.
   
9. Parental effects: parents better at causing change in children than children are (but another study showed that children are more easily treated for obesity than their parents).

Summary of Key Evidence

1. A recent paper reviewed the treatment of obesity.¹
   
2. Unclear whether all original trials in review were randomized, although some conclusions were lumped together with claim of coming only from RCT's.
   
3. Methods section describes searching multiple databases, but no effort is made to include unpublished trials.
   
4. The article was a compilation of results from other review articles, and no effort was made to assess validity of the reviews!
   
5. "Some treatment strategies seem to be working, but there is no clear consistency in effectiveness."
   
6. Different interventions were used in different trials.
   
7. Paper not explicit about how many different trials supported each conclusion.
   
8. With the exception of age, demographic data of studies was not addressed (i.e. race, SES, country of study).
   

Additional Comments

• Attitudes about and social acceptance of obesity may differ among race, culture, and SES.
• Prevalence of obesity may differ between races, cultures, SES classes, and countries.
• Much work still needs to be done in this area!
  
  

Citation

1. Edmunds L, Waters E, Elliott EJ. Evidence based management of childhood obesity. BMJ 2001; 323:pp.
   
2. Glenny A-M, O'Meara S. Systematic review of interventions in the treatment and prevention of obesity. NHS Centre for Reviews and Dissemination, University of York. York: York Publishing Services, 1997.
   
3. Epstein LH, Myers MD, Raynor HA, Saelens BE. Treatment of pediatric obesity. Pediatrics 1998; 101:554-70.
   
   

CAT Author: Patty McNally, MD

CAT Appraisers: John G. Frohna, MD, MPH

Date appraised: May 20, 2002