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Evaluation of a family-based behavioural intervention programme for children with obesity
Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
2013 (English)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

Background and aims: Impaired eating habits and reduced physical activity have become associated with obesity in children in the last three decades. Parents have a responsibility to be good models for their children regarding lifestyle patterns and habits. The aim of this thesis was to evaluate a family-based behavioural intervention programme (FBIP) for children with obesity designed for use in paediatric outpatient care. The specific aims were to investigate the clinical outcomes and programme adherence and to examine the children’s lifestyle habits according to their own and their parents’ reports, the agreement between these reports, and the correlations to change in z-BMI (standardized body mass index) from baseline to 12 months after the FBIP.

Subjects and methods: This thesis is based on a prospective single-group before/after design. Twenty-six children, 14 boys and 12 girls aged 8.3–12.0 years, and their parents attended 25 group sessions, in 3 child and 3 parental groups, during a 2-year FBIP. The treatment manual, Group treatment for children with Overweight and Obesity and their Parents and the semistructured interview called MORSE, a Swedish term for Food and Activity, Social and Emotional adaptation, emphasizes cognitive and behavioural guidelines and the focus is to change eating and physical activity habits and to maintain the new changes.

Results: The results showed that the children decreased their z-BMI from a mean of 3.3 (0.7 SD) at baseline to 2.9 (0.7 SD) 1 year after the completion of the programme. There was a significant decrease in z-BMI in boys from a mean of 3.5 (0.6 SD) at baseline to 3.0 (0.7 SD) (p = 0.001) at follow-up 12 months after completion of the programme; the z-BMI in the girls decreased from a mean of 3.0 (0.6 SD) at baseline to 2.7 (0.8 SD) (p = 0.155) at follow-up. The children’s waist/height ratio (the waist circumference in centimetres) divided by the height (in centimetres) showed no significant decrease over the same period. The biomedical markers of blood glucose metabolism and lipid status remained within the normal range at the 1-year follow-up after program completion compared with baseline. The rate of family adherence to the programme was high. The reports from the children and the parents regarding the children’s lifestyle habits showed a significant increase regarding the level of physical activity after the FBIP (24 months) compared with baseline. Agreement between the children and their parents improved after the FBIP (24 months) compared with baseline, regarding whether the children felt hungry most of the time and the children’s levels of physical and sedentary activity. Changes in the child or parental analyses of lifestyle were not significantly associated with reduced weight 1 year after the end of the FBIP.

Conclusions: A 2-year FBIP against childhood obesity implemented in a paediatric outpatient setting can be seen as a potential model for children and their parents. It is important to offer interventions to children with obesity although this FBIP needs to be confirmed with larger populations in a randomized controlled trial.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2013. , 63 p.
Series
Linköping Studies in Health Sciences. Thesis, ISSN 1100-6013 ; 124
Keyword [en]
Child obesity, family therapy, long-term intervention, eating, exercise
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-89959ISBN: 978-91-7519-683-1 (print)OAI: oai:DiVA.org:liu-89959DiVA: diva2:610588
Supervisors
Available from: 2013-03-12 Created: 2013-03-12 Last updated: 2016-05-04Bibliographically approved
List of papers
1. Family-based behavioural intervention programme for obese children: a feasibility study
Open this publication in new window or tab >>Family-based behavioural intervention programme for obese children: a feasibility study
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2012 (English)In: BMJ open, ISSN 2044-6055, Vol. 2, no 2, e000268- p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To assess a 2-year family-based behavioural intervention programme against child obesity.

DESIGN: Single-group pre- and post-intervention feasibility study.

SETTING: Swedish paediatric outpatient care.

PARTICIPANTS: 26 obese children aged 8.3-12.0 years and their parents who had consented to actively participate in a 2-year intervention.

INTERVENTIONS: 25 paediatric outpatient group sessions over a 2-year period with parallel groups for children and parents. The basis for the programme was a manual containing instructions for tutor-supervised group sessions with obese children and their parents. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was change in standardised body mass index between baseline and after 36 months. The secondary outcome measures were change in the waist:height ratio, metabolic parameters and programme adherence. The participants were examined at baseline and after 3, 12 and 24 months of therapy and at follow-up 12 months after completion of the programme.

RESULTS: The primary outcome measure, standardised body mass index, declined from a mean of 3.3 (0.7 SD) at baseline to 2.9 (0.7 SD) (p<0.001) at follow-up 12 months after completion of the programme. There was no change in the waist:height ratio. Biomedical markers of blood glucose metabolism and lipid status remained in the normal range. 96% of the families completed the programme.

CONCLUSIONS: This feasibility study of a 2-year family-based behavioural intervention programme in paediatric outpatient care showed promising results with regard to further weight gain and programme adherence. These findings must be confirmed in a randomised controlled trial with longer follow-up before the intervention programme can be implemented on a larger scale.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-75517 (URN)10.1136/bmjopen-2011-000268 (DOI)000315042100002 ()22389357 (PubMedID)
Available from: 2012-03-06 Created: 2012-03-06 Last updated: 2016-05-04
2. Family-based behavioural intervention program for obese children: an observational study of child and parent lifestyle interpretations
Open this publication in new window or tab >>Family-based behavioural intervention program for obese children: an observational study of child and parent lifestyle interpretations
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2013 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 8Article in journal (Refereed) Published
Abstract [en]

Background

Family-based behavioural intervention programs (FBIPs) against childhood obesity have shown promising results, but the mediating mechanisms have not been identified. The aim of this study was to examine changes in obese childreńs lifestyle habits during a 2-year FBIP according to their own and parents’ reports, the concordance between these reports and the correlations to change in post-intervention z-BMI.

Methods

An observational study of 26 children (8.3–12.0 years) and their parents participating in a 2-year FBIP was performed. Weight and height were measured from baseline to 12 months after the end of the program. Eating habits and physical- and sedentary activity were reported separately by children and parents. Data were analysed with regard to concordance between parents’ and children’s reports and association between the lifestyle reports and change in z-BMI at the study endpoint using descriptive statistics and parametric and non-parametric tests.

Results

According to both children’s and parents’ reports, the level of physical activity among the children had increased after the intervention as well as the agreement between the informants’ reports. According to the children, eating habits had improved, while the parents’ reports showed an improvement only with regard to binge eating. The concordance between children and parents regarding eating habits was slight to fair also after the intervention. No statistically significant associations between changes in lifestyle reports and changes in z-BMI were observed.

Conclusions

Child and parent reports of physical activity were found to converge and display an improvement in a 2-year FBIP, while the reports on eating habits showed a more refractory pattern. Changes in concordance and agreement between children and parents reports did not correlate with weight reduction. Further methods development and studies of the processes during family-based interventions against childhood obesity are warranted.

Place, publisher, year, edition, pages
PUBLIC LIBRARY SCIENCE, 2013
Keyword
Eating, exercise, mediators, obesity
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-89957 (URN)10.1371/journal.pone.0071482 (DOI)000323109700105 ()
Available from: 2013-03-12 Created: 2013-03-12 Last updated: 2017-12-06Bibliographically approved

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Teder, Marie

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