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Reducing Obesity Using a Family Centered Approach

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Reducing Obesity Using a Family Centered Approach

Reducing Obesity Using a Family Centered Approach


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  • 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.

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