In tackling childhood obesity, effective programs focus on the whole family

Editor's Note: The Children’s Health Matters blog is a space dedicated to sharing important new research, policy ideas, clinical findings and journalism on child health and development. The blog features an occassional column with new insights offered by two of Children’s Hospital Los Angeles’ leading community-based research teams. This post is from Megan Lipton-Inga, director of program development for the Diabetes and Obesity Program at Children's Hospital Los Angeles.

In 2000, a new weight management program at Children’s Hospital Los Angeles was in its infancy. Overweight and obese youth were learning about proper nutrition and engaging in exercise classes. “The instructors were bringing the children back to waiting room at the end of the class and their parents would be sitting there with McDonalds Big Macs and milkshakes waiting to pick them up,” recalled Sharon Braun, a dietitian who helped launch the program.

After the first session we realized we needed to regroup and create a program that involved the entire family. There was no way that we could expect kids to make any significant changes to their eating habits if their parents were not educated and motivated to model those same behaviors we were trying to teach their children. That marked the beginning of “Kids N Fitness,” an evidence-based weight management program that brings together the entire family over a six-week period to learn about creating and maintaining a healthy lifestyle though nutrition, physical activity, goal setting and self-monitoring. 

In the program, families learn about nutrition topics such as the five food groups and the healthiest options within each group. They learn how to read a food label, strategies for mindful eating, appropriate portion sizes, and tips for grocery shopping. Then, while the children participate in physically active games, the parents take part in a facilitated discussion where they learn the importance of modeling healthy behaviors and strategies for supporting their children in eating healthfully and being more active.

The rate of childhood obesity has tripled over the past 30 years. Despite the abundance of weight management pills, programs and advice out there, there’s no magic bullet or one-size-fits-all approach to solve the problem. That’s not surprising, as obesity is caused by a complex interaction of genetic, biological, and environmental forces. Factors such as one’s prenatal environment, pollution, and economics all play a part. Technological advances that make it possible to do almost everything from your seat, and the abundance of highly calorie, nutritionally empty food on every corner only makes the problem worse. Even for adults with every resource available to them, losing and maintaining a healthy weight is often a lifelong (and unsuccessful) struggle. Children are dependent on parents to purchase and prepare their food, and children typically adopt the preferences and eating behaviors of their parents. And children who are overweight stand a 70 percent chance of becoming overweight adults.

The family centered approach is key in addressing the problem. Having child and parent learn together and make health goals together encourages the growth of a family support system and helps parents serve as positive role models. It also reduces the stigma and blame that many overweight children experience, particularly if the child is the only overweight family member. Communication becomes more open. The child is empowered to assume a partnership role in his or her health and behaviors.

In group interventions such as these, where a health educator is providing nutrition information and suggestions for making healthier decisions, the parents are released from being the “nagger.” If anything, the children often become the food police for the parents and keep them in line. Family centered programs provide an opportunity for parents and children to socialize with peers who are working to manage their weight as well, which can provide further social support and friendship.

Of the more than 1,000 children who have participated in the Kids N Fitness program at the hospital and in the community, children typically reduce their body mass and body fat percentage. In a study of kids who participated in the 12-week Kids N Fitness program, there were slight but significant reductions in body mass, as well as reductions in risk factors such as a triglycerides, blood pressure and total cholesterol over the study period. Researchers also documented improvements in emotional well-being and behavior that went along with the weight loss.

Teaching children and the adults in their life to recognize features of their home, school, workplace, and community that make it difficult to eat nutritiously helps them to start making small changes. For a father who won’t give up soda, this might mean keeping his soda stash in the trunk of the car so the rest of the family isn’t tempted. It can mean that a parent dedicates two hours on Sunday to chop vegetables that can be quickly thrown into sauces, salads, or stir fries throughout week as a time saver. It can mean that rewards for good behavior now are a family trip to the beach rather than a trip for donuts. A whole-family approach can also mean that parents will feel more confident in saying no to junk food or excessive screen time, and children will be more willing to try healthier foods, as both together learn to create a day to day lifestyle with fewer temptations. We know that a strong support system is integral. Parents — and sibling and grandparents — who jump on the bandwagon to make small changes in the home together have the greatest chance of success.

Many health institutions are now offering similar programs, which are more cost-effective than one-on-one clinical prevention and treatment. More and more institutions are also teaming with community partners to offer classes in the community. For example, our program has adapted its curriculum for after school programs, faith-based settings, summer camps, and community clinics.

We now have a stronger evidence base for what works in such programs. Education is important, which means learning about appropriate portion sizes, how to read nutrition labels, mindful eating, and how to identify obesity risk factors. But motivation is crucial as well. Effective programs offer encouragement, set goals, lend support, and offer health-promoting incentives. The challenge is finding resourceful ways to engage the parents and families in light of busy schedules and competing priorities — and to find funding sources to sustain programs such as these.

Taken together, such family centered interventions can help parents and children make informed small behavior changes to their snacking, shopping and meal preparation habits. With support and persistence, those little changes can add up to large changes over time. 

Photo courtesy of CHLA/Megan Lipton-Inga.