Table of Contents
Trim Kids, also known as Committed to Kids (CTK), is a twelve-week behavioral weight management program for adolescents. The program integrates behavior modification, nutrition education, and exercise to promote lifestyle changes that carry into adulthood. Parental involvement is crucial as parents must provide limitations and support to help their child achieve weekly goals.
A team of health professionals led by Dr. Melinda Sothern researched childhood obesity at the Committed to Kids Pediatric Weight-Management Program at Louisiana State University Health Sciences Center. The team consisted of Dr. Sothern, an exercise psychologist, Dr. T. Kristian von Almen, a research psychologist, and Heidi Schumacher, a registered dietician. After fifteen years of research and implementation of the program, the team published Trim Kids. Trim Kids provides the materials necessary for parents to use the program at home. CTK follows the same twelve-week schedule, but is led by certified,
trained health professionals at hospitals, schools, and community centers across the country.
Trim Kids begins with an overview of the program in regard to expectations of participants, educational components, and fundamental behavior modifications for lifelong healthy living.
The program identifies what it means to be overweight and environmental factors more likely to cause obesity in children. A child’s level of obesity is broken down into three categories: at-risk, moderate, or severe. A child’s pediatrician should be consulted to determine the appropriate level.
The three components used to help children achieve their weight loss goals are nutrition education, increased physical activity, and behavior modification. These components must be used and embraced together for long-term success.
In addition, information on how to start moving away from fattening foods and introducing healthy alternatives is included along with the basics of physical activity and exercise. The primary behavior modifications that impact the entire family are also discussed.
The Twelve-Week Program
Trim Kids is very structured program. The following four sections comprise core areas addressed every week:
- Time to Stop and Think: A summary of information and behavior modifications to be covered that week.
- Time to Get Active: Introduces new fitness information and exercises appropriate to the child’s program level.
- Time to Dine: Provides nutritional education, weekly menu, shopping list, and recipes each week.
- Time to Sum Up: Review of the record forms completed throughout the week and challenges or improvements to highlight.
WEEK 1. The first week engages the family by having parents introduce the program, identify their role as a coach, and discuss methods for recording progress. The child’s level in the program is determined this week.
Trim Kids is divided into four levels:
- Level 1-Red: Severe obesity
- Level 2-Yellow: Moderate obesity due to diet, behavior, and/or fitness
- Level 3-Green: Overweight, at-risk for obesity
- Level 4-Blue: Program goal, maintaining healthy lifestyle
A pediatrician should determine the appropriate level for the program. They can provide guidance in regard to safe exercises, dietary restrictions, and additional medical support required.
The behavioral change at this stage focuses on having the child monitor their eating and activities. Allowing the child to recognize and record when, how much, and why they eat or exercise is shown to positively impact their progress.
WEEK 2. Nutrition is discussed at length in the second week. Families learn about portion control, healthy food choices, and involving the child in food selection. Lifestyle changes include eating slower, trying new foods, limiting portions, and eliminating sugary drinks.
WEEK 3. The third week stresses the importance of parents being good role models for their children. Parents must be willing to make the same types of changes to their diet and fitness levels they ask of their child. In addition, family members identify what prompts them to eat and learn about stimulus control as well as tricks for avoiding social scenarios that lead to overindulgence.
The Moderate-Intensity Progressive Exercise Program (MPEP) is introduced in the fitness section. MPEP Step is simply modifying an individual’s posture so they walk quickly with their head up and shoulders back. This posture makes an individual look taller, thinner, and more confident—all traits that usually lead to more energy and activity.
WEEK 5. The fifth week explores how new behaviors are acquired, the ABCs of behavior change (Antecedents, Behavior, Consequences), and the difference between hunger and cravings. Kids learn how to tune into their bodies by understanding metabolism, monitoring their target heart rate, and recognizing activity limitations.
WEEK6. The midpoint of the program teaches kids how to improve their self-esteem and self-image. This is accomplished primarily by learning to speak positively instead of having negative thoughts that foster inactivity and poor eating habits.
WEEK 7. In the seventh week, methods for relaxation are introduced to help both parents and kids handle stress that often develops when making life changes. This week is also an opportunity to evaluate overall success meeting weekly goals and make adjustments where necessary.
WEEK 8. During the eighth week parents are encouraged to hold family meetings on a regular basis. The meetings provide a forum to discuss how everyone is handling the changes taking place. Reinforcing positive behaviors and recognizing the family’s success helps maintain commitment. It is equally important to be aware of challenging program components and ask for input on how the family can remain on track.
WEEK 9. Week nine invites parents to talk with their child about responding to social and emotional pressures that prompt unhealthy habits. Support suggestions are offered to parents who may begin experiencing burnout. Connecting with other parents and children seeking a healthy lifestyle provides a positive support network as well as playmates and education exchanges.
WEEK10. Week ten addresses the topic of traveling while on the program. Recommendations for eating healthy on the road and remaining active are presented. Tips for notifying friends and family of the new eating habits when visiting are provided as well.
WEEK11. The eleventh week begins concluding the program and setting kids up for success on their own. Parents learn how to recognize the difference between lapse, relapse, and collapse of a child’s healthy lifestyle. It is normal for a child to lapse, but relapse and collapse require revaluating the situation and recommitting to the program goals.
WEEK 12. In the final week, the child’s pediatrician evaluates progress made. Depending on the child’s initial program level they may either graduate to the next level or remain at the current level. If the child has not yet reached the final level (Blue), the program repeats for twelve week increments until the weight loss goal is achieved. Children who do not make any progress during the twelve weeks must choose to recommit to their desire for a healthier lifestyle.
The ultimate goal of Trim Kids is to modify behaviors for healthy living. Kids who reach the Blue level continue to commit to the program guidelines in order to maintain their weight loss and improved fitness. Success is sustained more often when the entire family stays dedicated as well.
The Trim Kids program is designed for children between the ages of seven and seventeen. It is a structured twelve week plan that requires parent participation. Parents act as coaches to educate their children about healthy eating habits, nutrition information, and how to be more active. Behavior modification is an essential component of the program. Through self-assessments, children learn to recognize why, how, and what they eat. By teaching them how to respond to eating triggers with healthy alternatives, parents instill weight management tools they can use throughout life.
Involving the entire family in the program also lends to its success. The obese child is surrounded by a support system and is less isolated in regard to the lifestyle changes. Trim Kids teaches parents how to shop for healthy food and be positive role models to their children. The program encourages all family members to try new foods, eliminate unhealthy snacks, and find ways to be active together. The authors recommend that parents give credit to the child for inspiring the other family members to adopt a healthy lifestyle as well.
By integrating a series of small changes into a child’s routine, they are able to make big progress toward their weight loss goals. Modifications include drinking water instead of sugary drinks, walking around instead of sitting while talking on the phone, exercising or stretching during commercial breaks, and eating smaller portions. Cutting a few calories and exercising a few extra minutes throughout the day adds up quickly over the weeks. Since these changes are not as dramatic as most adult weight loss programs, kids are more likely to stick with them.
After fifteen years of hands-on research and implementation of the twelve week plan, the authors present concise information in a straightforward, repetitive layout week after week. The step-by-step format makes it simple to follow. In addition, forms for recording physical activity, food intake, goals, and strength/flexibility workouts are included.
The program facilitates changes in eating habits by providing weekly menus, shopping lists, and recipes. A table of food portions and their food unit (carbohydrate, protein, fat, vegetable) is a useful tool for preparing and serving meals.
In regard to physical activity, participants are educated about fitness topics such as body composition, muscular strength, flexibility, endurance, and how to find their target heart rate. Each week a new exercise is introduced with recommended goals based on program level. Frequent, moderate activity is emphasized as it is developmentally more appropriate for children. Ideas for indoor activities and family outings provide variety and prevent burnout.
A key aspect of the program is behavior modification. Issues with self-image, self-esteem, peer pressure, and stress are highlighted. Guidelines and suggestions are provided for both parents and children to address common tempting social scenarios such as parties, vacations, and holidays. Parents learn how to encourage their child’s progress by acknowledging their own role in the child’s obesity, modeling the desired behaviors, offering positive reinforcement, and providing choices.
Trim Kids is designed for use at home in conjunction with supervision by a pediatrician. As with any weight loss program, it is important to speak with a physician regarding any health issues, dietary restrictions, or physical activity limitations before starting. If participating in the CTK program, make sure facilitators are trained and certified by the Committed to Kids Weight-Management Program training team.
Due to the nature of this program, full participation of all family members is required. Parents need to be familiar with the program and clearly present expectations to everyone involved. Reservations or aversion to the program should be handled prior to starting.
There are no major risks associated with this weight loss program when followed as directed under a physician’s supervision.
Success at the CTK weight-management clinic at Louisiana State University (LSU) was the catalyst for the Trim Kids at-home program. CTK has been part of the LSU Health Sciences Center for over fifteen years. Dr. Sothern and her team of psychologists, dieticians, and exercise physiologists continue to research childhood obesity at CTK clinics and refine the Trim Kids program. Research findings from the clinic are published often in medical journals. However, research on the program from an outside perspective is not readily available.
The National Cancer Institute approved the CTK/Trim Kids program as a research tested intervention program (RTIP). This means the research program was funded and has been peer-reviewed as well as published in a peer-reviewed journal. RTIPs undergo evaluation and receive scoring in six different areas. A summary of the program combined with the program scores allows individuals to make comparisons and find additional resources. Trim Kids received high scores in all areas except Research Integrity. Research on the program is considered weak with only some confidence in research results.
According to a 2006 article in Journal of Adolescent Health weight management programs for children, including CTK, lack the necessary data to prove them effective. Despite this, CTKs multidiscipli-nary team approach to preventing and treating obesity in children is implemented in numerous schools, hospitals, and community centers.
Sothern, M. et al. Handbook of Pediatric Obesity: Clinical Management. Boca Raton, FL.: Taylor and Francis
Publishers, 2006. Sothern, M., etal. Trim Kids: The Proven Plan that has Helped Thousands of Children Achieve a Healthier Weight. New York, NY: Harper Collins Publishers, 2001.
Kohn, Michael, et al. ‘‘Preventing and Treating Adolescent Obesity: A Position Paper of the Society of Adolescent Medicine.’’ Journal of Adolescent Health. 38 (2006): 784-787. <http://www.adolescenthealth.org/PositionPaper_Preventing_and_Treating_Adolescent_Obesity.pdf>. <http://www.adolescenthealth.org/PositionPaper_Preventing_and_Treating_Adolescent_Obesity.pdf>.
National Cancer Institute. Research-Tested Intervention Programs. ‘‘Trim Kids.’’ <http://rtips.cancer.gov>.
Warner, Jennifer. ‘‘10 Ways to Raise Food-Smart Kids.’’ WebMD. May 16, 2006. <http://children.webmd.com/guide/10-ways-to-raise-food-smart-kids>.
Stacey L. Chamberlin