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Childhood Obesity Treatment

Behavioral Intervention, Modification and Family Based Treatment for Childhood Obesity

Abstract

Childhood obesity is an important health issue today because of its fastly increasing frequency and related undesirable medical and social consequences. It is one of the most exacerbating and challenging diseases that has immediate as well as long term adverse outcomes and without intervention such as behavioral and family based treatment and therapy adolescents are at risk for other chronic health problems in adulthood including diabetes, high blood pressure, heart disease and respiratory problems. Other critical predictors include parental weight status, sex, age, and race and ethnicity. Therefore, since most interventions are moderately successful much of the intervention should be tailored to the patient as well as the entire family.

Introduction

Pediatric and adolescent obesity is a multifaceted disorder that entails both genetic and environmental factors. However, the earlier the age of onset of childhood obesity, the greater the chance and severity of obesity in adulthood as well as long term health complications such as cardiovascular disease, high blood pressure, high cholesterol, and Type II diabetes. Yet, it is a serious concern that has steadily increased over the years.

The Center for Disease Control and Prevention (n.d.) lists according to the National Health and Nutrition surveys, the prevalence for obesity in preschool years (age 2-5) and children (6-11 years) from 1999 to 2002 has doubled and that adolescents (age 12-19 years) have tripled. Furthermore, in the United States alone Fowler-Brown & Kahwati (2004) found there are approximately 15% of children who are at risk for being overweight and an additional 15% who are overweight.

However, childhood obesity has still reached endemic proportions throughout the world in developed nations. Therefore, the prevalence of overweight children is even higher according to Singhal, Schwenk, & Kumar (2007) for certain ethnic groups such as African Americans, Mexican Americans, and Native Americans (p 1258).

In a study of 763 Chinese children aged 8 to 15 were compared for body composition in relation to the multiple dimensions of physical self concept to body composition Marsh, Hau, Sung, & Yu (2007) conclude that children in Western and Non Western societies were more prevalent for childhood obesity (p 647).

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The study also found that while eating disorders were relatively rare within the Chinese population, there still is a high incidence for Chinese females to have weight issues. While Chinese parents believe that obesity reflects healthier children there are still changes in diet along with other socio-psychological changes that make childhood obesity an emerging problem, particularly for young, high income and urban adolescents in China (Marsh et al, 2007). However, even though the prevalence for childhood obesity is still rather low in some developed countries there seems to be an increasing trend of obesity in China that is medically and socially related to the costs associated with obesity.

Whereas, in other societies Bruss, Morris, Dannison & Orbe (2005) found that among African Americans and Latino adolescents the problem of obesity has nearly doubled in previous years while among white youth obesity has increased over fifty percent (p 156). Therefore the most important concern is not only from other countries throughout the world but within the United States as well. In the table below Fowler-Brown & Kahwati (2004) show the prevalence of overweight children and adolescents according to the various races (p 3).

Table 1 Prevalence of overweight (%)
Sex Age (years) Whites Blacks Hispanics
Male 6 to 11 12.0 17.1 27.3
12 to 19 12.8 20.7 27.5
Female 6 to 11 11.6 22.2 19.6
12 to 19 12.4 26.6 19.4
Fowler-Brown, A. & Kahwati, L.C. (2004). Prevention and treatment of overweight in children and adolescents, Journal of American Academy of Family Physicians, 69, (11), p 1-14. Electronically retrieved November 1, 2007 from http://www.aafp.org

In addition, to the prevalence of overweight children culturally environmental and genetic factors including socio-cultural and familial habits is the next leading cause of childhood obesity. Researchers today are finding that it may be a combination of factors that are involved in childhood obesity.

In an epidemiological study conducted by Wu & Suzuki (2006) on different countries found that childhood obesity is associated with parental overweight (p 201). The cross sectional study conducted in Europe of 3,306 children aged 5-7 years showed parents in Germany had a significantly higher rate of body mass index than other children whose parents who were not overweight (Wu & Suzuki, 2006).

Therefore, researchers concluded that a child’s body mass index is more closely related to the maternal body mass index than with the paternal body mass index because of the child’s risk of becoming overweight increased with parental overweight and obesity (Wu & Suzuki, 2006).

However, other studies suggest that obesity in children happens when children are placed in adverse environments. For years food has been scarce, and in order to survive in some areas of the world humans need to work hard. For this reason the pressures of families to minimize food costs, while cutting preparation time for meals, have begun to consume more convenience foods that are not only high in fat but high in calories.

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Sedentary behaviors and poor dietary patterns have also increased among children and adolescents today. Children are spending more time watching television or using the computer that the behavior takes up valuable time that could otherwise be used for physical activity.

As a result the sedentary behavior are children is affected by the energy balance and energy intake that the energy expended during moments of sedentary behavior which in turn exceed the positive energy that automatically leads to weight gain (Hills, King, & Armstrong, 2007).

Sedentary behaviors are an opportunity and a choice for children. This is why physical activity is a need to be positive and conducted in a way that not only encourages enjoyment and fun but capitalizes on the pleasure of activity movement that is the trademark of young children. Hills et al, (2007) feels this can be done by first establishing habitual physical activity long-term, so that the child will experience a measure of success in the activity setting.

Without it children often have poor experiences with habitual physical activity that often there are diminished levels of participation therefore perpetuating any weight problem that exists. However, there are still many children who do not receive the opportunity to be adequately active in order to create a sound motor skill base. Therefore, it is necessary to expand the child’s activity opportunity so that the activity participation will likely increase into adult years.

Behavioral intervention & Modification

In addition to increasing children’s physical activity it is also necessary to initiate treatment for behavioral modification in order to surpass the trend of increasing weight versus height. To successfully complete this task the behavioral modification plan needs to address a dialogue of self monitoring and recording food intake for the child as well as how the child will increase physical activity and slow the rate of eating by limiting the place and time the child eats.

Rewards and incentives should also be listed in the behavioral plan so that when the child exhibits a desirable behavior they will be rewarded for changed behavior. Lastly, in order for the behavioral plan to be effective if is necessary to include the parents.

The primary goal of the behavioral modification /intervention plan is for the body to regulate weight and fat of the child with ample nutrition according to the growth and development of the child. Ideally this is done by associating positive and negative eating and listing activity habits through behavioral modification that will not only enhance the positive behaviors and support healthy eating and physical activity but will also incorporate any negative behavioral patterns that can be changed.

By changing the negative behavioral patterns it controls the child’s environmental cues and the child can begin to grow at the desired weight and height that is consistent with there individual genetic profile. However, to add long term weight continuance the intervention should incorporate a modified exercise and eating behavior plan that promotes healthy behaviors and replaces the unhealthy behaviors thereby allowing the healthy behavior to continue well into adulthood.

Behaviors alone are not influencers for changing what a person wants to eat. For that reason, successful behavioral change interventions are dependent on whether a person wants to change the behavior as well as any personal, environmental or social circumstances that are a determinant to change the behavior over time.

One such determinant is how people eat for pleasure or emotional nourishment. Often children as well as adults have their own distinctive relationship to food. Children learn to eat as a way to cope for the loneliness, nervousness or sadness they feel because of being overweight. They learn to relate to food as a means to hide low self esteem. Therefore, over time the pattern of excessive eating with the food solidifies and becomes harder to change.

It is also hard to change a pattern if the child is unconsciously aware of the behavior. Therefore, awareness is the first step to changing the behavior. This is why it is vital to gather information on the behavior such as how often does the behavior occur, and under what circumstances does it occur? Also does the inappropriate behavior always happen when the child is eating alone? Or is it when the child is supervised? By answering these questions the behavior plan can then help determine how the child is feeling and what attitude was the child was in when the behavior occurred so that the child will not repeat the behavior.

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Self Monitoring

One way to incorporate inconsistent patterns of eating behaviors is for parents to self monitor the child’s foods and quantities eaten along with the time and place the child eats. Physical activity should also be recorded. Since eating and exercise is self reported the behaviors should be listed in the plan along with all food consumed and the calories and fat grams in the foods as well as all physical activity performed.

This way the child and the parents have an increased awareness of the maladaptive pattern. However, in order to change the problematic behavior the child should always be involved in the process as much as possible. Families are then provided with a sense of accomplishment when the parents review the plan to see how the eating and exercise habits have improved.

Changing Antecedents

It is also important to note any important environmental determinants that inhibit the behavior. Include triggers such as feeling of hunger or foods that influence as well other environmental, cognitive or social cues about feelings or thoughts of eating, body weight and exercise.

Controlling the Stimulus

Next, it is important to control the child’s stimulus by first identifying any environmental cues that are associated with overeating or the child’s lack of physical activity. To modify the environmental cues parents must change the child’s environment in order to help the child achieve the targeted behavior change.

In order to decrease the number of the stimuli that controls the child’s eating the parent must encourage eating only in one location (e.g. dining room, or kitchen). It should be discouraged to have the child eat while watching television because television produces discriminative stimuli. Children also need to recognize safety cues in order not to be distracted.

Social Reinforcement

Social reinforcement is also necessary. It is crucial to praise the child through positive social reinforcement. This will not only support the child but the behavior change and will help to ensure that the child connects between the praise they receive and the specific behavior. The connection will then increase the likelihood that the child will repeat the necessary behavior.

It will also provide attention and create more of an incentive for positive behavior changes instead of producing negative behaviors. However, the child’s weight loss should not be targeted as a specific goal but rather as a recognized change in the behavior. Therefore, the parent should reinforce the new or changed behavior by recognizing small positive changes of behavior and then reward the new behavior either verbally or through some small intangible reward system.

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Reinforcers work because it not only fulfills the child’s basis needs but it is also a form of relief from the pain of overeating and obesity. Therefore, as the rein forcer increases the probability that the behavioral response also increases meaning that the response will happen again. However, the reinforcer should not be in the form of gifts, money or food but in special activities that include both the parent and the child such as in a special trip to the library or the park. In order to apply reinforcement every time the new or changed behavior occurs there must be a continuous schedule within the behavioral modification plan that addresses the specific behaviors or inconsistencies (if any). This will help the child not to become confused or show resentment.

Family Based Treatment

In addition, to reinforcing behavior changes it is vital to involve the entire family in the behavior modification plan, therapy and treatment for weight control. Since family based treatment for behavioral childhood obesity was first developed over 25 years ago, Epstein, Paluch, Roemmich & Beecher (2007) have found that over time, youth that have become more obese and with the environment more obesiogenic it influences the efficacy of child weight control (p 381).

Since obesity usually runs in families many researchers have hypothesized that by targeting eating and activity change in the child and the parent, along with teaching parents the necessary behavioral skills to facilitate the childs behavior change, could mobilize family resources and improve the efficacy (Epstein et al, 2007). Therefore by consecutively treating the parent as well as the child it benefits both and creates more of a positive relationship between the child and the parent’s weight change.

In addition to involving parents in the weight loss process it is essential for the family to begin a combination of behavioral modification and behavioral therapy to improve weight loss outcomes.

By treating obesity and increasing the child’s activity level while eating sensible the family can educate themselves on nutrition and exercise and find out what the weight loss that is recommended in order for the child to maintain his or her weight loss over time.

References

Baker, C.W., Little, T.D., & Brownell, K.D. (2003). Predicting adolescent eating and activity behaviors: the role of social norms and personal agency. Journal of the Division of Health Psychology, American Psychological Association, 22, (2), p 189-98

Bruss, M.B., Morris, J.R., Dannison, L.L., Orbe, M.P., Quitugua, J.A., & Palacios, R.T. (2005). Food, culture, and family: exploring the coordinated management of meaning regarding childhood obesity. Health Communication, 18, (2), p 155-175

Department of Health and Human Services, Center for Disease Control and Prevention. (n.d.).

Overweight and obesity. Retrieved October 12, 2007 from the Center for Disease Control and Prevention Web site: http://www.cdc.gov

Epstein, L.H. (1998). Treatment of pediatric obesity. Pediatrics, 101, (3), p 554-70

Fowler-Brown, A., Kahwati, L.C. (2004). Prevention and treatment in overweight children and

adolescents. American Family Physician, 69, (11), p 1-8. Retrieved October 12, 2007 from http://www.aafp.org/afp/20040601/2591.html

Teenagers are led to obesity By: Nanci Hellmich. USA Today, 09/25/2007http://ebsco.waldenu.edu/ehost/results?vid=3&hid=114&sid=7d44f47a-2fba-404f-ba08-4599844b159d%40sessionmgr106

Herbert, M.W., Hau, K.T., Sung, R.Y.T., & Yu, C.W. (2007). Childhood obesity, gender, actual-ideal body image discrepancies, and physical self concept in Hong Kong children: cultural differences in value of moderation. Developmental Psychology. 43, (3), p 647-662

Hills, A.P., King, N.A., & Armstrong, T.P. (2007). The contribution of physical activity and sedentary behaviors to the growth and development of children and adolescents. Sports Medicine, 36, (6), p 533-546

Moran, R. (1999). Evaluation and treatment of childhood obesity. American Academy of Family Physicians, 59, (4), p 1-12. Electronically retrieved October 28, 2007 from http://www.aafp.org

Villanova, N, Pasqui, F., Burzacchini, S., Forlani, G., Manini, R., Suppini, A., Melchionsa, N, & Marchesini, G. (2006). A physical activity program to reinforce weight maintenance following a behavior program in overweight/obese subjects. International Journal of Obesity, 30, p 697-703

Wu, Q., Suzuki, M. (2006). Parental obesity and overweight affect the body fat accumulation in the offspring: the possible effect of high diet through epigenetic inheritance. Obesity Review, 7, p 201-208

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