Introduction
Background
Early treatment
Length and intensity of treatment
Importance of parenting
General parenting as a treatment approach for preschool obesity
Conceptual influences
Program development
Mechanisms for treatment effect
Aims and hypothesis
Methods/Design
Design of the study
Ethical approval
Recruitment process
Participants
Inclusion and exclusion criteria
The power calculation
Allocation
Treatment approaches and settings
Standard treatment
Parent group treatment
Session | |
---|---|
1. | Welcome and Introduction: Parents’ Key Roles |
2. | Food and Play: When More, When Less? |
3. | Cooperation |
4. | Parents as Teachers |
5. | Charts and Incentives |
6. | Pre-teaching and Planning |
7. | Limit Setting Strategies |
8. | Power Struggles |
9. | More Support – Less Stress |
10. | Summary: Parenting and Balancing Food and Play |
Primary and secondary outcomes
Measure | Baseline | 3 months | 6 months | 12 months | ||
---|---|---|---|---|---|---|
Child
| ||||||
Weight/height | Measured by health professionals | x | x | x | x | |
Waist circumference | x | x | x | x | ||
Blood pressure | x | x | x | x | ||
Blood samples (glucose, HbA1c, insulin, CRP, kolesterol, LDL kolesterol, HDL kolesterol, triglyceriders, liver status, urate, TSH) | x | x | ||||
Date of birth | Child background questionnaire | x | ||||
Country of birth | x | |||||
Sex | x | |||||
Health status | x | x | ||||
Day care | x | x | ||||
Visits to health care regarding child weight | x | x | ||||
Sedentary behavior | x | x | x | x | ||
Food habits | Food frequency questionnaire | x | x | x | x | |
Eating behavior | Child Eating Behavior Questionnaire | x | x | x | x | |
Behavior | Child Behavior Checklist | x | x | |||
Parent
| ||||||
Weight/height | Parent background questionnaire | x | x | |||
Date of birth | x | |||||
Country of birth | x | |||||
Sex | x | |||||
Education level | x | |||||
Health status/weight reducing operation | x | x | ||||
Occupation status | x | x | ||||
Income | x | x | ||||
Family structure | x | x | ||||
Social and economic support from network | x | x | ||||
Perceived level of comfortable life | x | x | ||||
Perceived child problem behavior and parental confidence | Lifestyle Behavior Checklist | x | x | x | x | |
Feeding practices | Child Feeding Questionnaire | x | x | x | x | |
Limit setting strategies | Communicating with children | x | x | x | x | |
Family function | Family Assessment Device | x | x |
Anthropometrics
Metabolic markers and blood pressure
Child food and physical activity habits
Name of Instrument | Reference | Domains measured | Number of items | Brief description of measures: |
---|---|---|---|---|
Child Eating Behavior Questionnaire (CEBQ) | Wardle et. al. 2001 | 35 | ||
Food Approach
| ||||
Food Responsiveness (FR) | 5 | The child’s general appetite. | ||
Enjoyment of Food (EF) | 4 | The child’s interest in food. | ||
Emotional Overeating (EOE) | 4 | If the child eats as a response to emotions. | ||
Desire to Drink (DD) | 3 | The child’s desire to drink | ||
Food Avoidance
| ||||
Satiety Responsiveness (SR) | 5 | If the child gets full easily or not. | ||
Slowness in Eating (SE) | 4 | The child's speed of eating. | ||
Emotional Undereating (EUE) | 4 | If the child eats less as a response to emotions. | ||
Fussiness (FU) | 6 | The child eats a limited variety of food. | ||
Lifestyle Behavior Checklist (LBC) | West and Sanders 2009 West et. al. 2010 | Problem Scale/Confidence Scale | 25 | Parent’s perceptions of child obesity related problem behavior. Parent’s confidence in handling problematic behaviors. |
Overeating (OE) | 7 | If the child eats large potions or often asks for food. | ||
Misbehavior in relation to food (MB) | 7 | If the child throws tantrums about food or gets angry if not given food. | ||
Emotional correlates of being overweight (EMO) | 5 | If the child complains about e.g. peer problems, clothes being too small. | ||
Physical Activity (PA) | 5 | If the child is reluctant to physical activity and engages in sedentary behaviors. | ||
Child Feeding Questionnaire (CFQ) | Birch et. al 2001 | |||
Perceived Responsibility (PR) | 3 | Parental perception of their responsibility for child feeding. | ||
Parent Perceived Weight (PPW) | 4 | Parental perception of their own weight status history. | ||
Perceived Child Weight (PCW) | 6 | Parental perception of child weight status history. | ||
Concern about child weight (CN) | 3 | Parental concern about the child’s risk of overweight. | ||
Monitoring (MN) | 3 | The extent to which parent’s oversee the child’s food intake. | ||
Restriction (RST) | 8 | The extent to which parents restrict the child’s access to food. | ||
Pressure to Eat (PE) | 4 | Parent’s tendency to pressure the child to eat more food. | ||
Family Assessment Device (FAD) | Epstein et. al. 1983 | |||
Problem Solving | 5 | Ability to resolve problems in the family. | ||
Communication | 6 | Exchange of clear and direct verbal information. | ||
Roles | 8 | Division of responsibility for completing family tasks. | ||
Affective Responsiveness | 6 | Ability to respond with appropriate emotion | ||
Affective Involvement | 7 | Degree to which family members are involved and interested in one another. | ||
Behavior Control | 9 | Manner used to express and maintain standards of behavior. | ||
General Functioning | 12 | Overall function in the family. | ||
Child Behavior Checklist (CBCL) | Achenbach and Rescorla 2000 | 99 | ||
Internalizing Scale
| ||||
Emotionally Reactive | 9 | The child is easily disturbed, has mood swings etc. | ||
Anxious/Depressed | 8 | The child is overly sensitive, clings to parent or too independent, sad etc. | ||
Somatic Complaints | 11 | The child has aches, pain or vomits with no medical reason etc. | ||
Withdrawn | 8 | The child shows little interest in people or surroundings, doesn’t answer etc. | ||
Sleep Problems (not included in the Internalizing Scale) | 7 | The child doesn’t want to sleep alone, has nightmares, has little sleep etc. | ||
Externalizing Scale
| ||||
Attention Problems | 5 | The child can’t concentrate or sit still, wanders away et. | ||
Aggressive behavior | 19 | The child is angry, defiant, disobedient, demanding, stubborn etc. | ||
Beck’s Depression Inventory II (BDI-II) | Beck et. al 1988 | Mood, Pessimism, Sense of Failure, Lack of Satisfaction, Guilt Feelings, Sense of Punishment, Self-dislike, Self-accusation, Suicidal Wishes, Crying, Irritability, Social Withdrawal, Indecisiveness, Distortion of Body Image, Work Inhibition, Sleep Disturbance, Fatigability, Loss of Appetite, Weight Loss, Somatic Preoccupation and Loss of Libido. | 21 | Symptoms and attitudes to assess intensity of depression. |
Communicating with Children | (self-developed) | 12 | ||
Limit Setting Strategies | Parents limit setting strategies (consequent or not) | |||
Emotional Regulation | Parents ability of emotional control |