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What really works to prevent obesity in kids?

In the long drawn out battle to fight the childhood obesity epidemic, public health advocates, schools, parents -- heck, even the first lady -- have been trying a variety of strategies to see what, if anything, really works. An analysis of the latest research published yesterday by the Cochrane Colloboration may provide better guidance, identifying specific approaches that appear to work to prevent gaining excess body fat.

The Australian researchers reviewed 55 studies mostly targeting children ages 6 to 12 and found that overall, obesity prevention programs led to less excess body fat but that some programs were far more effective than others.


The authors urged that their findings be “interpreted cautiously” because their meta-analysis included several small studies that may have overstated the effectiveness of some programs. They were, though, able to glean some broad strategies that appeared to have the most impact, including:

-- a school curriculum that includes healthy eating, physical activity, and body image discussions

-- increased time for gym, and movement activities built into English, science, or math classes

-- improved nutrition in school lunches emphasizing less saturated fat and calories and more fruits, vegetables, and whole grains

-- creating an environment that makes it easy for kids to choose healthful foods and be active throughout the day

-- support for teachers and other staff trying to implement new strategies

-- support for parents trying to encourage their kids to eat more nutritiously and spend less time staring at computers, TV, and other screens.

While the Cochrane review focused on obesity prevention, those same strategies have proven useful for treating overweight children, said Dr. David Ludwig, director of the obesity prevention center at Children’s Hospital Boston. “They differ only in the intensity that we deploy them,” with more regimented eating and exercise plans needed to help children lose excess fat.


Ludwig also wasn’t surprised to see that many interventions in the Cochrane review had the best results in younger children. “It’s less difficult to make a behavioral change since parents have more influence.”

I see this with my own three kids who -- as they move through middle school and high school -- get more independent about taking snacks and making simple meals for themselves and spend a lot more time after school on their computers and iPods.

So what can I do to ensure that I’m taking the right approaches with them to keep them at a healthy weight?

Setting a firm limit on screen time is a start, recommended Ludwig, though that can be tough during the week since homework often involves the computer. I could also do a better job keeping nutritious food choices within easy reach. I have a bowl of clementines on my kitchen counter, but I also keep brownies there. And even sugary snack foods hidden away in my pantry are somehow always found by small eager hands, so I should probably buy fewer of them.

“Good sleep hygiene and stress reduction are also important,” Ludwig said. Those are two major challenges in teens. After having an argument with my 13-year-old son about his pushing his 10 p.m. bedtime further and further back, I finally put him on the phone with his pediatrician who told him he needs to get nine hours of sleep a night. With a wakeup time of 7 a.m., that means turning out the light on time, no excuses.


Stress reduction is tougher and usually is best accomplished through sports teams or outdoor pickup games around the basketball hoop. My daughter runs regularly and we usually take a walk to de-stress on Friday nights.

“In my practice, the general philosophy I take with overweight teens is to try to calm the conflicts that have often built up over time,” said Ludwig. “We sort through the family dynamic: Is there conflict at home? Are the parents neglectful or overly protective?” He also examines medical issues such as an underactive thyroid gland or psychological ones such as anxiety, depression, or eating disorders.

The fix to the obesity problem -- whether in one child or an entire nation of kids -- rests not in one solution but a whole range, emphasized Ludwig. “If we can address both home and school life, that can provide a very powerful shield,” he said.

Deborah Kotz can be reached at dkotz@globe.com. Follow her on Twitter @debkotz2.