Aug 13, 2008


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.


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.


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 85th
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

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.



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.

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.

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