Evaluation of a family-based behavioural intervention programme for children with obesity

Sammanfattning: 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.