Program

Oct 30, 2008

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.

KEYWORDS:
Physical Health, Obesity, High-Risk, Parent/Family Component, Middle Childhood
(6-11), Adolescence (12-17), Nutrition, White or Caucasian.

Program information last updated 10/30/08.