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Family-Based Behavioral Interventions for Childhood Obesity

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Pediatric Obesity

Part of the book series: Contemporary Endocrinology ((COE))

Abstract

Childhood obesity affects all systems of the body; it is associated with increased physical (e.g., diabetes) and psychosocial (e.g., depression, bullying) comorbidities and, for 80% of these children, tracking of obesity into adulthood. Early intervention is critical to prevent the onset of adult obesity, and effective treatments exist that have been shown to lead to sustainable weight changes in childhood. Family-based behavioral treatment (FBT) is a USPSTF guideline-based behavioral weight control intervention that concurrently targets children with obesity and their parents, intervening across all levels of influence, from the individual to the community environment. FBT focuses on successive changes using family support and utilizes strategies such as self-monitoring and reengineering the environment to facilitate behavior change. Basic social and behavioral science research can help us better understand the socioenvironmental factors that constrain or enhance energy balance behaviors, and with this information, we can create more potent and personalized interventions to treat childhood obesity. Additionally, national initiatives to speed the translation of basic science findings into clinical research and treatment development may also facilitate the creation of ever more potent and precise interventions to prevent and treat obesity across the life span.

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Acknowledgment

The authors would like to acknowledge Dr. Anna Vannucci and Dr. Emily White, coauthors of this chapter in the first edition. The first edition chapter was used as a starting point for this substantially updated and revised chapter in the second edition.

Editor’s Comments and Questions

  1. 1.

    Effective management of pediatric obesity requires considerable commitment on the part of the child, family, and health-care providers; successful counseling programs generally involve frequent and often prolonged (26 to >75 h) contacta. You note that streamlined approaches integrated with primary care could be effective in selected circumstances.

    1. (a)

      Do you believe in “preventive” counseling in young children at high risk (e.g., those with obese parents)?

    2. (b)

      What essential elements of counseling might be conveyed in an “abbreviated” form of family-based behavioral weight loss treatment (FBT) administered in a primary care clinic?

    3. (c)

      How might the use of short-term FBT be applied to adolescents, who in general are far more resistant than young children to weight loss interventions?

    4. (d)

      Do you consider group counseling an effective tool for prevention or treatment of childhood obesity?

  2. 2.

    Studies in adults suggest that monetary rewards may be useful in promoting weight loss in adults. Women, singles, and the unemployed appear most likely to respond. The amount of the award can spell success or failure. It is currently unclear if the effects of the incentives are sustained after termination of the programb. Financial incentives seem inappropriate for children but are commonly used by parents to support behavior change in their wayward teens.

    Do you believe that parents should pay, or provide gifts to, their overweight children or teenagers to reward them for losing weight?

References for Editor’s Comments and Questions Section

  1. (a)

    Whitlock EP, O’Connor EA, Williams SB, Beil TL, Lutz KW. Effectiveness of weight management interventions in children: a targeted systematic review for the USPSTF. Pediatrics. 2010;125(2):e396–418.

  2. (b)

    Paloyo AR, Reichert AR, Reuss-Borst M, Tauchmann H. Who responds to financial incentives for weight loss? Evidence from a randomized controlled trial. Soc Sci Med. 2015;145:44–52.

Authors’ Responses

  1. 1.

    Given that the most reliable risk factor for childhood obesity is having a parent with obesity,a and since two-thirds of adults have overweight or obesity,b the majority of children may be considered at high risk for obesity. Moreover, the risk for developing obesity increases as a child’s BMI percentile increases (e.g., children with a BMI percentile >75th have a 40–50% change of developing overweight over timec); therefore, even children at BMI percentiles below the cutoffs for overweight or obesity are at risk. Thus health professionals should not wait until a child meets criteria for overweight (i.e., BMI ≥ 85th percentile) but should consider having conversations regarding healthy behaviors with all children. These conversations should emphasize messages that target healthful eating, physical activity, and parental modeling of these behaviors (e.g., Let’s Go! message of 5–2–1-0,d or 5+ servings of fruits/vegetables per day, ≤ 2 h screen time per day, 1 + _ h of physical activity per day, and 0 sugar-sweetened beverages per day).

  2. 2.

    An abbreviated form of FBT delivered in a primary care clinic still should contain the core components of FBT, which are modification of energy balance behaviors (i.e., increase in energy expenditure, decrease in energy intake), use of behavior change strategies (e.g., goal setting, self-monitoring), and active parental/caregiver involvement. For example, the effective abbreviated form of FBT that was delivered in primary care clinics among 2–5-year-old children and their parents included modification of energy balance behaviors, behavior change strategies, and active involvement of a parent.e Of note, treatment was abbreviated by reducing the number of sessions to 10 (4 weekly, 2 bimonthly, and 4 monthly), all delivered in a group-based format.

  3. 3.

    The central components of FBT (modification of energy balance behaviors, behavior change strategies, and parental involvement) are still critical for FBT with adolescent populations; however, unlike with younger children, the role of the parent is primarily to support their child and less to act as an agent of change.f For example, parents may attend separate sessions from their child in which they learn how they can best support their child and implement behavior change strategies such as stimulus control. If an incentive system is used as part of FBT, the lists of rewards will be different than those used with children to be consistent with the interests of adolescents (e.g., having car privileges).

  4. 4.

    Potential benefits of group-based childhood obesity treatments are that they may treat more people with fewer resources (e.g., staffing, time) and promote social support among individuals. However, a review of the effectiveness of group-based childhood obesity treatment found mixed results.g Mixed-format approaches (i.e., some individual sessions, some group sessions) were found to be preferable because they retain the benefits of group-based treatments while still achieving medium to large weight loss effects similar to those seen with the individual family format.

  5. 5.

    Incentive or point systems are a behavior change tool frequently used in FBT for childhood obesity. Points are used to incentivize the attainment of behavior goals (e.g., ≤ 15 servings of high energy-dense foods/week). Families are typically given a list of suggested rewards, with several examples listed for each of the following categories: (1) sporting events and activities, (2) time with mom or dad, (3) privileges, and (4) specific places to go. Parents and children work together to choose the rewards for which children can exchange their points, with the ideal rewards being ones that reinforce the targeted behaviors (e.g., physically active outings such as getting to go to the baseball batting cages).

References for Authors’ Responses Section

  1. (a)

    Whitaker RC, Wright JA, Pepe MS, Seidel KD, Dietz WH. Predicting obesity in young adulthood from childhood and parental obesity. New England Journal of Medicine. 1997;337(13):869–73.

  2. (b)

    Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011–2012. Journal of the American Medical Association. 2014;311(8):806–14.

  3. (c)

    Let’s Go! http://www.letsgo.org/

  4. (d)

    Nader PR, O’Brien M, Houts R, Bradley R, Belsky J, Crosnoe R, Friedman S, Mei Z, Susman EJ. Identifying risk for obesity in early childhood. Pediatrics. 2006;118(3):e594–601.

  5. (e)

    Quattrin T, Roemmich JN, Paluch R, Yu J, Epstein LH, Ecker MA. Efficacy of family-based weight control program for preschool children in primary care. Pediatrics. 2012;130(4):660–6.

  6. (f)

    Lloyd-Richardson EE, Jelalian E, Sato AF, Hart CN, Mehlenbeck R, Wing RR. Two-year follow-up of an adolescent behavioral weight control intervention. Pediatrics. 2012;130(2):e281–8.

  7. (g)

    Hayes JF, Altman M, Coppock JH, Wilfley DE, Goldschmidt AB. Recent updates on the efficacy of group-based treatments for pediatric obesity. Current cardiovascular risk reports. 2015;9(4):1–0.

Author information

Authors and Affiliations

  1. Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA

    Denise E. Wilfley PhD

  2. Department of Exercise and Nutrition Sciences, University at Buffalo, New York, USA

    Katherine N. Balantekin PhD, RD

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  1. Denise E. Wilfley PhD
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  2. Katherine N. Balantekin PhD, RD
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Corresponding author

Correspondence to Denise E. Wilfley PhD .

Editor information

Editors and Affiliations

  1. Duke University School of Medicine , Durham, North Carolina, USA

    Michael S. Freemark

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Wilfley, D.E., Balantekin, K.N. (2018). Family-Based Behavioral Interventions for Childhood Obesity. In: Freemark, M. (eds) Pediatric Obesity. Contemporary Endocrinology. Humana Press, Cham. https://doi.org/10.1007/978-3-319-68192-4_32

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