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Family-focused weight management program for five- to nine-year-olds incorporating parenting skills training with healthy lifestyle information to support behaviour modification.

Article Excerpt
Abstract

This case study aims to describe how general parenting principles can be used as part of parent-led, family-focused child weight management that is in line with current Australian Clinical Practice Guidelines. A parent-led, family-focused child weight management program was designed for use by dietitians with parents of young children (five- to nine-year-olds). The program utilises the cornerstones of overweight treatment: diet, activity, behaviour modification and family support delivered in an age-appropriate, family-focused manner. Parents participate in 16 sessions (4 parenting-focused, 8 lifestyle-focused and 4 individual telephone support calls) conducted weekly, fortnightly then monthly over six months. This case study illustrates how a family used the program, resulting in reduced degree of overweight and stabilised waist circumference in the child over 12 months. In conclusion, linking parenting skills to healthy family lifestyle education provides an innovative approach to family-focused child weight management. It addresses key Australian Clinical Practice Guidelines, works at the family level, and provides a means for dietitians to easily adopt age-appropriate behaviour modification as part of their practice.

Key words: behaviour modification, child, parenting, weight management.

INTRODUCTION

Childhood overweight is a major Australian public health issue affecting more than 20% of Australian children. (1) From an early age, overweight impacts negatively on psychosocial development and the cardiovascular, endocrine, orthopaedic and respiratory systems. (2) The most significant long-term consequence of childhood overweight is its persistence into adulthood. (2) Effective, age-appropriate treatment approaches are required to address the immediate consequences of childhood obesity and prevent persistence into adulthood.

The Australian National Health and Medical Research Council (NHMRC) has developed evidence-based 'Clinical Practice Guidelines for the Management of Overweight and Obesity in Children and Adolescents'. (2) The NHMRC recommends utilising all available treatment components: diet, activity, behaviour modification and family support; and highlights that treatment needs to be delivered in an age-appropriate manner. (2) For young children, this may be best focused on parent-led family-based, rather than child-centred, treatment.

An Israeli study of 50 children aged 6-11 years found that when parents, rather than the overweight child, were targeted as the 'agent of change' for managing child overweight, there were better child weight outcomes eight years later (10 [+ or -] 11% vs 19 [+ or -] 14% overweight, P < 0.05). (3) A parent-led, family-focused approach acknowledges that parents and families are the key food providers and influences on young children's eating behaviours. (2) Focusing on the family also addresses 'family overweight', important given that parental overweight is the largest risk factor for childhood overweight. (2) The developmental capacity of young children also suggests that modifying children's eating and activity patterns is best considered within broader parenting and child behaviour.

Dietitians view weight management as an important professional role; however, they identify a range of barriers to working in this area. (4) Surveys conducted with Australian dietitians in 1997 and 2002 highlighted that many do not feel well prepared to manage overweight and obese clients, particularly children. (4,5) Many feel that their capacity to work effectively in this area is limited by inadequate resources and professional development opportunities, such as time, funding, staffing and training in specialist counselling skills. (5) In addition, limited use of available practice guidelines (2) and a lack of paediatric-specific dietetic practice guidelines may also be barriers to evidence-based child weight management. Further, papers detailing the interventions evaluated in studies are scarce--another barrier to effective practice in this area. (6)

Acquiring expertise in parenting skills may provide dietitians with a useful age-appropriate child behaviour modification approach to address family lifestyle and weight-related behaviours. This paper describes the novel adaptation and use of an established and evaluated general parenting skills program, for which materials and facilitator training are commercially...

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