Parenting change and effectiveness of pediatric weight control program
Nutrition Research Newsletter, Dec, 2005
Parental training is an important part of family-based behavioral treatment programs for childhood obesity. Parents are able to control the family's home environment to promote the child's healthy behaviors and parents can use behavioral strategies to encourage the child's efforts at behavioral change. Parenting behaviors are one of the main components of behavioral family-based pediatric obesity treatment programs, along with nutrition, physical activity, and other weight-control behaviors such as self-monitoring. The influence of parents on pediatric weight control has been investigated in various ways.
The parenting strategies highlighted in many behavioral family-based weight loss programs emphasize changes in acceptance of behavior and a firm parenting style, such as both parents taking control over the home environment, monitoring the child's weight-related behaviors, sticking to a structured reinforcement system, and using behavior change strategies emphasizing warm and positive parent--child interactions (that is, increasing praise and positive reinforcement, decreasing reliance on negative reinforcement or punishment). A recent study examined whether baseline levels and changes in maternal and paternal parenting styles were related to children's weight loss over 12 months.
Obese 8-year-old to 12-year-old children and their parents were recruited to participate in this study. A total of 51 children completed baseline and 6-month follow-up data on parenting and adherence for both mother and father and have been included in this analysis. Inclusion criteria included child at or above the 85th body mass index (BMI) percentile, one parent willing to attend treatment meetings with the child, no family members in other weight control programs, no child or parent with psychiatric disorders or dietary or activity restrictions and child could complete self-monitoring.
The larger study was designed to compare treatments that differed in the behavioral strategy used to reduce sedentary behaviors. Families in each cohort were randomized into one of two treatment groups: reinforced reduced sedentary behavior or stimulus control of sedentary behaviors. Data were collected at baseline, 6 months, and 12 months after randomization. Results showed no differences in rate of percentage overweight change between the two groups at 6 months or 12 months after randomization, with both groups significantly below baseline.
The treatment included 20 meetings over the first 6 months. Families were weighed at each session, met with an individual therapist, and attended separate 30-minute child and parent classes. The dietary intervention was implemented using the traffic light diet, in which foods are divided into red, yellow, and green classifications based on high, moderate, and low fat and sugar content of foods, and behavioral components of treatment included self-monitoring, praise, contracting, preplanning, and problem solving.
Height and weight were measured. Both parents and children recorded any sedentary or physical activity that took 10 min or longer in duration. Dietary intake was measured using a food intake questionnaire designed to assess servings of red (high-energy dense) foods, fruits, and vegetables. Adherence was measured using a 25-item laboratory-constructed questionnaire to assess maintenance of the behaviors related to weight control learned during the program. The 56-item version of the Child's Report of Parental Behavior Inventory (CRPBI) was used to measure childrearing behaviors. The CRPBI is a questionnaire that assesses three factors of parenting: acceptance versus rejection, psychological control versus autonomy, and firm versus lax control. Children completed the 56 items separately for their father's and mother's parenting behaviors.
Children's percentage overweight significantly decreased at 6 months (-16.3) and 12 (-11.1) months. Adherence to program goals significantly increased variance accounted for in the regression model by 10.8%, whereas adding baseline father acceptance and change in father acceptance accounted for another 20.5%. The overall model accounted for 40.6% of the variance in pediatric weight control. Analysis of variance (ANOVA) showed significantly greater percentage overweight decrease from baseline for youth with fathers who increased their acceptance versus those who decreased acceptance at 6 months (-19.8 versus--14.6) and 12 months (-17.4 versus -8.1).
Children who perceive an increase in father acceptance during treatment had better changes in percentage overweight over 12 months than those with lower ratings of father acceptance. Parental support appears to have a significant impact on success during a weight control program.
R. Stein, L. Epstein, H. Raynor, et al. The influence of parenting change on pediatric weight control. Obes Res; 13:1749-1755 (October 2005). [Correspondence: Leonard H. Epstein, Department of Pediatrics, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Farber Hall, Room G56, 3435 Main Street, Building 26, Buffalo, NY 14214-3000. E-mail:
LHENET@acsu.buffalo.edu].
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