children in the second group were midway between the other two groups, but not significantly different from either.
This study has been replicated in three additional randomized treatment studies designed to change the diet and exercise behaviors of obese children treated with behavioral family therapy (Epstein et al., 1994). Averaging across all four studies, Epstein and colleagues note that over a 10-year period, 34 percent of their subjects decreased their percent overweight by ≥ 20 percent, and 30 percent were no longer obese. The children did best when both they and their parents were targeted and reinforced for weight loss and when the children were treated with aerobic exercise and exercise was incorporated into their lifestyle. This 10-year success in the treatment of childhood obesity stands in marked contrast to the disappointing long-term results in treating adult obesity (Wilson, 1994a).
Many approaches to prevent obesity appear promising, though few studies are available to document long-term positive outcomes. Since success in prevention programs is often equated with the absence of future problems, the impact of universal prevention programs that target education and behavior change (e.g., in diet or exercise patterns) is difficult to evaluate except through longitudinal population studies. The recent literature in prevention has focused more on working with groups or individuals who are known to be at risk for a particular disorder. The emphasis on working with high-risk individuals with interventions that are matched or targeted to specific risk factors (as in selective and indicated prevention strategies) appears to have considerable merit. Only a few studies of this type have been conducted in obesity prevention. Future research on the development of prevention programs targeted to those at high risk for obesity is necessary before any conclusions can be drawn concerning this promising new approach.