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|Clinicians Digest Jan/Feb 2007 - Page 3|
Assessing Childhood-Obesity Prevention Programs
A metanalysis of 64 childhood-obesity prevention programs has yielded some sobering news: only 13 of them were effective, and of those, only 3 showed effects that lasted more than three years. This is cause for concern in the face of an increasing problem. The Centers for Disease Control says that in the past 20 years, the percentage of obese children aged 6 to11 has risen from 7 percent to almost 19 percent, and the number of obese adolescents has more than tripled, from 5 to 19 percent.
The metanalysis finds that programs targeted to adolescents and children work better than those targeted to preadolescents, says lead author Eric Stice of the Oregon Research Institute. He speculates that because adolescence involves learning about self-regulation, perhaps obesity-prevention programs resonate with that, whereas self-regulation is beyond preadolescents' interest and ability. Parents play an important role in the effectiveness of the programs for younger children, he thinks, providing the necessary motivation and structure.
The study found that girl-only programs were much more effective than mixed-gender ones, and that boy-only programs performed the worst. This wasn't surprising, given that girls, for better or worse, are more weight-conscious than boys. "Males," notes Stice, "aren't as discriminating about the difference between muscle and fat." Surprisingly, programs that stressed physical activity, a common strategy to address obesity, also fell far short. Stice thinks that students prone to obesity may dutifully do their structured exercises and then compensate for the exertion by doing no additional physical activity or by overeating.
Participants' motivation plays a significant role in program effectiveness: in the most successful programs, students chose to participate. So teaching all young people about obesity prevention may not be as effective as targeting specific students and getting their buy-in. A recent metanalysis of depression-prevention programs for children by Jason Horowitz and Judy Garber of Vanderbilt University yielded the same result: the programs that cast the widest net were the least effective.
Most of the 13 programs found to be effective were cardiovascular-disease prevention programs that addressed obesity prevention along with topics like diet, physical activity, and smoking. Although the most effective programs were 2 that solely addressed obesity, more general health programs, concludes Stice, "give more bang for the buck," an important consideration for cash-strapped schools and communities.