Methodological issues and ten-year outcomes for obese children.

In our research we have shown that obese children can lose weight and maintain this change in body composition over extended periods throughout development. Treatment variables that are important include having the parents as active participants in the treatment of their children and including exercise programs along with diet. The motivational structures within the family that support or discourage behavior change, however, may be as important as the specific behaviors that we attempt to modify. For example, we have observed successful long-term outcome in families in which we have used conjoint or reciprocal contracts, but not in families in which the child alone was targeted for behavior change. The specific methodology for including parents and children in treatment may be important, or it may just be important for both parents and children to be targeted for change and family members taught to support the behavior change of the other family members. Future research with children should pay attention to methods that mobilize family support for behavior change in multiple family members and strive for methods that will modify the sources of support for the targeted child, which will generalize to other family members.