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Kids' Obesity Program Focuses on More Than the Food

Family members awarded 'points' for success in changing lifestyles

TUESDAY, Nov. 26, 2002 (HealthDayNews) -- When an overweight youngster sheds pounds at an obesity program in Brooklyn, N.Y., the custom is to honor the parents.

"Kids get a kick out of giving rewards to their parents for making lifestyle changes, too," says Maureen Haugh, a pediatric psychologist and assistant director of The Kids Weight Down Program at Maimonides Medical Center.

This shared approach is an example of the appeal and success of the five-year-old, non-profit program that involves the whole family in a child's obesity problem.

The clinic approaches weight loss through a variety of disciplines: medical treatment, psychological supervision and family involvement. The intense 12-week program has doctors and health professionals at Maimonides aiming for lifestyle changes that are pervasive and long-lasting.

"Our program is unique in that there are lot of resources being used in a setting where there is constant positive reinforcement, a no-blame setting and realistic goals for weight management," says the program's director, Dr. Henry Anhalt.

And it seems to be working. Anhalt says what will be most telling are five- and 10-year follow-ups of the program participants, data that is not yet available. So far, however, reports on the approximately 2,000 children who've completed the program indicate a three- and four-year success rate of approximately 35 percent, measured by follow-up Body Mass Index's (BMI) of the children.

Not a moment too soon. Obesity in kids is now epidemic in the United States, according to the National Institutes of Health. The number of children who are overweight has doubled in the last two to three decades; currently one child in five is overweight. The increase is in both children and adolescents, and prevalent throughout all age, race and gender groups.

The Brooklyn program includes, first, a medical workup. Type II (so-called adult onset) diabetes is increasingly common among overweight children, as is high cholesterol, and doctors look to see if the child needs medical treatment.

Second, the child has an age-appropriate evaluation with a psychologist to assess his or her eating patterns and behavior around food and to see if there are any eating disorders or depression.

"The whole idea is to implement lifestyle changes for the whole family, to get the parent out of the role of a policeman limiting the intake of the child and put him or her in the role of a coach, encouraging their children to make changes and to make changes themselves, as well," says Haugh.

Strategies include having the child keep food and activity logs, which are reviewed with parents at the end of the day. The children are all encouraged to follow a diet based on research from Buffalo psychologist's Leonard H. Epstein's "Stop Light Diet for Children." This program divides foods into red (high-calorie, low-density sweets), yellow (staples like lean meats and fish) and green (fruits and vegetables that don't exceed 20 calories).

Equally important is to increase the family's physical activity. "We don't call it exercise, which is viewed as drudgery and sounds punitive, but activity level," says Haugh.

Recommendations include taking family bike rides, making a game of finding stairs to climb instead of taking elevators, or parking as far away as they can from a store and walking there.

And then there are the rewards. Children and parents each get points for participating in the program. Children get points for things like completing their food and activity logs every day, limiting their intake of "red" foods and losing or not gaining weight. Parents' points come from reviewing the food and activity logs with their children, establishing regular meal and snack times and keeping healthy foods in the house.

The parents reward the children with things like a bowling trip, a bike ride, or a walk along the Coney Island boardwalk, while children can reward their parents by cleaning up their room, letting the parents sleep in one morning, or reading to their them.

"Childhood obesity is truly a family affair, and as the incidence of obesity increases, these programs are going to become more and more important," says Maureen Storey, director of Center for Food and Nutrition Policy at Virginia Tech, in Alexandria, Va.

What To Do

The American Heart Association explains why physical activity is so important for children. For advice on helping your overweight child, visit The Mayo Clinic.

SOURCES: Henry Anhalt, D.O., director, The Kids Weight Down Program, Maimonides Medical Center, Brooklyn, N.Y.; Maureen Haugh, Ph.D., pediatric clinical psychologist, and assistant director, The Kids Weight Down Program, Maimonides Medical Center, Brooklyn, N.Y.; Maureen Storey, director, Center for Food and Nutrition Policy at Virginia Tech, Alexandria, Va.
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