review of seven popular books on pediatric weight loss

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DOI: 10.1089/obe.2009.0109 © Mary Ann Liebert, Inc. February 2009 Obesity Management 35 Introduction T he prevalence of obesity continues to rise, and the striking increase among youth over the past several decades is of significant concern. 1 Recent data reported that 34% of adolescents ages 12–19 were overweight or obese, 2 resulting in 4–5 million youth between the ages of 6–17 who are effected. 1 Naturally, family-based interventions are considered the most effec- tive treatments for childhood and adolescent obesity. Traditionally, these clinic-based interventions combine nutrition education and exercise with behavior therapy techniques. 3 Greater attention, however, is now being given to the dissemination of interventions to families and children who struggle with weight. A number of professionals working in the realm of childhood obesity have published books that are geared toward parents with children who are struggling with weight who are interested in implementing a weight-loss program at home. The following review of seven books seeks to provide healthcare professionals with insight into which books may be most appropriate for patients and families. By no means is this list intended as an exhaustive or inclusive list of all potential books on this topic. These particular books were selected because the authors believed they seemed relatively popular and/or because they were being used in various professionally conducted programs around the country. This review focuses on the audiences for which the books were intended, differences in the weight-loss programs the authors promote, the scientific foundation supporting the authors’ messages, and, when applicable, the practical- ity, clarity, and ease of use of the weight-loss program promoted in the book. Each of the seven books addresses pediatric and adoles- cent weight management, yet they are written for differ- ent audiences. Several of the authors, including Neufeld, Ludwig, and Sothern, write for parents of overweight children who are interested in a step-by-step weight-loss program geared toward children. These structured weekly programs include specific instructions about meals and activities, as well as worksheets for both parent and child to collaborate on together. Of note, the step-by-step pro- gram in each book varied in length; Neufeld, a 7-step program; Ludwig, a 9-week program; Sothern, a 12-week program. Kirschenbaum and Satter also wrote about weight-loss strategies for overweight youth, but did not include a step-by-step structured program. The books by Ludwig, Kirschenbaum, Neufeld, and Sothern may be particularly helpful for parents given some of the additional issues the authors address, includ- ing parenting strategies, increasing physical activity, and self-monitoring. In terms of parenting, Ludwig suggests cognitive–behavioral strategies in the context of a devel- opmental perspective, Sothern recommends behavioral strategies and problem solving strategies, and both these books include an emphasis on a reinforcement system. Kirschenbaum recommends a cognitive approach with stress management, although it should be noted that this book focuses more on parenting teenagers. Neufeld touches on teamwork of parents and children, but does not provide any specific parenting strategies. Each book additionally includes recommendations for increasing physical activity, although Sothern provides the most recommendations for physical activity, including strength and flexibility exercises. With regard to the practice of self-monitoring, all of the books touch on this subject to some degree, but the Kirschenbaum book highlights this Book Reviews Review of Seven Popular Books on Pediatric Weight Loss Book Reviews Family-based interventions are considered the most effective treatments for childhood and adolescent obesity.

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Page 1: Review of Seven Popular Books on Pediatric Weight Loss

DOI: 10.1089/obe.2009.0109 © Mary Ann Liebert, Inc. February 2009 Obesity Management 35

Introduction

The prevalence of obesity continues to rise, and the striking increase among youth over the past several decades is of significant concern.1 Recent

data reported that 34% of adolescents ages 12–19 were overweight or obese,2 resulting in 4–5 million youth between the ages of 6–17 who are effected.1 Naturally, family-based interventions are considered the most effec-tive treatments for childhood and adolescent obesity. Traditionally, these clinic-based interventions combine nutrition education and exercise with behavior therapy techniques.3 Greater attention, however, is now being given to the dissemination of interventions to families and children who struggle with weight.

A number of professionals working in the realm of childhood obesity have published books that are geared toward parents with children who are struggling with weight who are interested in implementing a weight-loss program at home. The following review of seven books seeks to provide healthcare professionals with insight into which books may be most appropriate for patients and families. By no means is this list intended as an exhaustive or inclusive list of all potential books on this topic. These particular books were selected because the authors believed they seemed relatively popular and/or because they were being used in various professionally conducted programs around the country. This review focuses on the audiences for which the books were intended, differences in the weight-loss programs the authors promote, the scientific foundation supporting the authors’ messages, and, when applicable, the practical-ity, clarity, and ease of use of the weight-loss program promoted in the book.

Each of the seven books addresses pediatric and adoles-cent weight management, yet they are written for differ-ent audiences. Several of the authors, including Neufeld, Ludwig, and Sothern, write for parents of overweight children who are interested in a step-by-step weight-loss program geared toward children. These structured weekly programs include specific instructions about meals and

activities, as well as worksheets for both parent and child to collaborate on together. Of note, the step-by-step pro-gram in each book varied in length; Neufeld, a 7-step program; Ludwig, a 9-week program; Sothern, a 12-week program. Kirschenbaum and Satter also wrote about weight-loss strategies for overweight youth, but did not include a step-by-step structured program.

The books by Ludwig, Kirschenbaum, Neufeld, and Sothern may be particularly helpful for parents given some of the additional issues the authors address, includ-ing parenting strategies, increasing physical activity, and self-monitoring. In terms of parenting, Ludwig suggests cognitive–behavioral strategies in the context of a devel-opmental perspective, Sothern recommends behavioral strategies and problem solving strategies, and both these books include an emphasis on a reinforcement system.

Kirschenbaum recommends a cognitive approach with stress management, although it should be noted that this book focuses more on parenting teenagers. Neufeld touches on teamwork of parents and children, but does not provide any specific parenting strategies. Each book additionally includes recommendations for increasing physical activity, although Sothern provides the most recommendations for physical activity, including strength and flexibility exercises. With regard to the practice of self-monitoring, all of the books touch on this subject to some degree, but the Kirschenbaum book highlights this

Book ReviewsReview of Seven Popular Books on Pediatric Weight Loss

Book Reviews

Family-based interventions are considered the

most effective treatments for childhood and

adolescent obesity.

Page 2: Review of Seven Popular Books on Pediatric Weight Loss

36 Obesity Management February 2009

topic best. Furthermore, each book includes material on goal setting, decreasing sedentary behavior, stimulus con-trol, and managing high-risk situations.

Despite the above similarities between the books by Ludwig, Kirschenbaum, Neufeld, and Sothern, the books differ to substantial degrees on diet recommen-dations. Ludwig recommends a low-glycemic diet; Kirschenbaum recommends a low-fat diet in addition to several other suggestions to reduce appetite; Neufeld recommends following the food pyramid; and the Soth-ern book focuses on an exchange system to promote a traditional balanced diet but also caloric restriction for weight loss.

The Satter book has a very different flavor compared to the other books described above. This book focuses on the “division of responsibility in feeding,” in which the parents are responsible for providing the food and the children are responsible for determining how much they

eat. The Satter book is written from a developmental per-spective. It is based on the idea that restricting children’s food and not accepting their bodies can negatively impact their behaviors, moods, and self-esteem. The scientific basis for the assertion that helping overweight children learn how to lose weight effectively (e.g., via caloric restriction, increased activity, improvement in self-regu-latory skills) often produces hearmful effects, however, is unclear (at best) to the present reviewers.

The books by Ellin and Fletcher focus on personal memoirs on adolescent weight loss, and both represent the voice of the overweight teen. Fletcher’s book sum-marizes the themes from 100 interviews with adolescents who lost weight and maintained the weight loss. This book is unique in that it highlights the notion that ado-lescents do not always listen to adults but rather listen to each other. The majority of the book is drawn from wisdom, strategies, and techniques used by teenagers on

how to be successful in losing weight. Ellin’s book is a personal recount of her own experiences as an overweight teen who attended weight-loss camps. Ellin captures the emotion involved in her struggle and the stigma associ-ated with being an overweight teen.

The majority of the books include at least some degree of scientific explanation for weight-loss recommenda-tions, but the books that promote a specific strategy for weight loss do this to a greater degree. The Kirschen-baum book was written in the most scientific manner of the group reviewed and discussed the specific biological mechanisms contributing to weight gain and loss. Other books, such as Ludwig, Sothern, Satter, and Fletcher cite the empirical literature that supports their recommenda-tions, but with less detail, which may make it easier for the lay reader.

In terms of practicality, certain books appear to be more useful to a parent of an overweight child. The Neufeld book was structured as a collection of “work-shops,” and included handouts and exercises at the end of every workshop. Sothern not only provides weekly plans for structuring diet and activity, but also includes helpful behavioral hints for parents while working with their children on the program. Similarly, Kirschenbaum discusses communication strategies and a model of recovery that parents can use with their children while helping them to lose weight. Although Ludwig does not focus on psychological mechanisms parents can use to help children lose weight in as much detail as Sothern and Kirschenbaum, he includes a helpful discussion on child development and parenting.

All of the books reviewed have strengths and weak-nesses and the value of each book might depend on the goal or motivation of the parent or teen who is reading it. For example, a parent who is interested in understanding the science behind weight gain and loss may be inter-ested in the Kirschenbaum book. The parent who wants a step-by-step program may benefit from reading the Ludwig, Neufeld, or Sothern books. A parent who wants a different perspective on feeding children might want to read the Satter book. A parent or teen who wants to read motivational stories about adolescents’ successes with weight management might read the Fletcher book. If a parent wants to better understand what their child is going through, or if a teen would benefit from reading stories about someone who has struggled with weight loss, the Ellin book might be the best choice. Despite the potential value of all of the books for the right audience, it is important to note that current research recommends reduction of total fat and caloric intake for weight loss4

and neither the Ellin or Satter book recommends these changes.

All the books reviewed have strengths and weaknesses and the value of each book might depend on the goal or motivation of the parent or teen who is reading it.

Page 3: Review of Seven Popular Books on Pediatric Weight Loss

February 2009 Obesity Management 37

Teenage Waistland: A Former Fat-Camper Weighs in on Living Large, Losing Weight, and How Parents Can (And Can’t) Help, by A. Ellin. Public Affairs, New York, NY; 2005.

SummaryThis book is a personal memoir on adolescent weight

loss and represents the voice of the overweight teen. Ellin captures the emotion involved in her struggle and the stigma associated with being an overweight adolescent as she recounts her experiences attending weight-loss camps during adolescence.

Most Useful forParents who want to better understand the emotional

experience of the overweight adolescents and adolescents who would benefit from reading stories about someone who also has struggled with weight loss.

Weight Loss Confidential: How Teens Lose Weight and Keep It Off and What They Wish Their Parents Knew, by A. Fletcher. Houghton Mifflin Company, Boston, MA, 2006.

SummaryThis book is a collection of 100 interviews with ado-

lescents who lost weight and maintained the weight loss. The aim of the book is to highlight the strategies and tech-niques used by these adolescents and communicate this advice to other adolescents struggling with weight loss.

Most Useful forParents or adolescents who want to read motivational

stories about adolescents’ successes with weight loss and management.

The Sierras Weight-Loss Solution for Teens and Kids: A Scientifically Based Program from the Highly Acclaimed Weight-loss School, by D. Kirschenbaum, R. Craig, and L. Tjelmeland. Avery, New York, 2007.

SummaryThis book reviews specific biological mechanisms con-

tributing to weight gain and loss and focuses on imple-mentation of behavioral strategies and a low-fat diet. Incorporates a cognitive approach for successful weight loss and includes discussion of communication strategies and a model of recovery that parents can use with their children while helping them to lose weight.

Most Useful forParents of overweight children and adolescents who

are interested in a specific diet strategy for their children. Given the cognitive focus of this book, it may better suit-ed for parents of adolescents and those who want to read about the science behind the strategies.

Ending the Food Fight: Guide Your Child to a Healthy Weight in a Fast Food/Fake Food World, by D. Ludwig and S. Rostler. Houghton Mifflin Company, Boston, MA, 2007.

Summary This book focuses on a 9-week weight-loss program

that incorporates a low-glycemic diet and physical activ-ity. It includes a discussion of cognitive–behavioral strat-egies in the context of child development.

Most Useful forParents of overweight children who are interested in a step-

by-step weight-loss program that includes strategies for diet, parenting, increasing physical activity, and self-monitoring.

Kidshape: A Practical Prescription for Raising Healthy, Fit Children, by N. Neufeld and P. Nelson. (2004). Rut-ledge Hill Press, Nashville, TN, 2004.

SummaryThis book is a collection of workshops that includes

handouts and exercises. Weekly plans for structuring diet and activity are provided and helpful behavioral hints for parents while working with their children on the program are also discussed.

Most Useful forParents of overweight children who are interested in a

step-by-step weight-loss program that includes strategies for diet, parenting, increasing physical activity, and self-monitoring.

Your Child’s Weight: Helping Without Harming, by E. Satter. Kelcy Press, Madison, WI, 2005.

SummaryThis book is written within a developmental context and

proposes the idea that restricting children’s food and not accepting their bodies as they are can negatively impact their behavior, mood, and self-esteem.

Page 4: Review of Seven Popular Books on Pediatric Weight Loss

38 Obesity Management February 2009

Most Useful forParents who are looking for a different perspective

on how to feed their children. Given the focus on early development, this book may be better suited for parents of younger children.

Trim Kids, by M. Sothern and T. Von Almen. HarperRe-source, New York, 2001.

SummaryThis book focuses on a 12-week step-by-step plan for

increasing physical activity and healthy eating. It provides a number of recommendations and ideas for incorporating physical activity, including strength and flexibility, into the daily routine. Also included is a discussion of behav-ioral strategies and problem-solving strategies for parents to help motivate their children.

Most Useful forParents of children who are interested in a step-by-step

program to increase physical activity and promote healthy eating. ■

References1. Ogden CL, Carroll MD, Flegal KM. High body mass index for

age among US children and adolescents, 2003–2006. JAMA. 2008;299:2401–2405.

2. Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Fle-gal KM. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA. 2006;295:1549–1555.

3. Epstein LH. Family-based behavioural intervention for obese chil-dren. Int J Obes Relat Metab Disord. 1996;20(Suppl 1):S14–21.

4. Miller WC, Koceja DM, Hamilton EJ. A meta-analysis of the past 25 years of weight loss research using diet, exercise or diet plus exercise: the evidence report. Int J Obes. 1997;21:941–947.

—Kerri N. Boutelle, Ph.D.Departments of Pediatrics and Psychiatry

University of California, San Diego

—Taya Cromley, Ph.D.Department of Psychiatry

University of California, San Diego

—Roxanne Rockwell, B.A.University of California, San Diego