Zyl, Sirja Van; (2004) UK evaluation of family-based behavioural intervention for paediatric obesity. Doctoral thesis (D.Clin.Psy), UCL (University College London).

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Abstract

The prevalence of childhood obesity has risen dramatically in recent years, yet little is known about effective intervention. Family Based Behavioural Treatment (FBBT) has been shown to be amongst the most effective treatments in the US, but has not been evaluated in the UK. The aim of this study was therefore to examine the impact of FBBT within a UK setting. Changes in %BMI were assessed at completion of and at three months post intervention. Furthermore, the effect of treatment on mood, self-esteem, self-perception of physical appearance, general difficulties and eating attitudes was examined. Factors targeted for change by the intervention including parental feeding style, diet and eating behaviour as well as activity levels were also evaluated. Obese children aged 8-12 years old were recruited through health professionals and the media. In total 65 children were referred for intervention, of which 37 were invited for assessment. Of these, 33 met eligibility criteria for the study and were assigned in order of presentation to one of 4 consecutive treatment groups. Furthermore, 6 of these children were assigned to a 3 month no intervention control group before commencing treatment. Children attended for FBBT together with at least one parent for 10 weekly sessions, followed by 2 fortnightly sessions and a follow-up session 3 months later. The intervention was based on the Stop Light Diet as described by Epstein and colleagues in the US. Changes in outcome variables were compared between the start and end of treatment as well as between the end of treatment and three month follow-up. Furthermore, changes in degree of overweight (%BMI) during the no intervention control period was compared to the intervention period. Results suggested that there was a significant reduction in %BMI at the end of treatment, which was maintained at follow-up. No change in %BMI was observed during the control period, suggesting that changes reported on completion of the intervention can be attributed to FBBT. Furthermore, there were significant improvements with respect to diet, levels of activity and sedentary behaviour, psychological functioning and parental relationship to child's eating, which was maintained or further improved on at follow-up. No increase in eating pathology was observed. Furthermore, treatment gains made with respect to consumption of food high in fat and sugar were not maintained. With respect to eating behaviours, eating in response to external cues (food responsiveness) significantly decreased at the end of treatment, whereas regulating food intake in response to internal cues (satiety responsiveness) significantly increased. In contrast, eating in response to emotional cues (emotional over- and undereating) did not change at the end of treatment. These finding were maintained at follow-up. The present findings suggest that FBBT was an effective and feasible treatment for childhood obesity in this study and would benefit from replication with a larger, randomised sample.

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