Reducing Obesity Using a Family Centered Approach

1. CHILDHOOD
OBESITY
A Family Centered Approach

2. Childhood Obesity has become an Epidemic
• Childhood obesity has more than doubled in the past 30 years
• In 2012, more than 1/3 of children and adolescents were overweight or obese,
which is more than 23 million children
• 70% of obese youth have at least one risk factor for cardiovascular disease
• Long term effects of childhood obesity include: diabetes, heart disease,
hypertension
• Obesity-related medical costs for children are about $14.8 billion

3. Individual Behaviors Contributing to Childhood Obesity
• 69% of high school students do not attend PE classes
• 32% of students watch 3 or more hours of TV on an average school day
• 11% of students drink 3 or more bottles of soda a day
• In teenage youth, children consume 700-1,000 more calories per day than what is
needed for healthy growth

4. Family Elements that Impact Childhood
Obesity

5. • Involvement of parents in family interventions that combat childhood
obesity exhibit great success.
• Utilizing the family paradigm in decreasing pediatric obesity is the “gold
standard” for enabling changes in behavior to improve the weight and
overall health of children.
• Family-centered approaches have been shown to reduce BMI and reduce
the incidence of overweight children.
The Importance of Family-Centered
Interventions

6. Family Elements that Impact
Childhood Obesity
II. Parenting Styles
High
Demandingness
Low
Demandingness
High
Responsiveness
Authoritative:
Respectful of child’s
opinions but
maintains clear
boundaries
Permissive:
Indulgent without
discipline
Low
Responsiveness
Authoritarian:
Strict disciplinarian
Neglectful:
Emotionally
uninvolved and
does not set goals
Adapted from: Rhee, K. (2008) Childhood overweight and the relationship between parent behaviors, parenting style, and family functioning.
AAPSS; 615: 12-32. DOI: 10.1177/0002716207308400.

7. Family Elements that Impact Childhood
Obesity
II. Parenting Styles continued
• An Authoritative style has been associated with positive childhood
outcomes
• Increased self-regulatory ability
• Fewer depressive symptoms
• Fewer risk taking behaviors
• Greater fruit and vegetable intake
• Increased physical activity behaviors

8. Family Elements that Impact Childhood
Obesity
• The other three parenting styles are associated with negative outcomes
• Lower levels of self-control
• Poorer psychosocial and emotional development
• Authoritarian style is associated with a 5-fold increase of having over-
weight children in first grade than the Authoritative patterns

9. Permissive
Neglectful

10. Family Elements that Impact
Childhood Obesity
III. Parental Modeling
• Children are more likely to choose healthier foods if the parents
choose healthy foods for themselves.
• The impact of modeling is enhanced with positive comments and
positive social affect.
• Modeling is also effective in promoting healthy activity.

11. Family Elements that Impact
Childhood Obesity
IV. Parental Control Over Food Consumption
• Negative factors
• Prompting to eat
• Use of food as rewards
• Restricting access to food
• Large portion sizes

12. Family Elements that Impact
Childhood Obesity
IV. Parental Control Over Food Consumption
• Positive factors
• Exposure and/or availability of certain foods
• Accessibility of specific foods
• Self-regulation or portion control
• Parent modeling of food consumption
• Parental warmth and sensitivity
• Family meals

13. Family Elements that Impact
Childhood Obesity
V. Relationship Dynamics Involving Food
• Negative: One-to-one relationship
• Food as a means to express love
• Using food to control the relationship
• Using food to compensate for the presence or
absence of the parent
• Positive: Family group relationship
• Using a meal to promote family cohesion
• The staging of the meal as an indicator of family
organization

14. Family Elements that Impact Childhood
Obesity
VI. Stress Responses
• Chronic stress diminishes self-regulatory capacity
• Deficits in emotional regulation also contribute to obesity
• Maladaptive stress response includes
• Internalizing behaviors: depression, anxiety, social withdrawal,
isolation
• Externalizing behaviors: hyperactivity, conduct problems, low
self-esteem, peer conflict, and peer interaction problems
• Uncontrolled eating behaviors: binge eating, all-or-nothing
attitude towards forbidden food

15. Family Elements that Impact
Childhood Obesity
VI. Stress Responses
• Chronic stress diminishes self-regulatory capacity
• Deficits in emotional regulation also contribute to
obesity

16. Family Elements that Impact
Childhood Obesity
VI. Stress Responses
Maladaptive stress responses include:
• Internalizing behaviors:
• depression
• anxiety
• social withdrawal
• isolation

17. Family Elements that Impact
Childhood Obesity
VI. Stress Responses
Externalizing behaviors:
• hyperactivity
• conduct problems
• low self-esteem
• peer conflict
• peer interaction problems

18. Family Elements that increase the
likelihood Childhood Obesity
VI. Stress Responses
• Uncontrolled eating behaviors:
• binge eating
• all-or-nothing attitude towards forbidden food

19. BARRIERS
 Provider Barriers
 Time constraints in practice
 Lack of reimbursement
 For preventative care and counseling
 Few opportunities to address obesity
 Short, infrequent visits between
providers and children
 Ineffective communication
 Lack of education on strategies and
techniques to address childhood obesity

20. BARRIERS
 Parent and Child Barriers
 Limited knowledge and health literacy
 Family lifestyle
 Lack of motivation
 Low income
 Sensitivity to the issue
 Lack of acknowledgement of the issue
 Lack of community resources
 Feeling judged or threatened

21. BARRIERS
 Community Barriers
 Lack of community resources
 Lack of education resources for parents and children
 Lack of spaces dedicated to physical activity for children: parks, gyms,
recreation centers, jungle gyms
 Sociocultural environment
 Physical and social environment that does not facilitate healthy living for
families

22. OVERCOMING BARRIERS
 What do practitioners need to effectively address obesity utilizing family dynamics?
 Tools for recognizing eating behaviors
 USDA Diet questionnaires- screen for fruit and vegetables, fat intake,
healthy behavior changes related to eating, overall diet quality, healthy body
 My Plate Portion Sizes- count consumed calories, calorie content of
common foods, identifies empty calories in food, label reading
 Eating disorder screening- SCOFF questionnaire
screens for maladaptive eating behaviors

23. OVERCOMING BARRIERS
 Family knowledge in regards to healthy eating
 Healthy foods- USDHHS provides tools to help families better understand nutrition and
how healthy eating plays a vital role in a healthy weight
 Cultural food differences- USDA provides different food pyramids for ethnic cuisines

24. OVERCOMING BARRIERS
 Reinforce positive strategies that the family is already employing
 Communication techniques to overcome barriers
Verbal and non verbal communication
 Reflective listening
 ChangeTalk
 Non-threatening and non-judgmental verbal and non-verbal communication
 Patient centered realistic goals.

25. OVERCOMING BARRIERS
 Assessment tools for the family unit
 Motivational Interviewing
 Helps illicit motivations for behavior change
 ex. Asking questions that elicit change, such as, do you think you are ready to lose
weight?
 SOFT: Standardized obesity family therapyTechnique
 Focuses on family interactions and their impact on lifestyle changes
 Only used for Obesity and utilizes medical and psychological support
 FCU: Family Check-up
 Utilization of FCU leads to increased quality of the parent and child relationship
which reinforces healthy family eating habits by assessing and intervening in a
systematic manner
 FCU focuses on broad areas of parenting in regards to involvement, monitoring and
communication.

26. SOFT
Van Ryzin, M. J., & Nowicka, P. (2013). Direct and indirect effects of a family-based
intervention in early adolescence on parent-youth relationship quality, late adolescent
health, and early adult obesity. Journal of Family Psychology, 27(1), 106-116

27. FAMILY CHECK UP
Norwicka, P., & Flodmark, C. (2011). Family therapy as a model for
treating childhood obesity: Useful tools for clinicians. Clinical Child
Psychology and Psychiatry, 16(1), 129-143.

28. CONCLUSION
 Practitioners need to be ready to face barriers of childhood obesity at
the family level and individual level
 Incorporating family to help aid in decreasing childhood obesity is more
successful then focusing individually
 Recognizing the family styles, authoritative vs. permissive, will enable the
practitioner to tailor interventions to the family needs
 Be able to recognize the elements that impact childhood obesity in a
specific demographic and select the appropriate interventions and
reinforce positive ones being practiced.
 Have the ability to identify the barriers types surrounding childhood
obesity and overcome them
 Be able to locate and identify the appropriate tools that may assist the
practitioner with childhood obesity interventions

29. RESOURCES
 Carlisle, K. L., Buser, J. K., & Carlisle, R. M. (2012). Childhood food
addiction and the family. Family Journal: Counseling andTherapy for Couples
and Families, 20(3), 332-339. Retrieved from
http://search.ebscohost.com/login.aspx?direct=true&db=eric&AN=EJ973
384&site=ehost-live; http://dx.doi.org/10.1177/1066480712449606
 Centers for Disease Control and Prevention. (2013).Adolescent and
School Health. Retrieved from
http://www.cdc.gov/healthyyouth/obesity/facts.htm
 Chen,A.Y., & Escarce, J. J. (2013). Family structure and childhood obesity:
An analysis through 8th grade. Maternal and Child Health Journal,
doi:10.1007/s10995-013-1422-7
 Davis, M.,Young, L., Davis, S. P., & Moll, G. (2011). Parental depression,
family functioning, and obesity among african american children. ABNF
Journal, 22(3), 53-57. Retrieved from
http://search.ebscohost.com/login.aspx?direct=true&db=26h&AN=6323
0017&site=ehost-live

30. RESOURCES
 Evans, G.W., Fuller-Rowell,T., & Doan, S. N. (2012).Childhood cumulative
risk and obesity:The mediating role of self-regulatory ability. US:American
Academy of Pediatrics. doi:10.1542/peds.2010-3647
 Gerards, S., Dagnelie, P., Jansen, M.,Vries, N., & Kremers, S. (2012).
Barriers to successful recruitment of parents of overweight children for
an obesity prevention intervention: a qualitative study among youth
health care professionals. BMC Family Practice , 13(37), 1-10.
http://dx.doi.org/10.1186/1471-2296-13-37
 Gundersen, C., Mahatmya, D., Garasky, S., & Lohman, B. (2011). Linking
psychosocial stressors and childhood obesity. Obesity Reviews, 12, e54-
e63. doi:10.1111/j.1467-789X.2010.00813.x
 Halliday, J.A., Palma, C. L., Mellor, D., Green, J., & Renzaho,A. M. N. (2014).
The relationship between family functioning and child and adolescent
overweight and obesity:A systematic review. International Journal of
Obesity (2005), 38(4), 480-493. doi:10.1038/ijo.2013.213

31. RESOURCES
 Lachal, J., Speranza, M.,Taïeb, O., Falissard, B., Lefèvre, H., Moro, M., & Revah-Levy,A.
(2012). Qualitative research using photo-elicitation to explore the role of food in
family relationships among obese adolescents. Appetite, 58(3), 1099-1105.
doi:http://dx.doi.org.libproxy.unh.edu/10.1016/j.appet.2012.02.045
 Larsen, L., Mandleco, B.,Williams, M., & Tiedeman, M. (2006). Childhood obesity:
prevention practices of nurse practitioners. Journal of the Academy of Nurse
Practitioners , 18(2), 70-79.
 Morgan, J. F., Reid, F., & Lacey, J. H. (2000).The SCOFF questionnaire. Western Journal
of Medicine, 172(3), 154-165.
 National Collaborative on Childhood Obesity Research. (2013). Childhood Obesity
in the United States. Retrieved from
http://www.nccor.org/downloads/ChildhoodObesity_020509.pdf
 National Heart, Lung, and Blood Institute. (2013). Nutrition Tools and Resources.
Retrieved from http://www.nhlbi.nih.gov/health/public/heart/obesity/wecan/tools-
resources/nutrition.htm
 Norwicka, P., & Flodmark, C. (2011). Family therapy as a model for treating childhood
obesity: Useful tools for clinicians. Clinical CHild Psychology and Psychiatry, 16(1), 129-
143.

32. RESOURCES
 Puder, J. J., & Munsch, S. (2010). Psychological correlates of childhood obesity.
International Journal of Obesity, 34, S37-S43. doi:10.1038/ijo.2010.238
 Regber, S., Marlid, S., & Johansson, J. (2013). Barriers to and facilitators of nurse-
parent interaction intended to promote healthy weight gain and prevent childhood
obesity at Swedish child health centers. BMC Nursing , 12(27).
http://dx.doi.org/10.1186/1472-6955-12-27
 Rhee, K. (2008). Childhood overweight and the relationship between parent
behaviors, parenting style, and family functioning. Annals of the American Academy of
Political & Social Science, 615, 11-37. Retrieved from
http://search.ebscohost.com/login.aspx?direct=true&db=26h&AN=28788969&site=e
host-live
 United States Department of Agriculture. (2014). My Plate Kids’ Place. Retrieved
from http://www.choosemyplate.gov/KIDS/
 United States Department of Agriculture. (2014). Dietary Assessment. Retrieved
from http://fnic.nal.usda.gov/dietary-guidance/dietary-assessment
 United States Department of Agriculture. (2014). Ethnic/Cultural Food Pyramids.
Retrieved from http://fnic.nal.usda.gov/dietary-guidance/past-food-pyramid-
materials/ethniccultural-food-pyramids
 Van Ryzin, M. J., & Nowicka, P. (2013). Direct and indirect effects of a family-based
intervention in early adolescence on parent-youth relationship quality, late
adolescent health, and early adult obesity. Journal of Family Psychology, 27(1), 106-116.