We are family: The importance of using a familybased behavioral approach in childhood obesity treatm

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We are family The importance of using a
family-based behavioral approach in childhood
obesity treatment

• Hollie Raynor, Ph.D., R.D.
• Assistant Professor
• Department of Nutrition
• Obesity Research Center
• University of Tennessee

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Behavioral Theory

• Evidence-based childhood obesity
  interventions are based on behavioral theory
• Antecedents Behaviors
  Consequences
• The intervention uses a family-based
  approach and focuses on behavior modification
  strategies for changing behaviors

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Childhood Obesity Interventions

• Children aged 8 to 12 years of age
• gt 85th percentile BMI, but not greater than 100
  overweight
• Conducted in research settings
• Treatment provided over 6 months

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Behavioral Targets

• Evidence-based interventions target behaviors
  that reduce energy intake and increase energy
  expenditure
• Low-calorie diet (1000-1200 kcals/day)
• Most widely studied is the Traffic Light Diet
  (Epstein and colleagues)
• Categorizes food into Green, Yellow, Red (based
  upon energy-density and nutrient quality)
• Reduce intake of fast-food, soda, sweet and salty
  snack foods
• Generally does not cause an increase in FV and
  dairy products unless specifically targeted in
  treatment

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Behavioral Targets

• Leisure-time activities
• Increase in physical activity (60 minutes/day),
  with focus on play and family activities
• Reduction in TV watching (lt 15 hours/week)
• Increases physical activity
• May help with decreasing intake

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Behavioral Parenting Program

• Strategies for Antecedents
• Parental modeling
• Parent makes all of the same changes in behaviors
  as child
• Change the home environment (stimulus control)
• Eating
• Overt and covert restriction
• Leisure-time behaviors
• Problem-solving and pre-planning

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Behavioral Parenting Program

• Strategies for behaviors
• Self-monitoring
• Goals of program
• Kcals, Red Foods, FV
• Physical Activity
• TV Watching
• Weight
• Parent-child meetings
• Tie weight change to behavior change to
  demonstrate relationship between behaviors and
  weight
• Feedback on self-monitoring is important

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Behavioral Parenting Program

• Strategies for consequences
• Positive reinforcement
• Praise
• Contingency contracting
• Point system
• Reduction of negative reinforcement
• Increase use of extinction for problematic
  behaviors

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Childhood Obesity Treatment

• These evidence-based interventions targeting
  children aged 8 to 12 years produces significant
  reductions in percent overweight
• (-15 to -20), with 10-year follow-up showing
  almost 1/3 of treated children no longer
  overweight and a mean reduction in percent
  overweight of -10 in treated children (Epstein,
  Paluch, Raynor, 2002 Epstein, Paluch,
  Kilanowski, Raynor, 2004 Raynor, Kilanowski,
  Esterlis, Epstein, 2002 )

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• What can be done with younger children?

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Pediatric Obesity Treatment

• Maternal and Child Health Bureau Recommendations
  for Treatment in a Primary Care Setting
• 1. Start treatment in children as young as 3
  years of age
• 2. Apply a family-based model in treatment
• 3. Use behavior modification techniques
• 4. Help families make small changes
• 5. Target changing 2 or 3 eating and activity
  behaviors at a
• time

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Pediatric Obesity Treatment

• Behaviors recommended to target in young children
• Fast-food intake (limit)
• Sweetened drink intake (limit)
• Sweet and salty snack foods (limit)
• Low-fat dairy (2 servings per day)
• Fruits vegetables (1.5 c fruits 2.5 c
  vegetables/day)
• Physical activity (60 minutes per day)
• TV watching (lt 2 hrs/day)

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Pediatric Obesity Treatment

• Will these recommendations be effective at
  treating young children who are overweight?
• AND
• What are the best behaviors to target?

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Pediatric Obesity Treatment

• Kids CAN and Child HELP
• Two research programs funded by the National
  Institutes of Health and the American Diabetes
  Association
• For children between the ages of 4 to 9 years, gt
  85th percentile BMI, with at least one
  problematic eating or activity behavior
• Intervention length is 6 months, with 6 months
  follow-up

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Pediatric Obesity Treatment

• Assessments conducted every 3 months (primary DV
  is change in weight status)
• Both programs randomly assign families to one of
  three interventions
• Behavioral parenting program (2 different
  parenting programs in each study)
• Newsletter

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Behavioral Parenting Program

• Parents attend 8, 45-minute sessions
• Instructed on how to
• monitor eating and activity behaviors (parent and
  child)
• change the home environment (stimulus control)
• parental modeling
• use positive reinforcement
• reduction of negative reinforcement in household
• increase use of extinction in household

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Kids CAN

• Substitution
• TV watching
• (lt 2 hours/day)
• Low-fat milk
• (2 servings/day)
• Focusing on substitute behaviors for targeted
  behaviors may enhance feelings of choice for
  engaging in targeted behavior

• Traditional
• Physical Activity
• (60 min/day)
• Sweetened drinks
• (lt3 servings/week)
• Traditional behaviors that target increasing
  energy expenditure and decreasing energy intake

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Child HELP

• Decrease
• Sweet/salty snack foods
• (lt 3 servings/week)
• Sweetened drinks
• (lt 3 servings/week)
• Decrease intake of foods that are low in
  nutrient- density and high in energy-density

• Increase
• Fruits and Vegetables
• (2 servings fruit and 3 servings vegetables/day)
• Low-fat dairy
• (2 servings/day)
• Low-energy-dense foods increase feelings of
  fullness and may displace consumption of low-
  nutrient-dense foods

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Summary

• For school-aged children, an evidence-based
  intervention for pediatric obesity has been
  developed
• This intervention is a family-based, behavioral
  interventions and has been effective in improving
  the weight status of children
• Childhood intervention studies produce better
  outcomes than adult behavioral weight loss
  programs
• Message to take away from these studies is the
  importance of the parent and the behavioral
  methods for helping children develop healthy
  lifestyles

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Research Team

• Hollie Raynor, Ph.D., R.D, Primary Investigator
• Rena Wing, Ph.D., Co-Investigator
• Elissa Jelalian, Ph.D., Co-Investigator
• Patrick Vivier, M.D., Consultant
• Chantelle Hart, Ph.D., Interventionist
• Kathrin Osterholt, M.S., Project Coordinator
• Debbie Maier, M. S., R. D., Project Coordinator
• Katie Dietz, B. A., Research Assistant
• Amanda Fine, B. A., Research Assistant
• Marie Kieras, B. A., Research Assistant
• Allison Martir, B. A., Research Assistant