Among children of reading age, does provision of written and pictorial nutrition informational material reduce obesity, compared to verbal information alone?

A2009 RCT in Australia (n5258) examined children five to 10 years old who were either obese or overweight to determine if structured counseling along with written materials improved body mass index (BMI). Overweight and obesity were based on the International Obesity Task Force definitions (which correspond to traditional adult BMI cutoffs of 25 and 30 kg/m) for children aged two to 18 years old. Patients classified as very obese were excluded. The intervention group (N5139) received four standardized consultations from 66 general practitioners (GPs) in 45 medical practices over 12 weeks. GPs performing the intervention had received two 2.5-hour training sessions focused on the “stages of change” model, were to watch a DVD outlining example patient encounters, and performed two simulated patient encounters. The four sessions involved an “intervention mapping” technique to set appropriate and healthy goals and focused on nutrition, physical activity, and sedentary behavior. Participants were given a 16-page “family folder” written at a 12-year-old reading level. The control group (n5119, mean age 7.6) received standard primary care to include no discussion of weight or BMI. At the 12-month follow-up, there was no difference in the intervention group’s mean BMI z score (adjusted for a “social disadvantage index,” age, sex, and raw BMI at baseline) compared to the control group. There were also no statistically significant differences in secondary outcomes between the intervention and control group to include physical activity, waist circumference, and nutrition. The cost of the intervention was $A1317 per patient, $A1236more than the cost of standard care. The study is limited by low patient compliance with the office visits. A 2013 RCT studied ninth through 11th graders (n551) whose BMI was greater than or equal to the 85 percentile, but less than 40 kg/m. Researchers sought to test the effectiveness of a school-based health center (SBHC) weight management program, “Adolescents Committed to Improvement of Nutrition and Physical Activity,” in managing weight for overweight and obese students. The intervention group (n528, average BMI percentile 94.5) received multifaceted education from a family medicine nurse practitioner at one SBHC regarding weight loss and exercise in eight sessions over one academic year. They also received a DVD, a DVD player, a summary of personal medical results (BMI, blood pressure, fasting glucose, and lipids), as well as American Academy of Pediatrics (AAP) obesity prevention/treatment recommendations. The “standard care” group (n523, BMI average percentile 94.4, SD 4.6) received from a family medicine physician at a different SBHC only the AAP’s “Balance for a Healthy Life” booklet, in addition to their medical assessment and AAP recommendations. At the end of the school year, there was no significant difference in the BMI percentile in either group, although the intervention group decreased by 0.3% (95% CI, 20.6 to 0.3) and the control group rose by 0.2% (95% CI, 20.1 to 0.80). There were no significant differences in secondary outcomes between control and intervention groups to include fasting blood glucose, blood pressure, and physical activity. This study is limited by the small number of participants and a short follow-up interval of one academic year. In the 2017 recommendation by the US Preventive Services Task Force “Screening for Obesity in Children and Adolescents,” efforts less than 26 hours of “comprehensive, intensive behavioral interventions” did not produce statistically significant weight loss. For the treatment of obesity specifically, nine trials with 1,315 participants involved one-to-five contact hours. The average weight gain for elementary school children was one to 12 pounds for intervention groups and two to 18 pounds for control groups. For adolescents, the average weight gain was four pounds for intervention groups and six to 12 pounds for control groups. The overall difference in BMI z score for all