The document summarizes the Pediatric School of Health in Iceland, which provides outpatient treatment for children with obesity and their families. It describes the multi-disciplinary team and treatment approach, which includes family-based cognitive behavioral therapy. It presents results showing improvements in children's BMI, emotional well-being, and quality of life following various treatment programs.

1. The Pediatric School of Health,
Department of Pediatrics, National
University Hospital of Iceland

2. Topics
Structure, procedures and collaboration
Treatment and results
Treatment
and results
Pediatric School of
Health

3. The Pediatric School of Health is an outpatient department for
children with obesity and their families
This service, in it’s current form started in 2011 and is provided at the
pediatric outpatient department 21-E at the Department of Pediatrics,
National University Hospital of Iceland. Over 200 children have
attended the Pediatric School of Health and approximately half have
attended group therapy.
Our clients are children with obesity from approximately 5 years of
age to 18 years as well as their families. The cut-off is BMI 2,5
standard deviations from the mean according to a normal distribution,
or a significant increase in a child’s weight over a short period of time.
Development and research: Our aim is to measure treatment
effectiveness and improve our treatment materials. A key factor in this
process is a strong collaboration with the University of Iceland.
Pediatric
School of
Health

4. Transdisciplinary team
Six professions
Anna Sigríður Ólafsdóttir, nutritionist
Berglind Brynjólfsdóttir, psychologist
Guðlaug M. Júlíusdóttir, social worker
Ólöf Elsa Björnsdóttir, nurse and public health specialist
Ragnar Bjarnason, chief physician
Sigurlaug Hrefna Traustadóttir, social worker
Tryggvi Helgason, pediatric physician
Þórður Sævarsson, sports scientist
Pediatric
School of
Health

5. Collaborators
Sidekick™

6. No
Yes
Workflow
Consultancy
Information gathering
Psychosocial information
Overall health
Exercise and eating behaviour
Background information
Bodily measurements
Height and weight
Blood pressure
Circumference of waist and upper
arm
Blood tests
Referral sheet
Parents
Health professionals
Referral
Screening interview
Nurse
(45 minutes)
Doctor
(45 minutes)
Psychologist
Further
assessment?Social worker
Type of
treatment
Follow up at the
health clinic
No
Further
treatment
needed?
Yes Group therapy
Individual therapy
Other specific
treatment resources
(pediatric psychiatry,
psychological
treatment)
The School of Health’s workflow
Assessment and
resources for
psychosocial
issues
Treatment type

7. Details on the initial interview at the Pediatric School of Health,
2011-2013 (n=180)Initial Interview
Mean ± SD or n (%)
Gender
girls
boys
101 (56 %)
79 (44 %)
Age (years) 11,5 ± 2,91
Height (cm) 153,5 ± 16,1
Weight (kg) 74,8 ± 24,95
BMI (kg/m2) 30,7 ± 5,26
BMI-SDS 3,5 ± 0,80
Waist circumference
(cm)
102,1 ± 14,1
Waist circumference/
height
0,66 ± 0,06
Ásdís Eva Lárusdóttir, B.Sc. theses in Medical Science, 2013. The impact of anthropometric factors on metabolic
aberrance in children and adolescents.

8. The average
child
participant at
the Pediatric
School of
Health

9. Normal
value
53%
Aberrance
47%
Aberrance in blood tests (n=54)
Hyper-
insulinemia
15%
Fatty liver 7%
Other aberrances 78%
Blood test
results Blood test results (n=116)
Ásdís Eva Lárusdóttir, B.Sc. theses in Medical Science, 2013. The impact of anthropometry on metabolic
aberrance in children and adolescents.

10. Workflow
Consultancy
Information gathering
Psychosocial information
Overall health
Exercise and eating
behaviour
Background information
Bodily measurements
Height and weight
Blood pressure
Circumference of waist and
upper arm
Blood tests
Referral sheet
Parents
Health professional
Assessment and
resources for
psychosocial
issues

11. Adolescents
Individual
treatment

12. Group therapy
8-12 years old

13. Family-based CBT
Family-based Cognitive Behavior Therapy – the children and
their parents are active participants
Information on healthy eating, the environmental impact on eating
behavior and exercise, the relationship between thoughts, emotions
and behavior and appetite awereness training.
Parents are taught about behavioral motivation in supporting their
children to change their behavior by using self monitoring, goal
setting, incentive systems (reward charts), observational learning and
positive reinforcement.
Do as I say but not as I do –
does not work!

14. Treatment
content

15. Log books
Goal setting
Incentive System
–Daily meetings of parent and child
–Write in the log book (at least 3 days a week)
–5 a day - fruits and vegetables
–Maximum 2 hours per day for screen time
–1 hour per day exercise
–1 portion or less of sweets per day
–1-3 portions low fat milk products
Realistic expectations
Realistic expectations

16. The shaping of
behavior –
exersice and
eating
Compliment the child when it
chooses to behave in a healthy
way

17. The Energy
Equation
(seesaw)
We only have one body-lets
take good care of it

18. The Magic
Triangle
What you think
Thought
How you feel
Feeling
What you do
Behavior
Healthy habits are not about
leading a perfectly healthy
lifestyle

19. Appetite
Awareness
Let’s show ourselves
understanding, empathy and
respect
The Appetite Awareness, Linda Craighead

20. Group therapy for 7-12 years olds receiving family CBT at the
Pediatric School of Health: Emotional wellbeing, quality of life and
anthropometric factors. Bryndís Kristjánsdóttir, MPH public health
specialist
Results
Research
Despite difficulties, don’t give
up–an opportunity for growth-
let’s do better next time

21. Table IV. Emotional wellbeing and quality of life
before and after treatment
´
**p<0.01
1
Strengths and Difficulties Questionniare
2
Pediatric Quality of life childs self-report
3
Pediatric Quality of life parent report
Pre treatment
Mean ±
Standard dev
Post treatment
Mean ±
Standard dev
Difference in means
(95% confidence
interval)
1
SDQ (n=22) 10.55 ± 5.88 9.59 ± 6.86 0.96 (0.7;2.5)
2
PedsQL
child (n=21)
70.55 ± 18.25 78.27 ± 16.00 -7.72(13.3;2.1)**
3
PedsQL
par.(n=21)
70.06 ± 16.39 76.86 ± 15.98 -6.80(-11.7;1.9)**

22. Table V. Emotional wellbeing and quality of life before
treatment compared to 3, 6 and 12 months post treatment
Pre treatment
mean ±
standard deviation
3 months post treatm
mean ±
standard deviation
Difference in
mean (95% conf
interval)
1
SDQ (n=10) 11,50 ± 4,30 9,10 ± 3,48 2,4 (1,2; 6,0)
2
Peds-QL child (n=10) 64,75 ± 21,44 85,44 ± 8,67 -20,7 (-5,5;-35,9)*
3
Peds-QL par. (n=9) 62,80 ± 19,46 83,07 ± 7,78 -20,3 (-33,5;-7,0)**
Pre treatment
mean ±
standard deviation
3 months post treatm
mean ±
standard deviation
Difference in
mean (95% conf
interval)
1
SDQ (n=11) 11,55 ± 5,39 11,00 ± 7,24 0,6 (-3,3;3,3)
2
Peds-QL child (n=10) 75,02 ± 16,43 80,40 ± 15,04 -5,4 (-17,1;6,3)
3
Peds-QL par. (n=11) 69,05 ± 13,70 79,94 ± 15,48 -10,9 (-16,3;-5,5)**
Pre treatment
mean ±
standard deviation
12 months post treatm
mean ±
standard deviation
Difference in
mean (95% conf
interval)
1
SDQ (n=16) 11,75 ± 5,62 11,12 ± 6,86 0,6 (-1,0; 2,3)
2
Peds-QL child (n=16) 66,81 ± 23,61 75,63 ± 13,89 -8,8 (-20,2;2,6)
3
Peds-QL par. (n=16) 66,65 ± 18,51 73,91 ± 18,93 -7,3 (-16,3;1,8)

23. Table II. Standardized Body Mass Index before and
after treatment
Pre treatment
Mean ±
standard dev
Post treatment
Mean ±
standard dev
Diff in means.
(95% conf
interval)
Children
(n=31)
3,49 ± 0,7 3,08 ± 0,6 0,41
(0,3;0,5)****
Boys (n=7) 3,80 ± 0,6 3,09 ± 0,4 0,71
(0,5;0,9)***
Girls
(n=24)
3,28 ± 0,6 2,96 ± 0,5 0,31
(0,2;0,4)****
***p<0,001,****p<0,0001

24. Table III. Standardized Body Mass Index before treatment
compared to 3, 6 and 12 months post treatment
Pre treatment
mean ±
standard deviation
3 mo post treatment
mean ±
standard deviation
Difference in means
(95% conf interv)
Children (n=31) 3,40 ± 0,6 2,95 ± 0,6 0,45 (0,4;0,6) ****
Boys (n=8) 3,84 ± 0,5 3,34 ± 0,6 0,50 (0,2; 0,8) **
Girls (n=23) 3,24 ± 0,6 2,82 ± 0,6 0,42 (0,3; 0,5)****
Pre treatment
mean ±
standard deviation
6 mo post treatment
mean ±
standard deviation
Difference in means
(95% conf interv)
Children (n=24) 3,45± 0,6 2,98 ± 0,6 0,47 (0,4;0,6)****
Boys(n=5) 3,86 ± 0,6 3,19 ± 0,5 0,67 (0,5;0,8)***
Girls (n=19) 3,35 ± 0,6 2,93 ± 0,6 0,42 (0,3;0,5)****
Pre treatment
mean ±
standard deviation
12 mo post treatment
mean ±
standard deviation
Difference in means
(95% conf interv)
Children (n=20) 3,36 ± 0,6 2,80 ± 0,4 0,55 (0,4;0,7)****
Boys (n=4) 3,79 ± 0,8 3,08 ± 0,4 0,80 (-0,1; 1,5)
Girls (n=16) 3,25 ± 0,5 2,73 ± 0,4 0,52 (0,4; 0,7)****

25. Parent testimonials
Happy about the
course, very
informative!
The best service
that I have
received!
A changed lifestyle is about
USING what we learn on
the course– MOST OF THE
TIME!
A brilliant course!
A brilliant feather in
the cap, the need is
great and we
learned so much on
the course!
We enjoyed the
course and it was
useful too!
Very happy!
The Pediatric School
of Health does an
excellent job!
Published with permission from Ásdís Eva Lárusdóttir, medical student