208 Obesity Treatment
postpartum weight retention (Greene et al., 1988; Schauberger, Rooney, and
Brimer, 1992), and many obese women state that their excessive weight was
initiated by pregnancy (Ohlin and Rossner, 1990). Research also indicates
that women who have become obese during pregnancy have gained 4 kg
more than controls at 6 weeks postpartum (Hunt et al., 1995). Preventive
interventions could therefore target women who are either trying to get
pregnant or are in early pregnancy.
At-risk children
As children with obese parents are more likely to become obese (see
chapter 8), preventive interventions could target these “at-risk” children.
In addition, obese children are at risk of becoming obese adults. In line
with this, Epstein et al. (1994) designed a family-based intervention and
recruited 6–12-year-old obese children and their parents. All subjects received
comparable advice on diet and exercise but were randomly allocated to one
of three groups. In one group both parent and child were rewarded for
changing their behavior, in the second group only the child was rewarded,
and in the third group the family was rewarded for attendance only. The
results showed that this intervention had a significant impact on weight at
5- and 10-year follow-ups. Specifically, those families who had received
rewards for both parent and child showed a 11.2 percent reduction in the
average percentage that people were overweight after 5 years and a 7.5 percent
reduction in overweight after 10 years. In contrast those in the control group
showed a 7.9 percent increase and a 14.3 percent increase respectively. In
sum, targeting both parent and child reduced overweight at follow-up.
Children in general
Given the evidence that childhood obesity may track into adulthood and
that eating and activity habits are laid down early, researchers and clini-
cians are increasingly developing and evaluating prevention programs
which target children. For example, in Australia the “Be active eat well”
campaign has been set up in the town of Colac, Victoria; it is designed
to encourage healthy eating and physical activity through capacity
building (see http://www.youtube.com/watch?v=KTrieEfyetY)..) The intervention
is based at the community level and aimed to change community norms
in terms of factors such as what constitutes a normal lunch box, what is a
normal canteen meal, what is a normal way to travel to school, and what
are normal activities to do after school. To achieve this change in norms,
schools changed their provision of food, people were trained to run active