Children Do Better Than Their Parents In Taking Weight Off, Keeping It Off Longer

BUFFALO, N.Y. -- Obese children take pounds off easier and keep them off longer than their obese parents, the first study to compare weight loss and weight-loss maintenance of children and adults enrolled in the same treatment program has shown.

The follow-up study of participants in weight-loss treatment programs showed that at 10 years, more than 20 percent of the children had maintained a 20 percent decrease in overweight, compared to less than 1 percent of the adults.

“A tremendous amount of resources are devoted to treating obesity in adulthood, with variable success,” said lead researcher Leonard H. Epstein, Ph.D., University at Buffalo professor of psychology, social and preventive medicine, and nutrition.

“These results suggest that as a public-health issue, it may be a better use of limited resources to focus on preventing obesity in children, instead of trying to reduce obesity after it is well established in adults, with the associated morbidity and mortality. ”

The study appeared in the September issue of Obesity Research.

Epstein, who heads UB’s Behavioral Medicine Laboratory, has worked in the field of childhood obesity for more than 20 years. Since 1980, he has conducted numerous studies comparing the effectiveness of different treatment programs in helping children lose weight and keep it off. The most effective program for the children has proven to be one that involves parents in treatment and reinforcement.

He currently works with overweight children between the ages of 8 and 12 who participate for four months in a comprehensive, family-based weight-control program called the Stoplight Diet Program. The Stoplight Diet teaches children to eat a nutritionally-balanced diet by linking foods to the three signals on a traffic light: high-calorie foods are red and should be eaten rarely, moderate-calorie foods are yellow and can be eaten in moderation, and low-calorie foods are green and can be eaten freely.

The program combines diet with regular exercise, behavior modification and a maintenance program. It is the only treatment program in the country to document success in children over an extended period.*

A 10-year follow-up of children enrolled in four randomized treatment studies, co-authored by Epstein and published in Health Psychology in 1994, showed that 34 percent had decreased their overweight by 20 percent or more. In contrast, adult obesity research has shown consistently that adults seldom maintain the weight they lose.

Given these contrasting findings, Epstein and colleagues reasoned that children may respond better to weight-loss intervention than adults.

As a first effort to investigate this hypothesis, Epstein launched the current study, which compared treatment results of children and parents from 113 families who had participated in behavioral weight-control conducted by his group. Children and parents in these programs were given similar diet, exercise and behavior-change recommendations.

The study cohort was composed of children 8-12 years old who were 20-100 percent overweight for age, sex and height, plus at least one obese parent from each family who followed the same treatment regimen.

At six months, about 40 percent of children and 20 percent of adults showed at least a 20 percent decrease in pounds overweight. While both children and parents regained weight after this initial drop, children’s weight gain at five years stabilized at about 7 percent below baseline and remained there at 10 years. Adults, on the other hand, returned to their baseline weight by five years and at 10 years weighed about 7 percent more than they did at the beginning of the study, results showed.

Epstein mentioned several reasons why children may experience better results than adults. He said an important factor is the nature of most adult treatment programs. “Typically, adults are treated by themselves, while children are treated within the family, which provides important support for habit changes and maintenance.” Other reasons include the natural tendency of children to be more active, a difference in motivation in children and adults, children's fewer number of fat cells and the fact that children's habits aren’t as deeply ingrained.

He called for more studies to replicate these findings and to better understand the mechanisms that may be responsible for the differences in effectiveness.

The study was completed while Epstein was a member of the Department of Psychiatry at the University of Pittsburgh. Additional researchers on the study were Alice M. Valoski of the School of Public Health, University of Pittsburgh; Melissa A. Kalarchian of Rutgers University, and James McCurley of the University of Pittsburgh School of Medicine.

The research was supported by grants from the National Institutes of Health.

*EDITOR’S NOTE: Epstein’s Stoplight Diet Program will be featured on CBS’s “48 Hours” on Thursday, Nov. 16.