Family-Based Behavior Modification Program to Target Obesity

 

OVERVIEW

 

A study was designed to assess the importance of family-based behavior modification weight-loss programs. Participants were randomly assigned to one of three conditions of weight-loss treatment, including a child target, parent/child target, or non-specific target group. A follow-up study of the same program was conducted 10 years later. In the earlier study, it was found that, while children in all 3 conditions presented similar percentage overweight changes throughout the treatment and follow-up.  Parents had more weight loss in the parent/child group during treatment. Children in the parent/child group maintained nonobesity in higher percentages than children in the other two groups.

 

DESCRIPTION OF PROGRAM

 

Target population: High-risk, pre-adolescent, obese children and their families

 

In the past, data had suggested that children who are obese are more likely to come from families with other obese people, and are more likely to become obese adults. A weight control program was designed to study the importance of targeting not just the child, but other family members with the intervention.  Specifically, this study placed participants in one of 3 randomly assigned conditions, one with just a child focus, another with a parent/child focus, and a third condition with a non-specific focus. Participants took part in a 14-session treatment program with follow-up 13 months after the end of treatment, or 21 months after the beginning. They received diet, nutrition, and exercise information. Depending on the condition they were in, either the child, both the child and the parent, or neither one, were the focus of several additional components.

 

EVALUATION(S) OF PROGRAM

 

Epstein, L. H., Wing, R.R., Koeske, R., Andrasik, F., & Ossip, D.J (1981).  Child and Parent Weight Loss in Family-Based Behavior Modification Programs.  Journal of Counseling and Clinical Psychology, 49(5), 674-685.

 

Evaluated population: 76 families including 86 children age 6-12 and 69 parents. Children ages 6-12 and their parents.

 

Approach: The 76 families that participated in treatment had to meet the following criteria: have at least one child and one parent between 115-180% of the ideal weight for their height and age, triceps skinfold greater than 95% of other children their age, height not below the 25th percentile for children their age, no history of psychiatric contact for children, both parents at home, a parent willing to participate in the program (and hopefully this being the overweight parent), and ability to attend at least 12 of the 14 treatment sessions. Participants were placed under treatment through stratified random assignment, into one of 3 groups. Children were stratified into equivalent classes based on age, percentage overweight ranges, and parents' percentage overweight ranges.

 

The 3 groups each had a different focus: parent/child, child, and nonspecific. Participants in all 3 groups received the same treatment - 14 sessions which included 8 weekly sessions and 6 sessions distributed over the next 6 months, at 2.5, 3, 4, 5, 6.5, and 8 months after treatment started. Follow-up took place 21 months after treatment started.

 

All 3 groups received the same information on diet, exercise, and some social learning principles, which included modeling, praise, and contracting. The traffic light diet system was used. Participants received information on aerobic exercise, stretching, and spot reducing, and were told to begin an exercise program.

 

In order to maintain active participation in the program, contracting was used. Parents deposited $65 at the beginning of treatment and received $5 back at each of the sessions. In order to receive the money, participants in the parent/child focus group had to show both child and parent weight loss. Participants in the child focus group received the money if there was child weight loss, and those in the nonspecific focus group received the money simply by attending.

 

Additional contracting techniques were taught to parents. The first technique was self-monitoring. Both parent and child were instructed to do this in the parent/child focus group, only the child in the child focus group and neither the parent or child in the nonspecific focus group. Both parent and child in groups 1 and 2 were trained to serve as role models in their family, and to praise other family members for changing their eating or exercise habits. Participants in groups 1 and 2 were in contact with a therapist throughout the last 6 months of treatment, to assess progress in behavior change and provide additional support. A contingency management procedure was used in which every week children and parents were presented with a new teaching module and then tested on the material. In the child focus group, both parent and child were expected to exhibit mastery of the child's material. In the parent/child focus group, they were each expected to master their own material. Those in the non-specific group were instructed in a lecture with question/answer format.

 

 

Results: Significant decreases in weight and percentage overweight were seen in those participating in all three treatment groups the program. Parents in the parent/child focus group lost more weight during treatment, although these differences disappeared by the end of follow-up. For children, there was no difference in average weight change over time across the three groups. The children in a group in which a parent was a target and who had reached a non-obese status by the end of the treatment were able to maintain this status throughout the follow-up period, while significantly smaller proportions of children were able to do the same if in a group in which a parent was not a target.

 

Although some parent and child changes were closely tied during treatment, this did not persist during the follow-up period. In fact, parents in all 3 groups showed poorer maintenance than their children. Forty percent of the children and 33% of the adults became nonobese at the end of treatment or follow-up. The amount of food and the types of food consumed changed during treatment and became more in-line with the goals of treatment. It was also seen that children who reduced their consumption of high fat, high sugar foods the most were the ones to lose the most weight.

 

Epstein, L.H., Valoski, A., Wing, R., & McCurley, J. (1990).  Ten-year follow-up of behavioral, family-based treatment for obese children.  JAMA, 264(19), 2519-2523.

 

Follow-up studies were also conducted 5 and 10 years after treatment. Due to attrition, data was only available for 55 of the original 76 families. Children in the child/parent group showed a decrease from baseline in percentage overweight after 5 and 10 years, while the children in the other two groups showed an increase in percentage overweight. No significant differences across the groups were found for participating parents at the 10 year follow-up.

 

 

SOURCES FOR MORE INFORMATION

 

References

 

Epstein, L. H., Wing, R.R., Koeske, R., Andrasik, F., & Ossip, D.J (1981).  Child and Parent Weight Loss in Family-Based Behavior Modification Programs.  Journal of Counseling and Clinical Psychology, 49(5), 674-685.

 

Epstein, L.H., Valoski, A., Wing, R., & McCurley, J. (1990).  Ten-year follow-up of behavioral, family-based treatment for obese children.  JAMA, 264(19), 2519-2523.

 

 

Program categorized in this guide according to the following:

 

Evaluated participant ages: 6-12

Program age ranges in the Guide: Middle Childhood, Adolescence

 Program components: Parent/Family Component

Measured outcomes: Physical Health

 

KEYWORDS: Behavior Modification, Weight-Loss, Physical Health, Obesity, High-Risk, Parent/Family Component, Middle Childhood (6-11), Adolescence (12-17), Nutrition, Exercise, Parental Reinforcement, Self-Regulation, White or Caucasian.

 

 

Program information last updated 10/30/08.

 

 

 

© Child Trends 2003