Compliance and Long-Term Follow-Up for Childhood Obesity: Retrospective Analysis
Leonard H. Epstein Alice Valoski James McCurley University of Pittsburgh School of Medicine
Obesity is a prevalent condition in childhood ( Dietz, & Gortmaker, 1984; Stark, Atkins, Wolff, & Douglas, 1981), and obese children are more likely to become an obese adult than lean children ( Abraham, Collins, & Nordsieck, 1971; Abraham & Nordsieck, 1960; Garn & LaVelle, 1985). Given the poor prognosis for obese adults ( Brownell & Wadden, 1986), and the fact that obese children are likely to become obese adults, effective interventions for childhood obesity are needed to reduce the risk of obese children becoming obese adults.
The largest body of research on the treatment of childhood obesity has focused on behavioral treatments ( Epstein & Wing, 1987). As we have previously discussed ( Epstein & Wing, 1987), the treatment literature is sufficiently developed to warrant long-term evaluation. Behavioral treatments have shown superior weight losses to both no treatment control ( Aragano, Cassady, & Drabman, 1979; Epstein, Wing, Koeske, & Valoski, 1984; Israel, Stolmaker, & Andrian, 1985; Israel, Stolmaker, Sharp, Silverman, & Simon, 1984; Kirschenbaum, Harris, & Tomarken, 1984; Senediak & Spence, 1985) and nonspecific attention placebo control treatments ( Epstein, Wing, Steranchak, Dickson, & Michelson, 1980; Epstein, Wing, Woodall, Penner, & Kress, 1985; Graves, Meyers, & Clark, 1988).
Behavioral treatments for childhood obesity are designed to change eating and exercise habits of children by training parents and children in behavioral methods ( Epstein & Wing, 1987). Basic behavioral skills taught in most programs include self-monitoring, calorie reduction, increasing exercise, modification of the environment (stimulus control), and the use of social and/or contractual reinforcement to support behavior change ( Epstein & Wing, 1987). Controlled outcome research has begun to identify some variables that are important to modification