Overweight youth: Changing behaviors that are barriers to health
Practical advice for dealing with the family, the child, and socioeconomic environment.
Identify the personal goals that motivate a child
Overweight youth motivated to change are more likely to exercise7,17 and make healthier nutritional choices.50 A child in the preparation/action stage of change is highly motivated to make changes.43 Often multiple discussions are needed before a patient is ready to make changes. Keep in mind when having these discussions that patients can be motivated by different goals (increased athleticism, appearance, social acceptance).
For patients with comorbid medical disorders, modify nutrition and activity recommendations accordingly. Patients with emotional or behavioral disorders may need to see a psychologist or psychiatrist who can evaluate for and treat the issues.46 Psychologist-led group therapy sessions for the youth and/or their parents can also be helpful in providing support and positive peer modeling.51 If significant family stress or negative family dynamics are present, a referral for family therapy could be helpful.
Educate patients and caregivers about nutritional foods
Some patients and their families need assistance in learning how to buy healthful foods on a limited income. For others, learning how to budget and distribute food throughout the month is important.
Omar et al9 reported that male caregivers were most interested in learning about nutritional food choices, and that female caregivers were most interested in time-cutting measures for feeding their children. Caregivers, in general, relied on other family members for most nutrition information, some of which was inaccurate. This disparity among caregivers opens avenues for educating families, and in some cases must include the extended family. Furthermore, misunderstandings of the meanings of common terms can be avoided with a review or educational handouts.52
Finally, your advocacy for better laws, school policies, and social services can positively affect the cost of food, access to healthy foods, and neighborhood safety.
Provide physical activity choices
Provide a list of no-cost or low-cost options for exercise.52 With the child’s or teen’s input, list all the physical activities they enjoy7 and review other activities that they might like to try. Contact community centers and local parks and recreation services for a list of child-appropriate low-cost or no-cost physical activities available and add them to the list. Emphasizing activities that the child/teen finds enjoyable will enhance willingness to participate and consistency.
Sometimes, several short bursts of physical activity are more logistically possible than a longer bout, and may be more reinforcing for children and adolescents.53 Sothern et al54 recommend physical exercise that is both structured and progressive. Walking 15 minutes a day, 3 times a week, and gradually increasing the time and intensity is both structured and progressive.
Introduce behavior modification
Prioritize changes or goals. Changing specific eating and activity behaviors is more realistic than setting a weight management goal,44 because behaviors are easily identifiable, and changing them will likely yield health benefits before weight loss occurs.55 Overweight children need reminding that even if they maintain their weight, they will often grow in height, improving their BMI.
Once you have emphasized the importance of behavioral changes, set specific changes as goals. For example, “decrease intake of drinks containing sugar such as juice, sweet tea, or soft drinks to 1 or less per week” or “move from 0 minutes of physical activity to 15 minutes per day.” Move toward initial goals slowly so they can be achieved, and build positive momentum toward further changes. Assess nutrition and activity goals regularly and refine and revise goals as needed.
Carefully tracking progress toward treatment goals will also help you assess where additional barriers might be and motivate and energize patients who are making changes. When goals are not met, ask patients “why” in a nonjudgmental manner; this approach might disclose other unforeseen barriers and lead to a problem-solving discussion that can overcome them.
Traditional behavioral modification techniques apply to nutrition and physical activity changes. Rewarding progress can increase compliance and motivation to maintain changes and set new goals. Stimulus control techniques can also be helpful (eating at the table, not in front of the TV). Another technique that can work is making sedentary activities such as time spent in front of a television or computer contingent upon completion of physical activity.56,57 This technique, called the Premack Principle58 involves using a favorite, high-frequency activity as a reward for a behavior you would like to increase, such as physical activity. The patient is only allowed to engage in this favorite, high frequency activity as a reward for achieving a daily goal.
