Dietetic Management of Pediatric Overweight: Development and Description of a Practical and Evidence-Based Behavioral Approach

      There is great uncertainty over how to treat childhood overweight. Recent systematic reviews provide a consensus on the most promising elements of treatment, but no successful, generalizable, evidence-based treatment model is currently available. We describe a novel approach to treatment that is evidence-based, putting recommendations of recent systematic reviews into practice. The novel treatment uses a client-centered approach and behavioral change techniques to increase and maintain motivation for lifestyle change. It focuses on increasing physical activity, reducing sedentary behavior, and changing diet in children who are overweight (body mass index >98th percentile) and of elementary school age. Treatment lasts for 6 months and requires 5 to 6 hours of a dietetics professional’s time per patient (in contrast to more traditional, less intensive approaches in the United Kingdom, which invest approximately 1.5 hours per patient). Preliminary assessment of the program suggests that it is practical, and patient dropout is low. Formal evaluation of efficacy will not be available until completion of a randomized, controlled trial in 2006. This description of our novel treatment will enhance generalizability of the program if it is successful, and a detailed description will assist in development of other treatments even if it is unsuccessful.
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      L. Stewart is a research dietitian, Division of Developmental Medicine, University of Glasgow and Yorkhill Hospitals, Glasgow, Scotland and the Department of Nutrition and Dietetics, Royal Hospital for Sick Children, Edinburgh, Scotland


      J. Houghton is a research dietitian, Division of Developmental Medicine, University of Glasgow, and Department of Dietetics, Yorkhill Hospitals, Glasgow, Scotland


      A. R. Hughes is a research fellow, Division of Developmental Medicine, University of Glasgow and Yorkhill Hospitals, Glasgow, Scotland


      D. Pearson is a freelance dietitian, Leics, UK


      J. J. Reilly is a reader, Division of Developmental Medicine, University of Glasgow, Yorkhill Hospitals, Glasgow, Scotland