Family-based lifestyle interventions that not only modify diet and physical activity but also include behaviour therapy programs can help obese children lose weight and maintain that loss for at least six months. This Cochrane Review also found that in adolescents the effect lasts for at least 12 months. Adding weight controlling drugs orlistat or sibutramine to behaviour change programs for adolescents may provide additional benefits.
These findings mark a change in opinion. A systematic review performed in 2003 could not find enough data to draw any conclusions about the effects of different programs. This time the researchers identified 64 randomised controlled trials involving 5230 participants, enabling them to see some definite effects.
"It is now clear that family-based, lifestyle interventions that include a behavioural program aimed at changing diet and physical activity provide significant and clinically meaningful decreases in overweight and obesity in both children and adolescents compared with standard care or self help regimes," says lead researcher Hiltje Oude Luttikhuis, who works at Beatrix Children's Hospital and the Department of Epidemiology in Groningen, Netherlands.
The worldwide obesity epidemic in young people is continuing to gain pace. The International Obesity Taskforce now claims that, worldwide, 10% of 5-17 year olds are overweight and 2-3% are obese. Paediatric obesity rates now stand at 30% for the Americas and 20% for Europe. Socio-economically disadvantaged children in developed countries and children of higher socio-economic status in developing countries are more likely to be overweight. "This highlights the importance of effective treatment strategies for children and young people already affected by the problem of obesity," states Oude Luttikhuis's collaborator, Professor Louise Baur, a paediatrician at The Children's Hospital at Westmead, and the University of Sydney.
There are many questions left unanswered. "We need to find out what types or aspects of different interventions work better for different groups of children, depending on their age, gender, socioeconomic background, faith or ethnic groups. The importance of self-esteem in influencing how successful an intervention will be, and whether there are any characteristics of individual families or patients that could help identify success, require further effort by researchers," says Oude Luttikhuis.