Application of Behavioral Economic Principles to Treatment of Childhood Obesity

  • Leonard H. Epstein
Part of the NATO ASI Series book series (NSSA, volume 278)


Obesity is a prevalent problem in childhood (Gortmaker, Dietz, Sobol, & Wehler, 1987), which increases the risk of adult obesity (Stark, Atkins, Wolff, & Douglas, 1981, Abraham, Collins, & Nordsieck, 1971), as well as adult morbidity and mortality (Must, Jacques, Dallal, Bajema, & Dietz, 1992,Nieto, Szklo, & Comstock, 1992). Behavioral treatment procedures have been used with considerable success in treating childhood obesity. Behavioral procedures have been shown to be superior to both no treatment (Epstein, Wing, Koeske, & Valoski, 1984; Israel, Stolmaker, Sharp, Silverman, & Simon, 1984, Kirschenbaum, Harris, & Tomarken, 1984) and attention placebo (Epstein, Wing, Steranchak, Dickson, & Michelson, 1980; Epstein, Wing, Woodall, Penner, Kress, & Koeske, 1985) controls for short term weight control, and behavioral treatments have been successful in maintaining treatment effects over five and then year intervals (Epstein, Valoski, Wing, & McCurley, 1990, Epstein, Valoski, Wing, & McCurley, 1993).


Sedentary Behavior Obese Child Vigorous Activity Exercise Behavior Behavioral Economic 
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  1. Abraham, S,. Collins, G., &Nordsieck, M. (1971). Relationship of childhood weight status to morbidity in adults. Public Health Records, 85, 273–284.Google Scholar
  2. Bouton, M., &Swartzentruber. D. (1991). Sources of relapse after extinction in Pavlovian and instrumental learning. Clinical Psychology Review, 11, 123–140.CrossRefGoogle Scholar
  3. Craighead. L. W., Stunkard, A. J., & O’Brien. R. (1981). Behavior therapy and pharmacotherapy for obesity. Archives of General Psychiatry, 38, 763–768.CrossRefGoogle Scholar
  4. Dietz, W. H., & Gortmaker, S. L. (1985). Do we fatten our children at the television set? Obesity and television viewing in children and adolexcents. Pediatrics, 75, 807–812.Google Scholar
  5. Elsmore, T. F., Fletcher, G. V., Conrad. I). G., &Sodetz, F. J. (1980). Reduction of heroin intake in baboons by an economic constraint. Pharmacology, Biochemistry and Behavior, 13, 729–731.CrossRefGoogle Scholar
  6. Epstein, L. H. (1990). Behavioral treatment of obesity. In E. M. Strieker (ed.). Handbook of Behavioral Neurobiology Volume 10 Neurobiology of Food and Fluid Intake (pp. 61–73). New York: Plenum Press.CrossRefGoogle Scholar
  7. Epstein, L. H. (1992). Role of behavior theory in behavioral medicine. Journal of Consulting and Clinieai Fsvehlogy, 60, 493–498.CrossRefGoogle Scholar
  8. Epstein, L. H.. Smith, J. A., Vara, L. S., &Rodefer, J. S. (1991). Behavioral economic analysis choice in obese children. Health Psychology, 10, 311–316.CrossRefGoogle Scholar
  9. Shrager, L. (1993). Comparative effects of decreasing sedentary behavior and increasing activity on weight change in obese children and their parents. Manuscript submitted for publication.Google Scholar
  10. Epstein, L. H., Valoski, A., Wing, R. R., &McCuriey, J. (1990). Ten-year follow-up of behavioral, family based treatment for obese children. JAMA, 264, 2519–1523.CrossRefGoogle Scholar
  11. Epstein, L. H., Valoski, A., Wing. R. R., &McCuriey. J. (1993). Ten-year outcomes of behavioral family based treatment for childhood obesity. Manuscript submitted for publication Google Scholar
  12. Epstein, L. H., &Wing. R. R. (1987). Behavioral treatment of childhood obesity. Psychological Bulletin 101. 331–342.CrossRefGoogle Scholar
  13. Epstein, L. H., Wing, R. R., Koeske, R., Ossip, D. J., &Beck, S. (1982). A comparison of lifestyle change and programmed aerobic exercise on weight and fitness changes in obese children. Behavior Therapy, 13, 651–665.CrossRefGoogle Scholar
  14. Epstein, L. H., Wing, R. R., Koeske, R., &Valoski, A. (1984). The effects of diet plus exercise on weight change in parents and children. Journal of Consulting and Clinical Psychology, 52, 429–437CrossRefGoogle Scholar
  15. Epstein, L. H., Wing, R. R., Steranchak, L., Dickson, B., &Michelson, J. (1980). Comparison of family based behavior modification and nutrition education for childhood obesity. Journal of Pediatric Psychology, 5, 25–36.CrossRefGoogle Scholar
  16. Epstein. L. H., Wing. R. R., Woodall, K., Penner, B. C., Kress. M. J., & Koeske, R. (1985). Effects of family based behavioral treatment on obese 5–8 year old children. Behavior Therapy, 16, 205–212.CrossRefGoogle Scholar
  17. Epstein, L. H., Wing. R. R., Valoski. A., &Penner. B. (1987). Stability of food preferences in 8–12 year old children and then parents during weight control. Behavior Modification, 11, 87–101.CrossRefGoogle Scholar
  18. Gortmaker, S. L., Dietz,. H., Sobol, A. M., &Wehler, C. A. (1987). Incresing pediatric obesity in the United States. American Journal of Diseases in Children. 141, 535–540.Google Scholar
  19. Hursh, S. R. (1991). Behavioral economics of drug self-administration and drug abuse policy. Journal of the Experimental Analysis of Behavior, 56. 377–393.CrossRefGoogle Scholar
  20. Hurch, S. R., &Bauman. R. A. (1987). A behavioral analysis of demand. In L. Green. J. H. KageL (Eds.), Advances in behavioral economics; Volume 1 (pp. 117–165). Norwood, NJ: Ablex.Google Scholar
  21. Hursh, S. R., &Natelson. B. H. (1981). Electrical brain stimulation and food reinforcement dissociated by demand elasticity. Physiology and Behavior, 26, 509–515.CrossRefGoogle Scholar
  22. Israel, A. C., Stolmaker. L., Sharp. J. P.. Silverman. W. K. &Sunon. L. G. (1984). An evaluation of two methods of parental involvement in treating obese children. Behavior Therapy. 15, 266–272.CrossRefGoogle Scholar
  23. Kaplan. R. M. (1990). Behavior as the central outcome in health care. American Psychologist, 45, 1211– 1220.CrossRefGoogle Scholar
  24. Kuschenbaum, D. S., Harris, E. S., &Tomarken, A. J. (1984). Effects of parental involvement in behavioral weight loss therapy for preadolescents Behavior Therapy, 15. 485–500.CrossRefGoogle Scholar
  25. Lappaleainen, R., &Epstein. L. H. (1990). A behavioral economics analysis of food choice in humans. _ Appetite. 14. 81–93.CrossRefGoogle Scholar
  26. Leitenberg, H., Rawson. R. A., & Bath. K (1970). Reinforcement of competing behavior during extinction. Science, 169, 301–303.CrossRefGoogle Scholar
  27. Leitenberg, H. Rawson, R. A., &Mulick. J. A. (1975). Extinction and reinforcement of alternative behavior. Journal of Comparative and Physiological Psychology. 88. 640–652.CrossRefGoogle Scholar
  28. Martin. J. E., Dubbert, P. M., Kartell, A. D., Thompson. J. K.. Raczynski, J. R., lake, M., Smith, P. O , Webster. J. S., Sikora. T., &Cohen. R. E. (1984). Behavioral control of exercise in sedentary adults. Studies 1 through 6. Journal of Consulting and Clinical Psychology. 52. 795–811.CrossRefGoogle Scholar
  29. Must, A., Jacques. P. F.. Dallal. G. F., Bajema, C. J., &Dietz, W. H. (1992). Long-term morbidity and mortality of overweight adolescents: A follow-up of the Harvard Growth Study of 1922 to 1935. New England Journal of Medicine, 327, 1350–1355.CrossRefGoogle Scholar
  30. Nieto. F. J., Szklo. M., &Comstock. G. W. (1992). Childhood weight and growth rate as predictors of adult mortality. American Journal of Epidemiology, 136, 201–213.Google Scholar
  31. Perri. M. G., Nezu, A. M., Patti, E. T., &McCann, K. L. (1989). Effect of length of treatment on weight loss. Journal of Consulting and Clinical Psychology, 57, 450–452.CrossRefGoogle Scholar
  32. Perrt M. G., Nezu, A. M., &Viegener. B. J. (1992). Improving the long-term management of obesity: Theory, research, and chnical guidelines. New York: John Wiley &Sons.Google Scholar
  33. Rahlin. H. (1989). Judgement, decision, and choice: A cognitve/behavioral synthesis. New York: W. H Freeman.Google Scholar
  34. Rolls, B. J., Rolls, E., Rowe. E. A., &Sweeny, K. (1981). Sensory specific satiety in man. Physiology & Behavior, 27, 137–142.CrossRefGoogle Scholar
  35. Siegel. P. S., &Pilgram. F. J. (1958). The effect of monotony on the acceptance of food. American Journal of Psychology, 71, 756–759.CrossRefGoogle Scholar
  36. Smith, J. A., &Esten. I. H. (1991). Behavioral economic analysis of food choice in obese children. Appetite. 11 91–95.CrossRefGoogle Scholar
  37. Stark. O. Atkins, E., Wolff. O. H., &Douglas, J. W. B. (1981). Longitudinal study of obesity in the National Survey of Health and Development. British Medical Journal. 283. 13–17.CrossRefGoogle Scholar
  38. Thompson, C. E., &Wankel, L. M. (1980). The effects of perceived activity choice upon frequency of exercise behavior. Journal of Applied Social Psychology, 10, 436–443.CrossRefGoogle Scholar
  39. Vara, L. S., &Epstein, L. H. (in press) Laboratory assessment of choice between exercise or sedentary behaviors. Research Quarterly for Exercise and Sport. Wadden, T. A., Stunkard, A. J., &Smoller. J. W. (1986). Three-year follow-up of the reatment of obesity by very low calorie diet, behavior therapy, and their combination. Journal of Consulting and Clinical Psychology, 56, 925–928.Google Scholar

Copyright information

© Springer Science+Business Media New York 1995

Authors and Affiliations

  • Leonard H. Epstein
    • 1
  1. 1.Department of PsychologyState University of New York at BuffaloBuffaloUSA

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