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Stanford pediatrician discusses developing effective programs to curtail childhood obesity

Efforts to develop long-term approaches to prevent or treat childhood obesity got a boost last week when the National Institute of Health funded two major research initiatives. One of those efforts, the Childhood Obesity Prevention and Treatment Research program, involves a treatment study taking place at Stanford and led by Thomas Robinson, MD, MPH.

In the following Q&A, Robinson discusses the NIH study, why prevention and treatment plans focused on fitness results often fail and if playing the Nintendo Wii should be considered exercise.

What makes the NIH-funded study different from past research on prevention and treatment of childhood obesity?

The treatment study we are developing will test a new model of community-based treatment linking primary care providers, after-school programs, home environment and family dynamics. So it's a really unique opportunity to address treatment from a community perspective. Another unique aspect of the study is that it will be a three-year intervention, which is unheard of. We'll also have two years at the beginning of the study to perform formative research and pilot work to make the intervention as effective as possible. In addition, since it's a collaborative project comprised of four separate studies all the findings will be shared among researchers.

What makes physical activity and fitness interventions or programs effective for preventing or treating childhood obesity?

A major weakness of many activity and fitness programs is that they aren't motivating in and of themselves. People want to exercise and have really good intentions but are not motivated to continue them over time. This is why a lot of the intervention programs we create are focused on things that make the activity fun as opposed to just a form of exercise.

One example is after-school ethnic dance programs for girls that involve social interactions, strengthening cultural ties and a performance aspect. Such activities meet the needs of the girls by putting them in touch with their cultural background, which also makes the parents happy.

We have done the same thing with after-school sports teams exclusively for overweight kids by making the experience about choice, belonging to a team and friendships as opposed to the physical activity itself. This way, overweight kids can play on a team in a protective and safe environment where they don't have to worry about being the last one chosen or the slowest kid on the field. A lot of sedentary overweight kids have always wanted to play sports but avoided it because of these negatives. If those issues are addressed, then the motivation becomes having fun as opposed to something you have to be persuaded to do because of your health.

We've also found that social issues and altruistic behaviors can motivate kids. For example, children are much more enthusiastic to walk or bike to school to help save the planet rather than to improve their health.

This previous research will provide models that will be incorporated into the new [NIH] treatment study.

What about the rise of exercise video games like Wii tennis? Can playing such video games be considered fitness?

Overall, the Wii is like any other home exercise program. If you play the games, as they are intended to be played, then you are getting some level of physical activity from them. The problem is a lot of people find a way to exert less activity, such as playing tennis while sitting on the couch, or just stop playing the games. While some kids become avid users, we find that most kids will lose interest quickly and not continue to play them. Being able to set increasing challenges and goals for yourself and competing with or comparing your performance with others can help increase motivation and persistence but, in general, they have not yet proven to be a panacea for most people. The bottom line is that you should try to find something active that you really enjoy doing for it’s own sake. For some people that will be Wii, for others it may be walking their dog, hiking in the foothills, or dancing. Then the activity becomes the reward itself and the weight loss and health benefits are nice side effects.

Previously: Stealth equals health
Photo by Port of San Diego

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