Program

Aug 31, 2012

OVERVIEW

The Behavioural Weight Control Programme is a therapy program that utilizes exercise, environmental, and dietary management techniques to reduce behaviors that play a role in obesity. Children between the ages of 6 and 13, and their parents, participate in either a rapid or gradual session version of the program, during which they are taught about engaging in aerobic exercise, following a healthy diet, and how parents can reinforce good behavior through praise. An experimental evaluation of the program 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: School-age children who are overweight

This program uses a combination of dietary, exercise and environmental management techniques to reduce behaviors contributing to obesity. There are two groups participants have been assigned into for this program: a rapid (closely-spaced sessions) approach or a gradual (intervals of increasing inter-session) approach. Participants in the rapid behavioral group take part in eight sessions, twice weekly, over four weeks with five or six parent-child pairs in each session. Each 90-minute session involves two therapists, and focuses on a variety of dietary, nutritional and environmental approaches. The diet used is based on the Traffic Light System (developed by Epstein and colleagues) and the Food Exchange System. Aerobic exercise is discussed and subjects are asked to engage in at least four, 30-minute aerobic exercise sessions per week. Other lifestyle changes are encouraged, such as a minimizing the use of energy-saving devices. Participants are asked to record their caloric intake and exercise activity each day. Parents are asked to serve as role models for their children and to use praise to reinforce good behaviors, while children are taught to use self-reinforcement skills. Stimulus control techniques are encouraged, such as restricting eating to specific times and places. Negative cognitions are discouraged, and children are taught to engage in “counter statements” in response to the thoughts that might contribute to obesity. In order to reduce drop-out problems, parents are required to deposit $30 at the beginning of the program, with $3 returned at every session and follow-up contact. Children and their parents are expected to attend all sessions and complete homework assignments, with assignment completion required for money to be reimbursed.

Participants in the gradual behavior group receive the same regime as the rapid behavioral group, but under a different schedule. Sessions occur 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.

EVALUATION(S) OF PROGRAM

Evaluated population: Participants consisted of a total of 45 children between the ages of 6 and 13. All children met the criteria of (a) being at least 20 percent above ideal for height, age and sex, (b) being a height not below the 20th percentile for age, (c) having no history of psychiatric contact or of endocrine or metabolic disorders, and (d) not receiving any special education. All children were required 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 37.2 percent overweight.

Approach:Children were randomly assigned to one of four conditions: a rapid behavioral group (N=12), a gradual behavioral group (N=12), a nonspecific control group (N=11), and a waiting list control group (N=10). The nonspecific control group followed the same treatment and follow-up schedule as the rapid behavioral group. 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 they would have to wait a while before starting therapy, because of the high response rate of the program.

To assess the effectiveness of the program, data were collected on weight, percentage overweight, skinfold thickness, caloric intake, and activity output. Data were collected at baseline and after four weeks. Follow-up evaluations were conducted at 10 and 21 weeks post-treatment for the rapid behavioral group and non-specific control group (weeks 15 and 26). Week 4 marked the post-test assessment of the rapid behavioral group and week 15 marked the post-test assessment for the gradual behavioral group. For ethical reasons, the waiting list was not extended past 4 weeks, at which point participants were given a behavioral program but were no longer considered part of the study.

Results: Analyses demonstrated that while participants in general showed reductions over time in measures of obesity, the behavioral approaches (combined) led to significantly greater reductions in absolute weight and percentage overweight than the non-specific or wait-list control approaches at week 4 and post-treatment (week 4 for the rapid behavioral group and week 15 for the gradual behavioral group). No differences were found between the combined behavioral approaches and the two control groups on skinfold at week 4, but comparing at post-test, the combined behavioral approaches had significantly greater reductions than the wait-list control group, but not the nonspecific control group. While no differences were found between the rapid and gradual approaches at week 4, comparisons between impacts at post-test for both groups demonstrated that the gradual approach had greater reductions in absolute weight and percentage overweight than the rapid approach.

At weeks 15 and 26, the combined behavioral approaches had significantly greater reductions on all obesity measures than the nonspecific control group. The gradual approach was also found to have a larger reduction in absolute weight than the rapid approach at week 15, but no differences were found on other measures or at week 26. Comparing groups at follow-up (week 15 for the rapid approach and nonspecific controls, week 26 for the gradual approach) the combined behavioral approaches had significantly larger reductions on all measures than the nonspecific controls. The gradual approach showed significantly greater reductions in percentage overweight than the rapid approach, but no differences were found on other measures.

In terms of caloric intake, at post-test the combined behavioral approaches were found to have a statistically significant reduction. There were no differences between the two groups. Similarly, the combined behavioral approaches were found to have significantly increased levels of aerobic exercises and lifestyle change exercises, but not conditioning exercises. Again no differences were found between 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.

KEYWORDS: Children, Adolescents, Males and Females (Co-Ed), Urban, Suburban, Home-based, Counseling/Therapy, Parent or Family Component, Skills Training, Physical Health – Other, Nutrition, Obesity

Program information last updated 8/31/12