Since the recognition of the “obesity epidemic”, a substantial amount of research has been conducted in an attempt to find effective ways to prevent and treat childhood obesity. Programs have been developed for use in schools, clinics, communities and commercial entities such as Weight Watchers. The programs vary in design and effectiveness. Those that are thought to be most effective include a combination of nutrition education, exercise, and behavior modification, but even then it is unclear which of the multiple strategies used was responsible for the outcomes.
Ultimately, changing eating and activity patterns means changing behavior. A child who eats a donut for breakfast will benefit from changing this behavior by choosing a whole grain cereal with low fat milk instead. The process of helping the child make this change is called behavior modification, and might include setting goals, keeping a food diary, providing feedback, restructuring the environment (ensuring that a cereal acceptable to the child is available), and more. Many strategies are used, and it is likely that some are more effective than others at achieving the desired outcomes.
The authors of a recent article published in the scientific journal International Journal of Obesity sought to evaluate the effectiveness of commonly used behavioral techniques by reviewing randomized controlled trials (participants are randomly assigned to a treatment group or a control group without treatment) conducted between 1999 and 2009, with kids ages 2-18 years. To be included studies had to monitor outcomes for at least 6 months after behavioral treatment ended to gauge whether the techniques “stuck.” Studies designed to prevent as well as treat overweight or obesity were included in the analysis.
A total of 17 studies meeting the above criteria were identified. What did they find?
Forget about telling kids that they may develop diabetes or heart disease in hopes of motivating them to change. The researchers found that giving general information about possible consequences of unhealthy eating behaviors did not change eating behaviors. Discussing how being overweight would affect the individual, for example having a hard time keeping up with friends, was more likely to be successful. Providing rewards was not effective, but changing the environment was. Other effective strategies included managing stress and controlling emotions, reviewing goals, self-monitoring using food logs, practicing new behaviors and preventing relapse by identifying high risk situations and devising a plan for dealing with them. Practicing healthy behaviors was helpful in prevention programs.
What can parents learn from this? Don’t bother offering to buy your child a new wardrobe or cell phone if they lose weight. Telling your child that he or she may develop chronic illness when they’re older is unlikely to motivate them to give up chips and candy for fruit and yogurt. Instead, help them by structuring your kitchen so that tempting foods are out of sight. Keep serving trays off the table to prevent kids from taking another serving just because it’s there. Encourage them to journal their food intake, physical activity, and emotional states.
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Many parents find that working with a professional such as a Registered Dietitian Nutritionist (RDN), who knows how to motivate their child and walk them through the process of change while ensuring a nutritionally adequate diet, is not only helpful but also relieves the stress that can overwhelm families dealing with this often emotionally charged issue.
The authors of the review suggest that future programs focus on behavior change strategies which have been found effective. They note that more research is needed to determine how individual strategies work together and whether there is a difference in the effectiveness of strategies with different populations (ethnic groups, socioeconomic status) before public health policies can be put into place.
Martin J, Chater A, Lorencatto F. Effective behavior change techniques in the prevention and management of childhood obesity. International Journal of Obesity 2013;7:1287-1294