Reducing Sedentary Behavior: Reinforcement vs. Stimulus Control

OVERVIEW

Sixty-three obese children and their families participated in a behavioral treatment program designed for weight loss through the use of two different methods. Participants were randomly assigned to either a reinforcement or a stimulus control group, both intended to reduce sedentary behaviors. Both treatments had positive and similar effects, and no significant difference was found in the efficacy of these programs. Children experienced significant decreases in sedentary behaviors and intake of high energy density food, as well as an increase in physical activity and consumption of fruits and vegetables in both conditions. Children who were able to substitute physical activities for sedentary ones experienced significantly greater changes in standardized body mass index (BMI). These changes were visible at the end of the treatment program (6 months after it began) and at the 12-month follow-up.

DESCRIPTION OF PROGRAM

Target population: Obese children

A study was conducted with obese children and their families to determine whether different methods of reducing targeted sedentary behaviors (such as watching TV, playing video games, etc) were associated with differences in changes in sedentary and active behaviors and percentage overweight. The study was also conducted to learn if treatment outcomes were related to individual differences in substitution of physical activities for sedentary ones, or if changes in eating habits are also related. Families undergoing the treatment were randomly selected to participate in either a stimulus control of sedentary behaviors or a reinforced reduced sedentary behaviors group.

EVALUATION(S) OF PROGRAM

Epstein, L.H., Paluch, R.A., Kilanowski, C.K., Raynor, H.A. (2004). The Effect of Reinforcement or Stimulus Control to Reduce Sedentary Behavior in the Treatment of Pediatric Obesity. Health Psychology, 23(4), 371-380.

Evaluated population: 63 families, consisting of an obese 8-12 year old child and their parent.

Data were collected on the 62 of the 63 families who completed at least 6 months of treatment. This sample consisted of 23 boys and 39 girls who were 90.3% White, 6.5% Black, 1.6% Hispanic, and 1.6% other racial/ethnic group. There was a mean age of 9.8 with a mean BMI of 27.7 Seventy-three percent of the parents were obese.

Approach: In order to participate, families had to meet the following criteria: Child being in the 85^th body mass index (BMI) percentile or higher, have a parent willing to participate, neither child or parent currently with a psychiatric problem or any dietary or exercise restrictions, and child able to read the manuals and be able to self-monitor food and activity. Seventy-two families who met the criteria were initially recruited, but nine withdrew before the treatment started.

Families were randomly assigned to one of two treatment groups: reinforced reduced sedentary behavior or stimulus control of sedentary behavior. The treatment lasted 6 months and included 16 weekly meetings followed by 2 bi-weekly meetings and 2 monthly meetings. Data were collected at baseline and at the end of the 6 months of treatment. Follow-up treatment and data collection also occurred 12 months after the beginning of the program.

Participants received family-based weight control notebooks which included an introduction to weight control and self-monitoring, the Traffic Light Diet (which categorizes foods into green, yellow and red - high calorie - foods and discouraging red foods) behavior change techniques, and maintenance of behavior change. At each meeting, participants were weighed and then met individually with a therapist for 15-30 minutes. After that, children and parents attended separate 30-minutes group meetings. Families kept habit books in which they were told to record home weights at least once per week, as well as daily food intake and targeted sedentary behavior times, such as TV and video games. These habit books were to be completed before each therapy session and then reviewed during it.

In order to motivate behavior change in children, families in both groups were taught to praise the children for meeting goals that were specific to their group. Children and parents also selected appropriate reinforcers which were assigned point values. Children could earn small, medium, and large reinforcers for meeting behavior change goals at weeks 1, 2, and 4, respectively.

Participants were taught to preplan so as to avoid difficulty at events such as parties, school or work functions, and holiday gatherings.

All participants were asked to reduce hours of targeted sedentary activity to 15 or fewer per week. Children in the reinforcement group were given points for reducing their sedentary behavior to meet that goal. Children in the stimulus control group were positively reinforced for recording their sedentary behaviors but not for any behavior change. In addition, those in the stimulus control group were told to change their environment so that they would abstain from engaging in the sedentary behaviors. They were asked to establish rules regarding these behaviors and to follow additional instructions, such as posting signs with limits on sedentary activities and unplugging targeted sedentary activities such as the TV.

Results: Significant decreases in percent overweight were seen for obese children in both groups. There was a significant decrease in the consumption of high energy foods from 0-6 months, as well as an increase in servings of fruits and vegetables. There was also a significant decrease in the percentage of time in targeted sedentary behaviors. There was an increase in moderate to vigorous physical activity in both groups. Results suggest no significant differences in weight control between the two groups.

Non-experimental analyses indicate that children who substituted active behaviors for sedentary behaviors showed a two-fold advantage over those who didn't, whereas children who reduced their consumption of high-energy-density foods with reductions in targeted sedentary behavior showed a little less, a 1.8 advantage. Boys were twice as likely (54% to 27%) to substitute physically active for sedentary behaviors. Substitution and changes in activity levels were predictors of both 6- and 12-month standardized BMI. Changes in high-energy-density foods were also predictive of a 6-month change.

SOURCES FOR MORE INFORMATION

References

Program categorized in this guide according to the following:

Evaluated participant ages: 8-12

Program age ranges in the guide: Middle Childhood

Program components: Parent/Family Component

Measured outcomes: Physical Health

KEYWORDS: Middle Childhood (6-11), Children (3-11), Adolescence (12-17), Clinic-based, Home-based, Life Skills Training, Counseling/Therapy, Physical Health, Nutrition, Overweight, Obese

Program information last updated 8/13/08.

		© Child Trends 2003