title: Efficacy of maintenance treatment approaches for childhood overweight: a randomized controlled trial.
abstract: BACKGROUND
  No trials for childhood overweight have examined maintenance interventions to augment the effects of initial weight loss programs.
  
  
  OBJECTIVE
  To determine the short-term and long-term efficacy of 2 distinct weight maintenance approaches vs no continued treatment control following standard family-based behavioral weight loss treatment for childhood overweight, and to examine children's social functioning as a moderator of outcome.
  
  
  METHODS
  A parallel-group, randomized controlled trial conducted between October 1999 and July 2004 in a university-based weight control clinic. Participants were 204 healthy 7- to 12-year-olds, 20% to 100% above median body mass index (BMI) for age and sex, with at least 1 overweight parent. Children enrolled in 5 months of weight loss treatment and 150 were randomized to 1 of 3 maintenance conditions. Follow-up assessments occurred immediately following maintenance treatments and 1 and 2 years following randomization.
  
  
  METHODS
  Maintenance conditions included the control group or 4 months of behavioral skills maintenance (BSM) or social facilitation maintenance (SFM) treatment.
  
  
  METHODS
  BMI z score and percentage overweight.
  
  
  RESULTS
  Children receiving either BSM or SFM maintained relative weight significantly better than children assigned to the control group from randomization to postweight maintenance (P< or =.01 for all; effect sizes d = 0.72-0.96; mean changes in BMI z scores = -0.04, -0.04, -0.05, and 0.05 for BSM alone, SFM alone, BSM and SFM together, and the control group, respectively). Active maintenance treatment efficacy relative to the control group declined during follow-up, but the effects of SFM alone (P = .03; d = 0.45; mean change in BMI z score = -0.24) and when analyzed together with BSM (P = .04; d = 0.38; mean change in BMI z score = -0.22) were significantly better than the control group (mean change in BMI z score = -0.06) when examining BMI z score outcomes from baseline to 2-year follow-up. Baseline child social problem scores moderated child relative weight change from baseline to 2-year follow-up, with low social problem children in SFM vs the control group having the best outcomes.
  
  
  CONCLUSIONS
  The addition of maintenance-targeted treatment improves short-term efficacy of weight loss treatment for children relative to no maintenance treatment. However, the waning of effects over follow-up, although moderated by child initial social problems, suggests the need for the bolstering of future maintenance treatments to sustain effects.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00301197.
authors.affiliation: Department of Psychiatry, Washington University School of Medicine, St Louis, MO 63110, USA. wilfleyd@psychiatry.wustl.edu
authors.forename: Denise E
authors.initials: DE
authors.lastname: Wilfley
authors.forename: Richard I
authors.initials: RI
authors.lastname: Stein
authors.forename: Brian E
authors.initials: BE
authors.lastname: Saelens
authors.forename: Danyte S
authors.initials: DS
authors.lastname: Mockus
authors.forename: Georg E
authors.initials: GE
authors.lastname: Matt
authors.forename: Helen A
authors.initials: HA
authors.lastname: Hayden-Wade
authors.forename: R Robinson
authors.initials: RR
authors.lastname: Welch
authors.forename: Kenneth B
authors.initials: KB
authors.lastname: Schechtman
authors.forename: Paul A
authors.initials: PA
authors.lastname: Thompson
authors.forename: Leonard H
authors.initials: LH
authors.lastname: Epstein
mesh_terms: D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D009765:Obesity / Q000517:prevention & control*; D050177:Overweight; D040242:Risk Reduction Behavior; D012944:Social Support; D015431:Weight Loss