When doctors urge overweight kids to pick up more activities, reading probably isn't what they have in mind. Yet a new study by obesity researchers at Duke University finds that the simple act of reading depending on the choice of material can spur weight loss in tween-age girls.
The study's experimental group included 31 obese girls aged 9 to 13, who were enrolled in the Healthy Lifestyles Program at Duke Children's Hospital, a comprehensive family-centered weight loss plan that addresses patients' medical, dietary and behavioral needs. The girls read a novel called Lake Rescue, whose protagonist is an overweight preteen who struggles with low self-esteem, feelings of isolation and teasing because of her size. A group of 33 girls read a different book called Charlotte in Paris, which did not have an overweight heroine, and another group of 17 girls read neither book.
At the end of the six-month intervention, all the girls who read books had lost weight, but the girls who read Lake Rescue lost more. They lowered their body mass index (BMI), a ratio of weight and height used to measure obesity, by .71, compared with .33 in the Charlotte group an average .05 increase among the nonreaders.
The idea behind the study, says Dr. Sarah Armstrong, a pediatrician and director of Healthy Lifestyles, was to find a way to motivate the girls without adopting the restrictive and often authoritative voice of so many other nutrition and diet programs. Lake Rescue was the perfect instrument, says Armstrong; it presents a likable character to whom the girls could relate and whom they could emulate. As the book progresses, its heroine learns to make healthier lifestyle choices and finds a mentor to help keep her on track, Amstrong says: "She learns that she can become healthier, and the self-efficacy part, the 'I can do it' feeling resonates with the preteen girls."
"There was some effect of the book in augmenting what we were doing in the clinic," she says. "And not only did it have a small but significant effect on BMI, but it also had a positive effect on the girls' self-esteem."
Although the amount of weight lost was small, researchers say its effect is important and cumulative. Healthy nine-to-13-year-old girls typically have a BMI between 16 and 19; the BMI of the girls in the study group was on average between 27 and 28. "If you start with a preteen with a BMI of 27, and if she continues to increase her BMI at her current rate, in six months she would probably be at 28," says Armstrong. "But instead of going from 27 to 28, she now goes from 27 to 26.3, which would put her in the normal BMI range by time she is 13. [Otherwise], she would have a BMI of over 30 by the time she is 13, which would be obese even by adult standards."
The weight-loss options for obese pre-adolescents are slim. The two most effective obesity medications on the market, (Orlistat and Meridia) are not approved for children under age 15, and surgical treatments such as gastric bypass are often too risky for kids. That leaves lifestyle- and behavior-modification programs, combined with counseling, which can be effective but unpredictable. But Armstrong's study suggests that there may be unconventional and useful ways, like reading, to teach weight-loss techniques that researchers may not have considered.
And that may be the study's most significant finding, says Dr. Sandra Hassink, director of the Weight Management Clinic at A.I. Dupont Hospital for Children in Wilmington, Del., and leader of the Obesity Leadership Group at the American Academy of Pediatrics. What's more, instituting a technique such as reading to promote weight loss would be fairly easy. Already, the Reach Out and Read Program, a nationwide non-profit literacy effort begun by pediatricians at the Boston Medical Center in 1989, encourages reading by providing books to preschool children each time they visit the doctor's office. Why not piggyback messages about healthy lifestyle habits on this existing reading framework? "This study makes me wonder if we could do that with older kids as well," says Hassink. "We are already thinking at our hospital about mixing in positive lifestyle books with what the kids read." It's a win-win situation, note Armstrong and Hassink. After all, there are few negative side effects to encouraging kids to read.