Program

Oct 21, 2007

OVERVIEW

This problem
solving program for childhood obesity is designed as a complement to obesity
programs for families with children who are more than 20 percent
overweight. The program is a fairly short, 6 month, intervention which
offers didactic problem solving training along with individual meetings with
therapists and also separated group sessions for both parents and
children. In one experimental evaluation of the program, 62 families were
randomly assigned to a parent and child training, child training, or “standard”
obesity intervention. The full parent and child problem solving training
was found to have unfavorable impacts on child Body Mass Index (BMI), compared
with the standard treatment. The full program did, however, lead to gains
in parental problem solving behaviors. There were no other consistent
program impacts. The child problem solving condition had no impacts on
any studied variables relative to the “standard” intervention. In an
earlier experimental evaluation of the program, children were randomly assigned
to a problem solving, behavioral, or instruction-only group. In this
evaluation, the problem-solving program was found to have a positive impact on
children’s weight, parent problem solving ability, and child food intake.
The program had no impacts on child physical activity.

DESCRIPTION OF PROGRAM

Target population: Families with children
who are at least 20% overweight

This program is meant to act as a supplement to obesity
programs and is intended to improve the acquisition of healthy behavior by
allowing families to break down barriers to change. Additionally, the
program is supposed to reduce family stress which may in turn lead to healthy
behaviors and prevent relapse into unhealthy behaviors. The program is
relatively short and consists of weekly sessions over the first few months of
the program and a few monthly meetings thereafter for weight
monitoring/maintenance. At these meetings, family members are weighed and
then meet with an individual therapist. After individual meetings,
families split up into child and parent groups and attend separate group
meetings. During these meetings, children and parents are introduced to
problem solving and problem solving techniques are used to address problems
that the family may be facing. Families are also given several homework
assignments and are also given workbooks which outline healthy eating habits,
physical activity levels, and behavior change techniques.

EVALUATION(S) OF PROGRAM

Epstein, L. H., Paluch, R. A., Gordy, C. C., Saelens, B.
E., & Ernst, M. M. (2000). Problem solving in the treatment of
childhood obesity. Journal of Consulting and Clinical Psychology, 68(4),
717-721.

Evaluated population: 62 families that had
a child who was more than 20 percent overweight. These families were
recruited from various sources including physicians and newspapers. The
sample was 97 percent non-Hispanic white, 2 percent African American, and 2
percent Hispanic. Children averaged slightly over 10 years of age and
most participants were male.

Approach: To be eligible for the study, each family
had to have one child who was more than 20 percent overweight, neither parent
was more than 100 percent overweight, one parent who would attend treatment
sessions, no family member in a weight treatment program, no family member with
psychiatric problems, no family member with activity restrictions, and the
target child had to be reading at a third-grade level or higher. Families
were matched on child’s gender and obesity level and then randomly assigned to
one of three conditions: parent and child problem solving, child problem
solving, standard family-based treatment.

Families in the program received 16 weekly meetings in the
first four months and 2 monthly meetings thereafter for a total of 6 months of
treatment. At these meetings, family members were weighed, met with an
individual therapist, and then attended separate group meetings for both
children and parents. Families were also provided with workbooks on
positive diets. Families assigned to the parent and child problem solving
condition were provided with didactic training and group problem solving
activities during the group sessions described above. Children in
families assigned to the child problem solving condition would receive problem
solving training in their separate group sessions. In these groups,
parents and children were also given problem-solving worksheets and homework.
Families who were assigned to the “standard” treatment received homework
assignments and group sessions which were not geared towards
problem-solving. In all conditions, a $75 deposit was collected from all
families and was returned if the family attended 75% of the treatment sessions.

Parents and children were assessed on Body Mass Index which
were based on self-reported body weight and height. Researchers also
assessed child problem solving, parent problem solving, child behavior which
included competence, internalizing and externalizing behavior problems, and
parent psychological problems.

Results: At baseline, there were no differences
between groups on any measures, suggesting that random assignment was
successful. The problem-solving program has unfavorable impacts on BMI as
children in the parent and child group had larger increases than children in
the standard intervention group. Similarly, those in the parent and child
problem solving group had a smaller percentage of children with large BMI
decreases. The problem solving program had no effect on child problem
solving, parent weight change, and behavior problems.

Graves, T.,
Meyers, A. W., & Clark, L. (1988). An evaluation of parental
problem-solving training in the behavioral treatment of childhood
obesity. Journal of Consulting and Clinical Psychology, 56(2),
246-250.

Evaluated population: 40 children ages 6-12 years who
were at least 20 percent overweight for their age, sex, and height.

Approach: Children were randomly assigned to
either the intervention problem-solving group, a behavioral treatment group, or
an information only control group. All groups were given a series of 8
weekly hour-long group sessions. In the treatment group, children
reviewed the prior week’s lesson, completed food intake and activity sheets,
learned about techniques for weight reduction, and then were given 20 minutes
of problem solving exercises. Children in the behavioral treatment group
received the same treatment except that parents in this group exchanged recipes
and exercise ideas for their children instead of problem solving
exercises. Children in the instruction-only group were given the same
information about weight reduction techniques, parents exchanged recipes and
exercise ideas, and children exercised at the meetings for 15 minutes.

Children in the study were assessed at 1, 2, 3, and 6 months
following the end of the program on measures of Body Mass Index (BMI), food
intake, and physical activity.

Results: At post-test, children in the problem
solving group had decreased their weight more than those in the behavioral and
instruction only groups. At 6-months, these gains by the problem solving
group persisted. Parents whose children were assigned to the problem
solving group increased more than their counterparts in the behavioral and
instruction only groups on measures of problem solving ability. This
finding was also maintained at the 6-month follow-up. Children in both
problem solving and behavioral groups had healthier eating habits than those in
the instruction only group. The behavioral group had initial impacts on
weight, BMI, and percentage overweight, but the impacts were smaller than the
problem-solving group and did not persist. The program had no impacts on
physical activity levels.

SOURCES FOR MORE INFORMATION

References

Epstein, L. H., Paluch, R. A., Gordy, C. C., Saelens, B. E.,
& Ernst, M. M. (2000). Problem solving in the treatment of childhood
obesity. Journal of Consulting and Clinical Psychology, 68(4),
717-721.

Graves, T., Meyers, A. W.,
& Clark, L. (1988). An evaluation of parental problem-solving
training in the behavioral treatment of childhood obesity. Journal of
Consulting and Clinical Psychology, 56
(2), 246-250.

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

Program information last updated 10/21/07