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The impact on parental weight, activity and cardiovascular risk factors of treating childhood obesity

 

Obesity is a problem that is often shared by both parents and their children. Obesity treatment is usually targeted at either the parents or the children. If childhood obesity is being investigated, the children are nearly always involved (either with or without parental involvement). This study is interesting because it examines a way to treat childhood obesity without the children being involved; the parents are the sole agents of change. The authors believe that this approach will not only result in weight loss in the children; benefits will also be observed in their overweight parents. In this study they examine what happens to parents' weight, physical activity and cardiovascular disease risk factors when their children are being treated for obesity and test their belief by comparing two approaches; one targeting the parents only, the other targeting the children only. (The children's results are reported in a separate paper.)

Message

The differences between the two approaches weren't astonishing but if treating childhood obesity using parents as the sole agents of change results in just a few or small improvements in parental weight, physical activity and cardiovascular disease risk, compared with giving children sole responsibility, then this approach is worth using. However, to be able to choose the best approach, the impact of a programme targeting children with parental involvement also needs to be assessed and with a much larger number of participants.

Reference

M Golan et al. Impact of treatment for childhood obesity on parental risk factors for cardiovascular disease. Preventive Medicine 1999 29: 519-526.

Study

Sixty obese children (more than 20% over ideal weight for age, height and gender) aged between 6 and 11 years, with both parents living at home, were assigned randomly to either an experimental programme (targeting parents only) or a conventional programme (targeting children only). The two groups of children (30 in each) were similar according to gender, age and percentage of overweight.

Experimental - parent only - programme

Fourteen one-hour sessions were conducted by a clinical dietician for both parents. They were instructed to alter the family sedentary lifestyle, reduce fat intake, decrease exposure to food stimuli, apply behavioural modifications and practice relevant parenting skills. They were not instructed directly to lose weight. The children were not involved.

Conventional - children only - programme

Thirty sessions were conducted by a clinical dietician for the children. They were instructed to restrict their energy intake, reduce fat intake and increase physical activity. Problem solving, cognitive restructuring and using social support was also included. Apart from data collection the parents were not involved.

The following were measured in children and parents at the beginning and end of the programme (twelve months later): weight, height, percentage of overweight, blood pressure, fasting plasma glucose levels, insulin levels, total cholesterol, LDL, HDL, triglyceride concentrations. Sociodemographic, and family eating and activity questionnaires were completed at the beginning and at the end of the programme. The latter examined level of physical activity, exposure to food, and poor eating behaviours (eating while standing, eating with accompanied activity, eating following stress and eating between meals).

Results

There were no differences between the two groups of parents in terms of age, height, weight or percentage of overweight. In the experimental group 15 mothers and 21 fathers were obese (more than 20% overweight) and in the conventional group, 12 mothers and 17 fathers were obese.

The rate of attendance was similar in both groups: 70% attended the sessions.

Weight loss

Fathers' percentage of overweight decreased significantly in the experimental programme (Table 1). Mothers' overweight did not change in either group.

Risk factors for cardiovascular disease

The only risk factors to show a significant improvement in parents in the experimental programme, compared with the conventional programme, were fathers' glucose levels and mothers' total and LDL cholesterol levels (Table 1).

Table 1. Parental measurements before and after 12 months' treatment of their obese children.

 

Experimental programme

Conventional programme

Initial

At 1 year

Initial

At 1 year

Mothers

Total cholesterol (mg/dl)

183

178

203

205

LDL cholesterol (mg/dl)

118

108

137

142

Fathers

Overweight (%)

30.1

25.7

23.9

24.1

Glucose (mg/dl)

95.9

82.9

84.9

84.8

 

Eating and activity habits

After 12 months, poor eating behaviours improved more in parents in the experimental programme (seven out of a possible eight) than in the conventional programme (three out of eight). Mothers in the experimental programme increased their physical activity by 66%. A significant reduction in having snacks, sweets, cakes and ice cream in the house was reported by parents in the experimental programme compared to the reduction of ice cream only by parents in the conventional programme.

Comment

The authors conclude that the experimental approach resulted in many parental benefits, making this programme ideal for treatment of obesity in children and their overweight parents. While parental changes were observed in the experimental programme, only a few reached statistical significance (and so only these, reported above, can be deemed improvements). However, the number of participants in each group was very small and with a larger sample size these changes may reach significance.

Nevertheless, to expect a programme aimed at reducing obesity in children to impact on parents as well may be a tall order. Parents may experience more difficulty losing weight than their children. Adults have had more time to accumulate unhealthy eating habits and may find them more difficult to give up. The reasons why adults have unhealthy eating habits may be more complicated than their children and need to be dealt with in a different way. Parents can reduce the availability of high fat, high sugar foods to their children, but it is unlikely there will be someone to limit availability of these foods to them (e.g. when the children are at school or in bed). However, this approach may educate parents in healthier eating and activity habits (as observed in this study) which is worthwhile.

Although a larger sized sample is needed to determine how much more beneficial to parents a parent targeted approach is than a child directed one, even if the benefits are few the parent targeted approach would be the one to follow, given the choice. However, there is not enough evidence to suggest that a childhood obesity treatment programme can treat their overweight parents satisfactorily without additional help.