PROBLEM SOLVING PROGRAM FOR CHILDHOOD OBESITY
OVERVIEW
This problem solving program for childhood obesity is designed as a complement to obesity programs for families with children who are more than 20 percent overweight. The program is a fairly short, 6 month, intervention which offers didactic problem solving training along with individual meetings with therapists and also separated group sessions for both parents and children. In one experimental evaluation of the program, 62 families were randomly assigned to a parent and child training, child training, or “standard” obesity intervention. The full parent and child problem solving training was found to have unfavorable impacts on child Body Mass Index (BMI), compared with the standard treatment. The full program did, however, lead to gains in parental problem solving behaviors. There were no other consistent program impacts. The child problem solving condition had no impacts on any studied variables relative to the “standard” intervention. In an earlier experimental evaluation of the program, children were randomly assigned to a problem solving, behavioral, or instruction-only group. In this evaluation, the problem-solving program was found to have a positive impact on children’s weight, parent problem solving ability, and child food intake. The program had no impacts on child physical activity.
DESCRIPTION OF PROGRAM
Target population: Families with children who are at least 20% overweight
This program is meant to act as a supplement to obesity programs and is intended to improve the acquisition of healthy behavior by allowing families to break down barriers to change. Additionally, the program is supposed to reduce family stress which may in turn lead to healthy behaviors and prevent relapse into unhealthy behaviors. The program is relatively short and consists of weekly sessions over the first few months of the program and a few monthly meetings thereafter for weight monitoring/maintenance. At these meetings, family members are weighed and then meet with an individual therapist. After individual meetings, families split up into child and parent groups and attend separate group meetings. During these meetings, children and parents are introduced to problem solving and problem solving techniques are used to address problems that the family may be facing. Families are also given several homework assignments and are also given workbooks which outline healthy eating habits, physical activity levels, and behavior change techniques.
EVALUATION(S) OF PROGRAM
Epstein, L. H., Paluch, R. A., Gordy, C. C., Saelens, B. E., & Ernst, M. M. (2000). Problem solving in the treatment of childhood obesity. Journal of Consulting and Clinical Psychology, 68(4), 717-721.
Evaluated population: 62 families that had a child who was more than 20 percent overweight. These families were recruited from various sources including physicians and newspapers. The sample was 97 percent non-Hispanic white, 2 percent African American, and 2 percent Hispanic. Children averaged slightly over 10 years of age and most participants were male.
Approach: To be eligible for the study, each family had to have one child who was more than 20 percent overweight, neither parent was more than 100 percent overweight, one parent who would attend treatment sessions, no family member in a weight treatment program, no family member with psychiatric problems, no family member with activity restrictions, and the target child had to be reading at a third-grade level or higher. Families were matched on child’s gender and obesity level and then randomly assigned to one of three conditions: parent and child problem solving, child problem solving, standard family-based treatment.
Families in the program received 16 weekly meetings in the first four months and 2 monthly meetings thereafter for a total of 6 months of treatment. At these meetings, family members were weighed, met with an individual therapist, and then attended separate group meetings for both children and parents. Families were also provided with workbooks on positive diets. Families assigned to the parent and child problem solving condition were provided with didactic training and group problem solving activities during the group sessions described above. Children in families assigned to the child problem solving condition would receive problem solving training in their separate group sessions. In these groups, parents and children were also given problem-solving worksheets and homework. Families who were assigned to the “standard” treatment received homework assignments and group sessions which were not geared towards problem-solving. In all conditions, a $75 deposit was collected from all families and was returned if the family attended 75% of the treatment sessions.
Parents and children were assessed on Body Mass Index which were based on self-reported body weight and height. Researchers also assessed child problem solving, parent problem solving, child behavior which included competence, internalizing and externalizing behavior problems, and parent psychological problems.
Results: At baseline, there were no differences between groups on any measures, suggesting that random assignment was successful. The problem-solving program has unfavorable impacts on BMI as children in the parent and child group had larger increases than children in the standard intervention group. Similarly, those in the parent and child problem solving group had a smaller percentage of children with large BMI decreases. The problem solving program had no effect on child problem solving, parent weight change, and behavior problems.
Evaluated population: 40 children ages 6-12 years who were at least 20 percent overweight for their age, sex, and height.
Approach: Children were randomly assigned to either the intervention problem-solving group, a behavioral treatment group, or an information only control group. All groups were given a series of 8 weekly hour-long group sessions. In the treatment group, children reviewed the prior week’s lesson, completed food intake and activity sheets, learned about techniques for weight reduction, and then were given 20 minutes of problem solving exercises. Children in the behavioral treatment group received the same treatment except that parents in this group exchanged recipes and exercise ideas for their children instead of problem solving exercises. Children in the instruction-only group were given the same information about weight reduction techniques, parents exchanged recipes and exercise ideas, and children exercised at the meetings for 15 minutes.
Children in the study were assessed at 1, 2, 3, and 6 months following the end of the program on measures of Body Mass Index (BMI), food intake, and physical activity.
Results: At post-test, children in the problem solving group had decreased their weight more than those in the behavioral and instruction only groups. At 6-months, these gains by the problem solving group persisted. Parents whose children were assigned to the problem solving group increased more than their counterparts in the behavioral and instruction only groups on measures of problem solving ability. This finding was also maintained at the 6-month follow-up. Children in both problem solving and behavioral groups had healthier eating habits than those in the instruction only group. The behavioral group had initial impacts on weight, BMI, and percentage overweight, but the impacts were smaller than the problem-solving group and did not persist. The program had no impacts on physical activity levels.
SOURCES FOR MORE INFORMATION
References
Epstein, L. H., Paluch, R. A., Gordy, C. C., Saelens, B. E., & Ernst, M. M. (2000). Problem solving in the treatment of childhood obesity. Journal of Consulting and Clinical Psychology, 68(4), 717-721.
Program categorized in this guide according to the following:
Evaluated participant ages: 6-12 years / Program age ranges in the Guide: middle childhood
Program components: clinic-based, provider-based, or miscellaneous; parent or family component
Measured outcomes: education and cognitive development; physical health; behavioral problems
KEYWORDS: Middle Childhood (6-11), Adolescence (12-17), Children (3-11), Clinic-based, Home-based, Life Skills Training, Physical Health, Nutrition, Overweight, Obese
Program information last updated 10/21/07
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© Child Trends 2003 |
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