OJPed  Vol.2 No.3 , September 2012
Action-oriented obesity counseling attains weight stabilization and improves liver enzymes among overweight and obese children and adolescents
Abstract: Introduction: Pediatricians are encouraged to promote behavior modification to reduce childhood obesity and its co-morbidities, yet the effectiveness of office counseling is unclear. We aimed to evaluate if a low-intensity intervention (action-oriented counseling) in a clinic setting results in weight stabilization, and if the effect is modified by a diagnosis of non-alcoholic fatty liver disease (NAFLD). We hypothesized that patients with NAFLD would be more motivated to adhere to the lifestyle goals set in clinic, due to the diagnosis of an obesity-related condition; and, would therefore achieve greater weight reduction compared to similarly overweight and obese patients without a diagnosis of NAFLD. Methods: A retrospective chart review was conducted on 73 (35 male, 38 female) overweight and obese patients (BMI ≥ 85th percentile) attending a pediatric GI clinic between January 2006 and October 2011. Analysis was conducted to determine if lifestyle goals discussed with the patient at each clinic visit were associated with improved BMI, BMI z-score, and liver enzymes. Treatment outcomes among NAFLD patients and similarly obese patients without NAFLD were compared using t-tests and chi-square tests. Results: Of the children evaluated, 74.0% achieved a reduction or stabilization in BMI z-score after 3 months of follow-up. Among NAFLD patients, liver enzymes improved in 72% of those who were able to stabilize or reduce their BMI and among 43% of those who gained weight. Treatment outcome did not significantly differ based on having a diagnosis of NAFLD, although there was a trend towards greater improvements. Conclusion: Our study suggests that action oriented counseling including goal-setting in a low intensity, clinic based approach is effective in improving patient BMI, in the presence or absence of an obesity-related co-morbidity, such as NAFLD. Further, we demonstrated that lifestyle modification led to improvement of liver enzymes in NAFLD patients and may result in other clinically relevant improvements. Longer studies will be needed to determine if the improvements are sustained.
Cite this paper: C. Sylvetsky, A. , A. Welsh, J. , M. Walsh, S. and B. Vos, M. (2012) Action-oriented obesity counseling attains weight stabilization and improves liver enzymes among overweight and obese children and adolescents. Open Journal of Pediatrics, 2, 236-243. doi: 10.4236/ojped.2012.23037.

[1]   WHO (2009) Population-based prevention strategies for childhood obesity. Report of the WHO Forum and Technical Meeting, WHO, Geneva.

[2]   Biro, F.M. and Wien, M. (2010) Childhood obesity and adult morbidites. American Journal of Clinical Nutrition, 91, 1499S-1505S. doi:10.3945/ajcn.2010.28701B

[3]   Barlow, S.E. and the Expert Committee (2007) Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: Summary report. Pediatrics, 120, S164-S192. doi:10.1542/peds.2007-2329C

[4]   Moroshko, I., Brennan, L. and O’Brien, P. (2011) Predictors of dropout in weight loss interventions: A systematic review of the literature. Obesity Reviews, 12, 912-934. doi:10.1111/j.1467-789X.2011.00915.x

[5]   Waters, E., et al. (2011) Interventions for preventing obesity in children. Cochrane Database of Systematic Reviews, 12, p. CD001871.

[6]   Kesten, J.M., Griffiths, P.L. and Cameron, N. (2011) A systematic review to determine the effectiveness of interventions designed to prevent overweight and obesity in pre-adolescent girls. Obesity Reviews, 12, 997-1021. doi:10.1111/j.1467-789X.2011.00919.x

[7]   Barton, M. (2010) Screening for obesity in children and adolescents: US Preventive Services Task Force recommendation statement. Pediatrics, 125, 361-367. doi:10.1542/peds.2009-2037

[8]   Jones, R.A., et al. (2007) The HIKCUPS trial: A multi-site randomized controlled trial of a combined physical activity skill-development and dietary modification program in overweight and obese children. BMC Public Health, 7, 15. doi:10.1186/1471-2458-7-15

[9]   Pinard, C.A., et al. (2012) Smart choices for healthy families: A pilot study for the treatment of childhood obesity in low-income families. Health, Education and Behavior, 39, 433-445. doi:10.1177/1090198111425686

[10]   Vignolo, M., et al. (2008) Five-year follow-up of a cognitive-behavioural lifestyle multidisciplinary programme for childhood obesity outpatient treatment. European Journal of Clinical Nutrition, 62, 1047-1057. doi:10.1038/sj.ejcn.1602819

[11]   Shalitin, S., et al. (2009) Effects of a twelve-week randomized intervention of exercise and/or diet on weight loss and weight maintenance, and other metabolic parameters in obese preadolescent children. Hormone Research, 72, 287-301. doi:10.1159/000245931

[12]   Nemet, D., et al. (2005) Short- and long-term beneficial effects of a combined dietary-behavioral-physical activity intervention for the treatment of childhood obesity. Pediatrics, 115, e443-e449. doi:10.1542/peds.2004-2172

[13]   Sealy, Y.M. and Farmer, G.L. (2011) Parents’ stage of change for diet and physical activity: Influence on childhood obesity. Social Work Health Care, 50, 274-291. doi:10.1080/00981389.2010.529384

[14]   Resnicow, K., Davis, R. and Rollnick, S. (2006) Motivational interviewing for pediatric obesity: Conceptual issues and evidence review. Journal of the American Dietetic Association, 106, 2024-2033. doi:10.1016/j.jada.2006.09.015

[15]   Tripp, S.B., et al. (2011) Providers as weight coaches: Using practice guides and motivational interview to treat obesity in the pediatric office. Journal of Pediatric Nursing, 26, 474-479. doi:10.1016/j.pedn.2011.07.009

[16]   Schwartz, R.P. (2010) Motivational interviewing (patient- centered counseling) to address childhood obesity. Pediatric Annals, 39, 154-158. doi:10.3928/00904481-20100223-06

[17]   Taveras, E.M., et al. (2011) Randomized controlled trial to improve primary care to prevent and manage childhood obesity: The high five for kids study. Archives of Pediatrics and Adolescent Medicine, 165, 714-722. doi:10.1001/archpediatrics.2011.44

[18]   Armstrong, M.J., et al. (2011) Motivational interviewing to improve weight loss in overweight and/or obese patients: A systematic review and meta-analysis of randomized controlled trials. Obesity Reviews, 12, 709-723.

[19]   Colby, S.M., et al. (2005) Brief motivational intervention for adolescent smokers in medical settings. Addictive Behaviors, 30, 865-874. doi:10.1016/j.addbeh.2004.10.001

[20]   Colby, S.M., et al. (2012) Enhanced motivational interviewing versus brief advice for adolescent smoking cessation: Results from a randomized clinical trial. Addictive Behaviors, 37, 817-823. doi:10.1016/j.addbeh.2012.03.011

[21]   Feldstein, S.W. and Forcehimes, A.A. (2007) Motivational interviewing with underage college drinkers: A preliminary look at the role of empathy and alliance. The American Journal of Drug and Alcohol Abuse, 33, 737-746. doi:10.1080/00952990701522690

[22]   Dermen, K.H. and Thomas, S.N. (2011) Randomized controlled trial of brief interventions to reduce college students’ drinking and risky sex. Psychology of Addictive Behaviors, 25, 583-594. doi:10.1037/a0025472

[23]   DiLillo, V. and West, D.S. (2011) Motivational interviewing for weight loss. Psychiatric Clinics of North America, 34, 861-869. doi:10.1016/j.psc.2011.08.003

[24]   Joy, E.A. (2008) Practical approaches to office-based physical activity promotion for children and adolescents. Current Sports Medicine Reports, 7, 367-372.

[25]   Prochaska, J.O. and Velicer, W.F. (1997) The transtheoretical model of health behavior change. American Journal of Health Promotion, 12, 38-48. doi:10.4278/0890-1171-12.1.38

[26]   Prochaska, J.O. and DiClemente, C.C. (1992) Stages of change in the modification of problem behaviors. Progress in Behavior Modification, 28, 183-218.

[27]   Jay, M., et al. (2010) Physicians’ use of the 5As in counseling obese patients: Is the quality of counseling associated with patients’ motivation and intention to lose weight? BMC Health Services Research, 10, 159. doi:10.1186/1472-6963-10-159

[28]   National Center for Health Statistics (2000) CDC growth charts.

[29]   Whitlock, E.P., et al. (2005) Screening and interventions for childhood overweight: A summary of evidence for the US Preventive Services Task Force. Pediatrics, 116, e125-e144. doi:10.1542/peds.2005-0242

[30]   Ford, A.L., et al. (2010) What reduction in BMI SDS is required in obese adolescents to improve body composition and cardiometabolic health? Archives of Disease in Childhood, 95, 256-261. doi:10.1136/adc.2009.165340

[31]   Porter, J.S., et al. (2010) Psychosocial factors and perspectives on weight gain and barriers to weight loss among adolescents enrolled in obesity treatment. Journal of Clinical Psychology in Medical Settings, 17, 98-102. doi:10.1007/s10880-010-9186-3

[32]   Jelalian, E., et al. (2008) Predictors of attrition and weight loss in an adolescent weight control program. Obesity, 16, 1318-1323. doi:10.1038/oby.2008.51

[33]   Tershakovec, A.M. and Kuppler, K. (2003) Ethnicity, insurance type, and follow-up in a pediatric weight management program. Obesity Research, 11, 17-20. doi:10.1038/oby.2003.4

[34]   Sabin, M.A., et al. (2007) Which factors are associated with a successful outcome in a weight management programme for obese children? Journal of Evaluation in Clinical Practice, 13, 364-368. doi:10.1111/j.1365-2753.2006.00706.x

[35]   Reinehr, T., et al. (2009) Lifestyle intervention in obese children with non-alcoholic fatty liver disease: 2-year follow-up study. Archives of Disease in Childhood, 94, 437-442. doi:10.1136/adc.2008.143594

[36]   St. George, A., et al. (2009) Effect of a lifestyle intervention in patients with abnormal liver enzymes and metabolic risk factors. Journal of Gastroenterology and Hepatology, 24, 399-407. doi:10.1111/j.1440-1746.2008.05694.x

[37]   Koot, B.G., et al. (2011) Lifestyle intervention for non-alcoholic fatty liver disease: Prospective cohort study of its efficacy and factors related to improvement. Archives of Disease in Childhood, 96, 669-674. doi:10.1136/adc.2010.199760

[38]   Skelton, J.A., DeMattia, L.G. and Flores, G. (2008) A pediatric weight management program for high-risk populations: a preliminary analysis. Obesity, 16, 1698-1701. doi:10.1038/oby.2008.243

[39]   Barlow, S.E. and Ohlemeyer, C.L. (2006) Parent reasons for nonreturn to a pediatric weight management program. Clinical Pediatrics, 45, 355-360. doi:10.1177/000992280604500408

[40]   Dalton, W.T. 3rd, et al. (2010) Family functioning and children’s response to primary care treatment for overweight: A preliminary study. Journal of Pediatric Nursing, 25, 282-288. doi:10.1016/j.pedn.2009.04.005

[41]   Skelton, J.A. and Beech, B.M. (2011) Attrition in paediatric weight management: A review of the literature and new directions. Obesity Reviews, 12, e273-e281. doi:10.1111/j.1467-789X.2010.00803.x

[42]   Madsen, K.A., et al. (2009) A clinic-based lifestyle intervention for pediatric obesity: Efficacy and behavioral and biochemical predictors of response. Journal of Pediatric Endocrinology and Metabolism, 22, 805-814. doi:10.1515/JPEM.2009.22.9.805

[43]   Williamson, D.A., et al. (2010) Early behavioral adherence predicts short and long-term weight loss in the POUNDS LOST study. Journal of Behavioral Medicine, 33, 305-314. doi:10.1007/s10865-010-9253-0

[44]   Dreimane, D., et al. (2007) Feasibility of a hospital-based, family-centered intervention to reduce weight gain in overweight children and adolescents. Diabetes Research and Clinical Practice, 75, 159-168. doi:10.1016/j.diabres.2006.05.017

[45]   Zeller, M., et al. (2004) Predictors of attrition from a pediatric weight management program. The Journal of Pediatrics, 144, 466-470. doi:10.1016/j.jpeds.2003.12.031

[46]   Cote, M.P., et al. (2004) Service quality and attrition: An examination of a pediatric obesity program. International Journal of Quality in Health Care, 16, 165-173. doi:10.1093/intqhc/mzh015

[47]   Walker, O., et al. (2007) A qualitative study of primary care clinicians’ views of treating childhood obesity. BMC Family Practice, 8, 50. doi:10.1186/1471-2296-8-50

[48]   Holt, N., et al. (2011) Primary care practice addressing child overweight and obesity: A survey of primary care physicians at four clinics in southern Appalachia. Southern Medical Journal, 104, 14-19. doi:10.1097/SMJ.0b013e3181fc968a

[49]   Mercer, S.W. and Tessier, S. (2001) A qualitative study of general practitioners’ and practice nurses’ attitudes to obesity management in primary care. Health Bulletin, 59, 248-253.

[50]   Taveras, E.M., et al. (2008) Parental perceptions of overweight counseling in primary care: The roles of race/ethnicity and parent overweight. Obesity, 16, 1794-1801. doi:10.1038/oby.2008.264

[51]   Stewart, L., et al. (2008) The use of behavioural change techniques in the treatment of paediatric obesity: Qualitative evaluation of parental perspectives on treatment. Journal of Human Nutrition and Dietetics, 21, 464-473. doi:10.1111/j.1365-277X.2008.00888.x

[52]   Stewart, L., et al. (2008) Parents’ journey through treatment for their child’s obesity: A qualitative study. Archives of Diseases in Childhood, 93, 35-39. doi:10.1136/adc.2007.125146