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Five-year follow-up of a cognitive-behavioural lifestyle multidisciplinary programme for childhood obesity outpatient treatment

Abstract

Objective:

Aim of this study is to examine the 5-year follow-up results of MI PIACE PIACERMI (I like to like and please myself), a cognitive-behavioural programme intended to obtain a weight growth regulation over an extended period.

Design:

Longitudinal observational clinical study.

Setting:

Hospital-based programme, through outpatient activities.

Subjects:

Thirty-one simple obese children, 13 boys and 18 girls, 6–12 years of age on admission.

Intervention:

The intervention was carried out by a multidisciplinary team (paediatrician, cognitive-behavioural psychologist, physical therapist). It employed cognitive-behavioural techniques, nutrition education, promotion of physical activity, setting a high value on free play in motion. The programme actively involves parents. The following measurements were taken on admission and at 5-year follow-up: height, weight, waist circumference, body mass index (BMI), BMI standardized (BMI-SDS), and adjusted BMI (a-BMI) as actual BMI/BMI (50th percentile)*100. Dietary habits were investigated by interview and 24-h recall. Parents completed the Family Habit Inventory and the Child Behaviour Checklist (CBCL). Motor skills were assessed by using Frostig's test.

Results:

The dropout rate was 35.5 %. In subjects who completed the 5-year follow-up, the mean and s.d. of BMI-SDS and a-BMI were, respectively, 4.23±0.71 and 54.7%±9.0 at baseline and 2.74±0.85 and 43.2%±17.3 at the last visit. Waist circumference decreased. Family habits improved significantly. Total energy intake was significantly reduced. Emotional and social aspects of obesity-related behaviours showed positive changes. Motor skills globally improved.

Conclusions:

The study provides further evidence that positive persistent results may be obtained in obese children with treatment programmes combining a lifestyle centred approach, parental involvement, nutrition education and cognitive-behavioural strategies.

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References

  • Achenbach TM (1991). Manual for the Child Behavior Checklist/4-18 and 1991 Profile. University of Vermont: Burlington.

    Google Scholar 

  • Amador M, Ramos LT, Morono M, Hermelo MP (1990). Growth rate reduction during energy restriction in obese adolescents. Exp Clin Endocrinol 96, 73–82.

    Article  CAS  PubMed  Google Scholar 

  • Barlow SE, Dietz WH (1998). Obesity evaluation and treatment: expert committee recommendations. The Maternal and Child Health Bureau, Health Resources and Services Administration and the Department of Health and Human Services. Pediatrics 102, E29.

    Article  CAS  PubMed  Google Scholar 

  • Bingham SA (1991). Limitations of the various methods for collecting dietary intake data. Ann Nutr Metab 35, 117–127.

    Article  CAS  PubMed  Google Scholar 

  • Bohler T, Alex C, Becker E, Becker R, Hoffmann S, Hutzler D et al. (2004). Quality indicators for ambulatory health education programme for overweight and obese children and adolescents. Gesundheitswesen 66, 748–753.

    Article  CAS  PubMed  Google Scholar 

  • Braet C, Van Winckel M (2000). Long-term follow-up of a cognitive-behavioral treatment program for obese children. Behavior Ther 31, 55–74.

    Article  Google Scholar 

  • Braet C, Van Winckel M, Van Leeuwen K (1997). Follow-up results of different treatment programs for obese children. Acta Paediatr 86, 397–402.

    Article  CAS  PubMed  Google Scholar 

  • Cole TJ (1990). The LMS method for constructing normalized growth standards. Eur J Clin Nutr 44, 45–60.

    CAS  PubMed  Google Scholar 

  • de Mello ED, Luft VC, Meyer F (2004). Individual outpatient care versus group education programs. Which leads to greater change in dietary and physical activity habits for obese children? J Pediatr 80, 468–474.

    Article  Google Scholar 

  • Edmunds L, Waters E, Elliot EJ (2001). Evidence based management of childhood obesity. BMJ 323, 916–919.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Eliakim A, Friedland O, Kowen G, Wolach B, Nemet D (2004). Parental obesity and higher pre-intervention BMI reduce the likelihood of a multidisciplinary childhood obesity program to succeed – a clinical observation. J Pediatr Endocrinol Metab 17, 1055–1061.

    Article  PubMed  Google Scholar 

  • Eliakim A, Kaven G, Berger I, Friedland O, Wolach B, Nemet D (2002). The effect of a combined intervention on body mass index and fitness in obese children and adolescents – a clinical experience. Eur J Pediatr 161, 449–454.

    Article  PubMed  Google Scholar 

  • Epstein LH (1996). Family-based behavioural intervention for obese children. Int J Obes Relat Metab Disord 20 (Suppl 1), S14–S21.

    PubMed  Google Scholar 

  • Epstein LH, McCurley J, Wing RR, Valoski A (1990a). Five-year follow-up of family-based behavioral treatments for childhood obesity. J Consult Clin Psychol 58, 661–664.

    Article  CAS  PubMed  Google Scholar 

  • Epstein LH, Valoski A, Wing RR, McCurley J (1990b). Ten-year follow-up of behavioral, family-based treatment for obese children. JAMA 264, 2519–2523. (bis).

    Article  CAS  PubMed  Google Scholar 

  • Epstein LH, Wing RR, Koesle R, Valoski A (1984). The effects of diet plus exercise on weight change in parents and children. J Consult Clin Psychol 52, 429–437.

    Article  CAS  PubMed  Google Scholar 

  • Fernandez JR, Redden DT, Pietrobelli A, Allison DB (2004). Waist circumference percentiles in nationally representative samples of African-American, European-American, and Mexican-American children and adolescents. J Pediatr 145, 439–444.

    Article  PubMed  Google Scholar 

  • Frostig M, Ma slow P (1977). Educazione motoria. Teoria e pratica. Edizioni Omega: Torino.

    Google Scholar 

  • Golan M, Crow S (2004). Targeting parents exclusively in the treatment of childhood obesity: long-term results. Obes Res 12, 357–361.

    Article  PubMed  Google Scholar 

  • Istituto Nazionale di Ricerca per gli Alimenti e la Nutrizione (2003). Linee Guida per una Sana Alimentazione Italiana.

  • Jiang JX, Xia XL, Greiner T, Lian GL, Rosenqvist U (2005). A two year family based behaviour treatment for obese children. Arch Dis Child 90, 1235–1238.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Kirk S, Zeller M, Kirk S, Zeller M, Claytor R, Santangelo M et al. (2005). The relationship of health outcomes to improvement in BMI in children and adolescents. Obes Res 13, 876–882.

    Article  PubMed  Google Scholar 

  • Korsten-Reck U, Kromeyer-Hauschild K, Wolfarth B, Dickhuth HH, Berg A (2005). Freiburg Intervention Trial for Obese Children (FITOC): results of a clinical observation study. Int J Obes 29, 356–361.

    Article  CAS  Google Scholar 

  • Lifshitz F, Moses N (1989). A complication of dietary treatment of hypercholesterinemia. Am J Dis Child 14, 537–542.

    Article  Google Scholar 

  • Mellin LM, Slinkard LA, Irwin Jr CE (1987). Adolescent obesity intervention: validation of the SHAPEDOWN program. J Am Diet Assoc 87, 333–338.

    CAS  PubMed  Google Scholar 

  • Must A, Jacques PF, Dallal GE, Bajema CJ, Dietz WH (1992). Long-term morbidity and mortality of overweight adolescents. A follow-up of the Harvard Growth Study of 1922 to 1935. N Engl J Med 327, 1350–1355.

    Article  CAS  PubMed  Google Scholar 

  • Nemet D, Barkan S, Epstein Y, Friedland O, Kowen G, Eliakim A (2005). Short- and long-term beneficial effects of a combined dietary-behavioral-physical activity intervention for the treatment of childhood obesity. Pediatrics 115, 443–449.

    Article  Google Scholar 

  • Pi-Sunyer FX (1991). Health implication of obesity. Am J Nutr 53, 1595S–1603S.

    Article  CAS  Google Scholar 

  • Pope A, McHale S, Craighead E (1992). Migliorare l’autostima. Edizioni Centro Studi Erickson, Trento: Trento.

    Google Scholar 

  • Prochaska JO, Di Clemente CC (1982). Transteoretical therapy: towards a more integrative model of change. Psychotherapy 19, 276–288.

    Article  Google Scholar 

  • Progeo software 2002. www.proge.it.

  • Reinehr T, Kersting M, Wollenhaupt A, Alexy U, Kling B, Strobele K . et al. (2005). Evaluation of the training program ‘OBELDICKS’ for obese children and adolescents. Klin Padiatr 217, 1–8.

    Article  CAS  PubMed  Google Scholar 

  • Rolland-Cachera MF, Cole TJ, Sempe M, Tichet J, Rossignol C, Charraud A (1991). Body mass index variations: centiles from birth to 87 years. Eur J Clin Nutr 45, 13–21.

    CAS  PubMed  Google Scholar 

  • Sacher PM, Chadwick P, Wells JC, Williams JE, Cole TJ, Lawson MS (2005). Assessing the acceptability and feasibility of the MEND Programme in a small group of obese 7-11-year-old children. J Hum Nutr Diet 18, 3–5.

    Article  CAS  PubMed  Google Scholar 

  • Speiser PW, Rudolf MC, Anhalt H, Camacho-Hubner C, Chiarelli F, Eliakim A et al. (2005). Obesity Consensus Working Group. Childhood obesity. J Clin Endocrinol Metab 90, 1871–1887.

    Article  CAS  PubMed  Google Scholar 

  • Summerbell CD, Ashton V, Campbell KJ, Edmunds L, Kelly S, Waters E (2003). Interventions for treating obesity in children. Cochrane Database Syst Rev 3, CD001872.

    Google Scholar 

  • Tanner JM, Whitehouse RH (1976). Clinical longitudinal standards for height, weight, height velocity, weight velocity, and stages of puberty. Arch Dis Child 51, 170–179.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Vignolo M, Rossi F, Bardazza G (2005). Mi piace piacermi. Franco Angeli: Milano.

    Google Scholar 

  • Warschburger P, Fromme C, Petermann F, Wojtalla N, Oepen J (2001). Conceptualisation and evaluation of a cognitive-behavioural training programme for children and adolescents with obesity. Int J Obes Relat Metab Disord 25 (Suppl 1), S93–S95.

    Article  PubMed  Google Scholar 

Download references

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Vignolo, M., Rossi, F., Bardazza, G. et al. Five-year follow-up of a cognitive-behavioural lifestyle multidisciplinary programme for childhood obesity outpatient treatment. Eur J Clin Nutr 62, 1047–1057 (2008). https://doi.org/10.1038/sj.ejcn.1602819

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