Reprinted from Eating Disorders Review
March/April 2003 Volume 13, Number 2
©2002 Gürze Books
Group treatment may be more cost-effective than a combination of group and individual therapy for treating childhood obesity, according to researchers at State University of New York at Buffalo (Int J Obesity 2001;25:1843).
When 31 families with obese 8- to 12-year-old children were randomized to group therapy or mixed group and individual therapy, the cost of mixed group and individual therapy was 2.8 times higher per family than was group treatment ($1390.70 versus $495.51). The percentage of change in body mass index after the study was similar in the two groups.
The group sessions, for parent and child, included 8 weekly meetings, 4 biweekly sessions, and 1 monthly session. The participants received parent and child manuals, with modules on diet, activity, behavioral change, parenting, and coping with common problems faced by obese children, including peer teasing and body image concerns.
The mixed treatment group had 15- to 20-minute individual sessions with a therapist and 40 minutes of group therapy. The individual therapy sessions were designed to help the parents and children identify the behaviors that influenced their weight changes, to evaluate whether program goals were being met, to determine the accuracy of food and habit records, and to give feedback and help solve problems that hindered behavioral changes.
Both groups were introduced to the Traffic Light Diet, a program where foods are rated as green, yellow, or red, depending upon their caloric and nutrient content. “Green foods,” such as fruits and vegetables, are low in calories. “Yellow foods,” such as yogurt and 2% milk, contain moderate amounts of calories. “Red foods,” for example, potato chips and candy, are high in calories but have little nutrient value.
Children and parents were instructed to consume between 1000 and 1200 kcal per day, and to reduce their intake of “red” foods to less than 15 per week. Both groups also received information about physical activity, and were given exercise goals that began at 30 minutes per week and increased until they reached 180 minutes per week at moderate intensity. Participants weighed themselves daily at home and graphed their weight. They also kept a “habit” book in which they recorded foods and caloric intake, number of red foods and time spent in physical activity.
Why did less treatment work as well?
Although both group and individual treatments for obesity involved education about energy balance and behavior change as well as treatment to help patients make those changes, the difference in results may have been due to the unique effects of group therapy. According to the authors, group sessions may provide social support and problem-solving, areas that also can be influenced by individual therapy. Members of a group provide information to each other, such as tips on nutrition, exercise, lifestyle changes, or examples of how they coped with a difficult situation.
The authors did comment that the study group was mildly to moderately obese and further research is needed to see if their findings would apply to children who are more obese, and thus who might need individualized treatment. Another advantage of family-based treatment is that it can help modify some aspects of the family environment that may be contributing to the development of obesity.