Motivating Parents Fails to Help Kids Shed Pounds

WINSTON-SALEM, N.C., May 8 -- Motivational advice from physicians and dietitians to parents about how to help heavy or obese children slim down doesn't seem to translate into significant weight loss, found researchers here.

Moreover, half of the parents who received a double-dose of motivational talks about curbing obesity in kids dropped out of the study, Robert P. Schwartz, M.D., of Wake Forest, and colleagues, reported in the May issue of the Archives of Pediatrics and Adolescent Medicine.

The pilot study recruited parents of 91 children ages three to seven who visited pediatricians for regular well-child visits. Fifteen pediatricians participated in the study.

Fifty-two of the children were overweight -- defined as a body mass index at the 85^th percentile or higher but lower than the 95^th percentile -- and 39 were normal weight but had a parent with a BMI of 30 or more.

At six months' follow-up, children whose parents had a total of four motivational sessions -- two with the pediatrician and two with a registered dietitian -- reduced their body mass index percentile rank by an average of 2.6 percentiles compared with a 1.9 percentile drop for those whose parents had a single motivational session with a pediatrician, and a 0.6 percentile decline in the control group (P=0.85).

The dropout rate for the three groups was directly related to the intervention strategy. Ten percent of parents in the control group dropped out versus 32% of the parents in the minimal (pediatrician-only) intervention group and 50% of parents in the intensive intervention.

Pediatricians and dietitians participated in a one-day training session in motivational interview techniques, including the use of open-ended questions and reflective listening.

Parents assigned to the minimal intervention had a 10- to 15-minute motivational interview with the pediatrician. Those in the intensive intervention followed up each session with the pediatrician with a 45-minute motivational session with a registered dietitian. In both interventions parents were also given tip sheets on healthy eating and a video that "modeled parent behavior around feeding issues."

The parents were asked to fill out Youth/Adolescent Food Frequency Questionnaires at baseline and at six months. These questionnaires recorded not only food consumption but also questions on activities such as dining at restaurants and TV watching.

Both minimal and intensive intervention strategies influenced behavior compared with controls. In the minimum intervention group parents reported a significant decrease in child's intake of snacks compared with children in the control group (P=0.01). In the intensive intervention arm parents said they had a net decrease in dining out compared with the minimal intervention group (P=0.04).

The authors concluded that the study confirmed that both pediatricians and dietitians can be taught motivational techniques and that parents find those techniques helpful. But future studies, they said, are needed in order to improve study retention and increase the efficacy of the intervention.