Last time, we discussed the usefulness of cognitive behavioral therapy for people who want to escape obesity. The fact that it works is wonderful, but it’s still unfortunate that this therapy or any other kind is needed at all. Many health professionals have become persuaded that therapy for the patient won’t be needed if therapy can instead be done with the parents of that potential future patient. Rather than have a person grow up to need counseling, maybe the problem can be caught hold of earlier, by applying the counseling to the person’s mother instead.
A project designed to shed some light on this was initiated by three Finnish institutions: the Foundation of Pediatric Research, Vaasa Hospital District’s Medical Research Fund, and Tampere’s Pediatric Research Centre. They began with the premise that “there are only few reported early interventions to prevent childhood obesity, and these are mostly not implemented in normal primary care practice.”
Here is a list of the study’s components:
- intensified diet and physical activity counseling during pregnancy
- mothers are advised to breastfeed
- parents are advised to help children adopt healthy food preferences
- parents are advised to encourage physical activity and discourage sedentary pursuits
- parents are advised to make sure children get enough uninterrupted sleep
The researchers describe the study as:
[...] designed to be a pragmatic trial integrated in health care practice… Our intervention targeted several lifestyle factors that are known to affect the child’s weight gain. Multifaceted intervention programmes are thought to be suitable for pragmatic trials and most effective in preventing overweight, since obesity is a result of many lifestyle factors in addition to genetic susceptibility.
A multifaceted intervention program means they’re trying a lot of things at once. It’s not as simple as taking a pill; it’s as complicated as building a lifestyle. The Finnish call this a “pragmatic trial,” which roughly translated means that the fact that it works means more than the reason why it works. According to the researchers:
The importance of pragmatic trials is that they help to define the best use of limited resources as well as policymakers and practitioners to make choices between customary care and the new counseling practice. Attempts to achieve methodological purity in explanatory trials can produce results that are not applicable in real life…
Now, a cynic could claim, “This is a perfect way to disguise the fact that a study has not learned anything. Because it includes so many variables, the facts can never be sorted out. This is not the way to do research.”
And then another voice, arguing against the cynic, could say, “Perhaps it is the way, if the subject of the research is how to actually make a difference. If the focus is not so much on assigning blame, but more on finding out what actually helps. And if it helps, maybe understanding exactly why, right now, is not so important.”
At any rate, this study is meant to cover each child for nearly six years — starting before birth and continuing five years afterward, and it is still in progress. The mothers are chosen for being “at risk of having overweight or obese offspring.” They are gaining too much weight and their glucose tolerance is impaired, or they have already had obese children.
The researchers admit that good results are more likely to be obvious in this population than if the participants were random. But that is fine, because random pregnant women are more likely to do okay without intervention, and the members of a selected risk group, who most need help, are enrolled in a program that was created to help them. So nobody loses.
The authors say their study “was designed to be integrated in routine health care practice and to maximize the applicability of results to usual care setting.” So far, the intervention costs are low, and following this model looks like a good bet for municipal health care, i.e., the public sector. What they are trying do is find out not only what helps, but how to make it scalable.
Your responses and feedback are welcome!
Source: “Behavioral counseling to prevent childhood obesity — study protocol of a pragmatic trial in maternity and child health care,” BMC Pediatrics, 2012
Image by jordanfischer (Jordan Fischer).