Behavioural Weight Control Programme

 

OVERVIEW

 

A study of a behavioral obesity reduction program involving 45 children ages 6-13 and their parents was conducted. Participants were randomly assigned one of two experimental conditions or one of two control conditions. Experimental participants took part in either a rapid or gradual procedure of weight control sessions. The children were expected to attend 8 sessions accompanied by a parent. It was found that the behavioral approach led to significantly greater reductions in obesity, as measured by absolute weight loss and percentage overweight for age, sex, and height when compared with both control groups. When looking at results over a 26-week period, little difference was found between the rapid and gradual behavioral approaches.

 

DESCRIPTION OF PROGRAM

 

Target population: Children ages 6-13 and their parents

 

A study was designed to determine the effectiveness of a behavioral intervention to reduce obesity in children. The benefits of a rapid (closely-spaced sessions) versus a gradual (intervals of increasing inter-session) approach were assessed. The procedures used a combination of dietary, exercise and environmental management techniques led by two therapists. Participants were randomly assigned to one of these two conditions, or to one of two control group conditions: a non-specific control procedure, or a waiting list control group. Children and their parents were expected to attend all sessions and complete homework assignments.

 

EVALUATION(S) OF PROGRAM

 

Senediak, C. & Spence S. H. (1985).  Rapid versus gradual scheduling of therapeutic contact in a family based behavioural weight control programme for children. Behavioural Psychotherapy, 13, 256-287.

 

Evaluated population: 45 children between the ages of 6 and 13. All children met the criteria of being at least 20% above ideal for height, age and sex, of a height not below the 20^th percentile for age, having no history of psychiatric contact or of endocrine or metabolic disorders, and not receiving any special education. All children were required to have the ability to attend all sessions and have a parent willing to participate in the weight loss program. The children were an average age of 10.3 years, there were about twice as many males as females, and they were on average 37.22% overweight.

 

Approach: Children were randomly assigned to one of four conditions: a rapid behavioral group, a gradual behavioral group, a non-specific control group, and a waiting list control group. Participants in the rapid behavioral group took part in eight sessions, twice weekly, over four weeks with five or six parent-child pairs in each session. Each 90-minute session involved two therapists, and focused on a variety of dietary, nutritional and environmental approaches. The diet used was based on the Traffic Light System (developed by Epstein and colleagues) and the Food Exchange System. Aerobic exercise was discussed and subjects were asked to engage in at least four, 30-minute aerobic exercise sessions per week. Other lifestyle changes were encouraged, such as a minimizing the use of energy-saving devices. Participants were asked to record their caloric intake and exercise activity each day. Parents were asked to serve as role models for their children and to use praise to reinforce good behaviors, while children were taught to use self-reinforcement skills. Stimulus control techniques were encouraged, such as restricting eating to specific times and places. Negative cognitions were discouraged and children were taught to engage in “counter statements” in response to the thoughts that might contribute to obesity. Follow-up evaluations took place at 11 and 21 weeks after the treatment ended. In order to reduce drop-out problems, parents were required to deposit $30 at the beginning of the program, with $3 returned at every session and follow-up contact. Homework assignments were also assigned and had to be completed for the money to be reimbursed.

 

Participants in the gradual behavior group received the same regime as the rapid behavioral group, but under a different schedule. Sessions occurred over a 15-week period, with sessions 1 to 4 taking place weekly, sessions 5 and 6 occurring every 2 weeks, and sessions 7 and 8 taking place after a 3 week interval. This group had only one follow-up assessment, 11 weeks after the end of the program.

 

The non-specific control group followed the same treatment and follow-up schedule as the rapid behavioral group. The sessions included a social support procedure, during which parents and children discussed weight control matters amongst themselves with the therapist serving as a facilitator. Participants were also trained in progressive relaxation techniques, mood monitoring and will-power training. No information regarding caloric values of food or exercise activities was shared with the participants. Parents in this group were also required to make a monetary deposit. After the last follow-up, participants were provided with dietary and exercise information.

 

Participants in the waiting list control group were told that because of the high response rate of the program they’d have to wait a while before starting therapy. Assessments were conducted at weeks 1 and 4, but for ethical reasons the waiting list was not extended past 4 weeks. At that point participants were given a behavioral program but were no longer considered part of the study.

 

Results: Analyses showed that the behavioral approach led to significantly greater reductions in weight (a large effect size of 1.66) and percentage overweight (a large effect size of 1.71) by week 4 and by the end of the treatment (large effect sizes of 1.08 and 1.09 respectively) than the non-specific control approach. Comparing these two groups also showed a significantly greater reduction on all measures of obesity (.  Participants did show a reduction on all measure of obesity over time, but the impact wasn’t as great for the non-specific control group. The waiting list control group showed a small increase on all measures of obesity in the four-week period they formed part of the study.

 

Comparing the rapid and gradual behavioral procedures at 15 weeks for both groups, there was no difference found in percentage overweight, although the gradual group still had a significantly greater reduction in absolute weight. At 26 weeks, there were no differences between the groups, suggestion that in the medium run there isn’t much of a difference produced by the sequencing of sessions.

 

Overall, the behavioral procedures appeared effective in helping change eating and exercise habits of participants. The rapid behavioral group continued to show reductions in percentage overweight throughout the 21-week post-treatment follow-up period. Both rapid and gradual behavioral groups had reduced percentage overweight by week 26. Significant reductions in caloric intake and increases in exercise activity were seen in both groups.

 

 

 

SOURCES FOR MORE INFORMATION

 

References

 

Senediak, C. & Spence S. H. (1985).  Rapid versus gradual scheduling of therapeutic contact in a family based behavioural weight control programme for children. Behavioural Psychotherapy, 13, 256-287.

 

Program categorized in this guide according to the following:

 

Evaluated participant ages: 6-13

Program age ranges in the guide: Middle Childhood, Adolescence

Program components: Parent/Family Component

Measured outcomes: Physical Health

 

 KEYWORDS: Middle Childhood (6-11), Adolescence (11-17), Children (3-11), Home-based, Urban, Suburban, Counseling/Therapy, Life Skills Training, Physical  Health, Nutrition, Overweight, Obese, co-ed

 

Program information last updated 12/17/08

 

		© Child Trends 2004