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Open Access 01-12-2022 | Obesity | Research

Perceptions of a family-based lifestyle intervention for children with overweight and obesity: a qualitative study on sustainability, self-regulation, and program optimization

Authors: Kaila C. Putter, Ben Jackson, Ashleigh L. Thornton, Claire E. Willis, Kong Min Bryce Goh, Mark R. Beauchamp, Nat Benjanuvatra, James A. Dimmock, Timothy Budden

Published in: BMC Public Health | Issue 1/2022

Abstract

Background

Family-based lifestyle interventions (FBLIs) are an important method for treating childhood weight problems. Despite being recognized as an effective intervention method, the optimal structure of these interventions for children’s overweight and obesity has yet to be determined. Our aim was to better understand participants’ (a) implementation of behaviour strategies and long-term outcomes, (b) perceptions regarding the optimal structure of FBLIs, and (c) insights into psychological concepts that may explain the success of these programs.

Methods

Purposive sampling was used to recruit participants. We conducted focus groups as well as one-to-one interviews with parents (n = 53) and children (n = 50; aged 7–13, M = 9.4 yr, SD = 3.1) three months following their involvement in a 10-week, multi-component, FBLI involving education and activities relating to healthy nutrition, physical activity, and behavior modification. Using an interpretivist approach, a qualitative study design was employed to examine participant experiences.

Results

We identified three higher-order categories: (a) participants’ program experiences and perceptions (b) lifestyle changes post-program, and (c) recommendations for optimizing family-based programs. Themes identified within these categories included (a) support and structure & content, (b) diet and physical activity, and (c) in-program recommendations and post-program recommendations.

Conclusions

We identified several challenges that can impair lasting behavior change (e.g., physical activity participation) following involvement in a FBLI. On optimizing these programs, participants emphasized fun, interactive content, interpersonal support, appropriate educational content, and behavior change techniques. Concepts rooted in motivational theory could help address calls for greater theoretical and mechanistic insight in FBLIs. Findings may support research advancement and assist health professionals to more consistently realize the potential of these interventions.

World Health Organization. “Fact sheet on obesity and overweight.” http://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. Accessed 25 Nov 2020.

Australian Bureau of Statistics. National Health Survey: First Results, Australia 2017–18. Australia: The Australian Bureau of Statistics. Canberra; 2018. https://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4364.0.55.0012017-18?OpenDocument.

Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity among adults and youth: United States, 2015–2016. NCHS data brief, no 288. Hyattsville: MD: National Center for Health Statistics; 2017.

National Health Service Digital. National child measurement programme, England 2018/19 School Year [NS]. United Kingdom: Health and Social Care Information Centre; 2019.

Kelly AS, Barlow SE, Rao G, et al. Severe obesity in children and adolescents: Identification, associated health risks, and treatment approaches. Circ. 2013;128:1689–712. https://doi.org/10.1161/CIR.0b013e3182a5cfb3.CrossRef

Sanders RH, Han A, Baker JS, Cobley S. Childhood obesity and its physical and psychological co-morbidities: a systematic review of Australian children and adolescents. Eur J Pediatr. 2015;174(6):715–46. https://doi.org/10.1007/s00431-015-2551-3.CrossRefPubMed

Cornette R. The emotional impact of obesity on children. Worldviews on Evid-Based Nurs. 2008;5(3):136–41. https://doi.org/10.1016/B978-0-12-374995-6.10024-6.CrossRef

Kang NR, Kwack YS. An update on mental health problems and cognitive behavioral therapy in pediatric obesity. Pediatric Gastroenterology, Hepatology & Nutrition. 2020;23(1):15–25. https://doi.org/10.5223/pghn.2020.23.1.15.CrossRef

Rankin J, Matthews L, Cobley S, Han A, Sanders R, Wiltshire HD, Baker JS. Psychological consequences of childhood obesity: Psychiatric comorbidity and prevention. Adolesc Health Med Ther. 2016;7:125. https://doi.org/10.2147/AHMT.S101631.CrossRefPubMedPubMedCentral

10.

Bendor CD, Bardugo A, Pinhas-Hamiel O, Afek A, Twig G. Cardiovascular morbidity, diabetes and cancer risk among children and adolescents with severe obesity. Cardiovasc Diabetol. 2020;19(1):1–79. https://doi.org/10.1186/s12933-020-01052-1.CrossRef

11.

Freedman DS, Dietz WH, Srinivasan SR, Berenson GS. The relation of overweight to cardiovascular risk factors among children and adolescents: the Bogalusa heart study. Pediatrics. 1999;103:1175–82. https://doi.org/10.1542/peds.103.6.1175.CrossRefPubMed

12.

Puhl RM, Latner JD. Stigma, obesity, and the health of the nation’s children. Psychological Bull. 2007;133:557–80. https://doi.org/10.1037/0033-2909.133.4.557.CrossRef

13.

Thompson I, Hong JS, Lee JM, Prys NA, Morgan JT, Udo-Inyang I. A review of the empirical research on weight-based bullying and peer victimisation published between 2006 and 2016. Educ Rev. 2020;72(1):88–110. https://doi.org/10.1080/00131911.2018.1483894.CrossRef

14.

Gow Tee MS, Garnett SP, Baur LA, Aldwell K, Thomas S, Lister NB, Paxton SJ, & Jebeile H. Pediatric obesity treatment, self-esteem, and body image: a systematic review with meta-analysis. Pediatric Obesity. 2020;15(3). https://doi.org/10.1111/ijpo.12600

15.

Wang F, Wild TC, Kipp W, Kuhle S, Veugelers PJ. The influence of childhood obesity on the development of self-esteem. Health Rep. 2009;20:21–7.PubMed

16.

Russell-Mayhew S, McVey G, Bardick A, Ireland A. Mental health, wellness, and childhood overweight/obesity. J. Obes. 2012:9 https://doi.org/10.1155/2012/281801

17.

Horesh A, Tsur AM, Bardugo A, Twig G. Adolescent and childhood obesity and excess morbidity and mortality in young adulthood—a systematic review. Curr Obes Rep. 2021;10(3):301–10. https://doi.org/10.1007/s13679-021-00439-9.CrossRefPubMed

18.

Lobstein T, Baur L, Uauy R. Obesity in children and young people: a crisis in public health. Obes Rev. 2004;5(S1):4–85. https://doi.org/10.1111/j.1467-789X.2004.00133.x.CrossRefPubMed

19.

Dong C, Sanchez LE, Price RA. Relationship of obesity to depression: a family-based study. International J Obes and Relat Disord. 2004;28:790–5. https://doi.org/10.1038/sj.ijo.0802626.CrossRef

20.

Altman M, Wilfley DE. Evidence update on the treatment of overweight and obesity in children and adolescents. J Clin Child & Adolescent Psychology. 2015;44:521–37. https://doi.org/10.1080/15374416.2014.963854.CrossRef

21.

Latzer Y, Edmunds L, Fenig S, et al. Managing childhood overweight: Behaviour, family, pharmacology, and bariatric surgery interventions. Obes. 2009;17:411–23. https://doi.org/10.1038/oby.2008.553.CrossRef

22.

Sbruzzi G, Eibel B, Barbiero SM, Petkowicz RO, Ribeiro RA, Cesa CC, Martins CC, Marobin R, Schaan CW, Souza WB, Schaan BD, Pellanda LC. Educational interventions in childhood obesity: A systematic review with meta-analysis of randomized clinical trials. Preventive Medicine. 2013;56:254–64. https://doi.org/10.1016/j.ypmed.2013.02.024.CrossRefPubMed

23.

Cole K, Waldrop J, D’Auria J, Garner H. An integrative research review: Effective school-based childhood overweight interventions. J for Specialists in Pediatric Nurs. 2006;11:166–77. https://doi.org/10.1111/j.1744-6155.2006.00061.x.CrossRef

24.

Liu Z, Xu HM, Wen LM, Peng YZ, Lin LZ, Zhou S, Li WH, Wang HJ. A systematic review and meta-analysis of the overall effects of school-based obesity prevention interventions and effect differences by intervention components. Int J Behav Nutr Phys Act. 2019;16(1):1–12. https://doi.org/10.1186/s12966-019-0848-8.CrossRef

25.

Ewald H, Kirby J, Rees K, Robertson W. Parent-only interventions in the treatment of childhood obesity: A systematic review of randomized controlled trials. J Public Health. 2014;36(3):476–89. https://doi.org/10.1093/pubmed/fdt108.CrossRef

26.

Jansen E, Mulkens S, Jansen A. Tackling childhood overweight: Treating parents exclusively is effective. International J Obes. 2011;35:501–9. https://doi.org/10.1038/ijo.2011.16.CrossRef

27.

Zarychta K, Mullan B, Luszczynska A. It doesn’t matter what they say, it matters how they behave: Parental influences and changes in body mass among overweight and obese adolescents. Appetite. 2016;96:47–55. https://doi.org/10.1016/j.appet.2015.08.040.CrossRefPubMed

28.

Chai LK, Collins C, May C, Brain K, See DW, Burrows T. Effectiveness of family-based weight management interventions for children with overweight and obesity: An umbrella review. JBI Evidence Synthesis. 2019;17(7):1341–427. https://doi.org/10.11124/JBISRIR-2017-003695.CrossRef

29.

Jull A, Chen R. Parent-only vs. parent-child (family-focused) approaches for weight loss in obese and overweight children: A systematic review and meta-analysis. Obesity Reviews. 2013;14(9):761–8. https://doi.org/10.1111/obr.12042.CrossRefPubMed

30.

Berge JM, Everts JC. Family-based interventions targeting childhood obesity: a meta-analysis. Child Obes. 2011;7:110–21. https://doi.org/10.1089/chi.2011.07.02.1004.berge.CrossRefPubMedPubMedCentral

31.

Pratt KJ, Skelton JA. Family functioning and childhood obesity treatment: a family systems theory-informed approach. Acad Pediatr. 2018;18(6):620–7. https://doi.org/10.1016/j.acap.2018.04.001.CrossRefPubMedPubMedCentral

32.

Yackobovitch-Gavan MD, Wolf Linhard N, Nagelberg I, Poraz S, Shalitin M, Phillip M, Meyerovitch J. Intervention for childhood obesity based on parents only or parents and child compared with follow-up alone. Pediatric Obesity. 2018;13(11):647–55. https://doi.org/10.1111/ijpo.12263.CrossRefPubMed

33.

Brown HE, Schiff A, van Sluijs EMF. Engaging families in physical activity research: a family-based focus group study. BMC Public Health. 2015;15(1):1178. https://doi.org/10.1186/s12889-015-2497-4.CrossRefPubMedPubMedCentral

34.

Mead E, Brown T, Rees K, et al. Diet, physical activity and behavioural interventions for the treatment of overweight or obese children from the age of 6 to 11 years. Cochrane Database of Systematic Reviews. 2018;6. https://doi.org/10.1002/14651858.CD012651

35.

Sacher PM PM, Kolotourou M M, Chadwick PM, et al. Randomized controlled trial of the MEND program: a family-based community intervention for childhood obesity. Obes. 2010;18(S1):S62–8. https://doi.org/10.1038/oby.2009.433.CrossRef

36.

Hayes JF, Fowler LA, Balantekin KN, Saelens BE, Stein RI, Perri MG, Welch RR, Epstein LH, Wilfley DE. Children with severe obesity in family-based obesity treatment compared with other participants: conclusions depend on metrics. Obesity. 2021;29(2):393–401. https://doi.org/10.1002/oby.23071.CrossRefPubMed

37.

Vaughan-Johnston TI, Jacobson, JA. Self-efficacy theory. In: Carducci BJ, Nave CS, Mio JS, Riggio, RE, editors. The Wiley encyclopedia of personality and individual differences: Models and theories. Newark: John Wiley & Sons, Ltd; 2020. pp. 375–379. https://doi.org/10.1002/9781119547143.ch62

38.

Ivy VN, PhD., Gaudreault KL, PhD., Baghurst T, PhD. Self-efficacy of overweight and obese youth participating in a multidisciplinary afterschool program. International Journal of Child and Adolescent Health. 2019;12(2):157–170. Available from: https://elibrary.jcu.edu.au/login?url=https://www.proquest.com/scholarly-journals/self-efficacy-overweight-obese-youth/docview/2273102042/se-2?accountid=16285

39.

Teixeira PJ, Silva MN, Mata J, Palmeira AL, Markland D. Motivation, self-determination, and long-term weight control. Int J Behav Nutr PhysActivity. 2012;9:22. https://doi.org/10.1186/1479-5868-9-22.CrossRef

40.

Ryan RM, Deci EL. Self-determination theory and the role of basic psychological needs in personality and the organization of behaviour. In: John OP, Robins RW, Pervin LA, editors. Handb of personality: Theory and res. New York, NY: The Guilford Press; 2008. p. 654–78.

41.

Sung-Chan P, Sung YW, Zhao X, Brownson RC. Family-based models for childhood-obesity intervention: a systematic review of randomized controlled trials. Obes Reviews. 2013;14:265–78. https://doi.org/10.1111/obr.12000.CrossRef

42.

Epstein LH, Paluch RA, Roemmich JN, Beecher MD. Family-based obesity treatment, then and now: twenty-five years of pediatric obesity treatment. Health Psychol. 2007;26:381–91. https://doi.org/10.1037/0278-6133.26.4.381.CrossRefPubMedPubMedCentral

43.

Jones HM, Al-Khudairy L, Melendez-Torres GJ, Oyebode O. Viewpoints of adolescents with overweight and obesity attending lifestyle obesity treatment interventions: a qualitative systematic review. Obes Rev. 2019;20(1):156–69. https://doi.org/10.1111/obr.12771.CrossRefPubMed

44.

Pietrabissa G, Rossi A, Borrello M, Manzoni GM, Mannarini S, Castelnuovo G, Molinari E. Development and validation of a self-determination theory-based measure of motivation to exercise and diet in children. Front Psychol. 2020;11:1299.CrossRef

45.

Zolotarjova J, ten Velde G, Vreugdenhil ACE. Effects of multidisciplinary interventions on weight loss and health outcomes in children and adolescents with morbid obesity. Obes Reviews. 2018;19:931–46. https://doi.org/10.1111/obr.12680.CrossRef

46.

Denzin NK, Lincoln YS. Strategies of Qualitative Inquiry. 4th ed. London: Sage; 2013.

47.

Sparkes AC, Smith B. Qualitative research methods in sport, exercise and health: From process to product. Routledge; 2013.

48.

Braun V, Clarke V. Reflecting on reflexive thematic analysis. Qual Res Sport Exerc Health. 2019;11:589–97. https://doi.org/10.1080/2159676X.2019.1628806.CrossRef

49.

Clarke V, Braun V, Terry G, Hayfield N. Thematic analysis. In: Liamputtong P, editors. Handb. Res. Methods in Health and Soc. Sciences. Singapore: Springer; 2019:843–860. https://doi.org/10.1007/978-981-10-5251-4_103

50.

Adler, K., Salanterä, S., & Zumstein-Shaha, M. Focus group interviews in child, youth, and parent research: An integrative literature review. Int J Qual Methods. 2019;18. https://doi.org/10.1177/1609406919887274

51.

Jones CD, Newsome J, Levin K, Wilmot A, McNulty JA, Kline T. Friends or strangers? a feasibility study of an innovative focus group methodology. The Qualitative Report. 2018;23(1):98–112. https://doi.org/10.46743/2160-3715/2018.2940.CrossRef

52.

Braun V, Clarke V. To saturate or not to saturate? Questioning data saturation as a useful concept for thematic analysis and sample-size rationales. Qualitative Res Sport Exercise Health. 2021;13(2):201–16. https://doi.org/10.1080/2159676X.2019.1704846.CrossRef

53.

Birch LL, Ventura AK. Preventing childhood obesity: what works? International J Obes. 2018;33:S74–81. https://doi.org/10.1038/ijo.2009.22.CrossRef

54.

Sargent GM, Pilotto LS, Baur LA. Components of primary care interventions to treat childhood overweight and obesity: a systematic review of effect. Obes Reviews. 2011;12:e219–35. https://doi.org/10.1111/j.1467-789X.2010.00777.x.CrossRef

55.

Smith B, McGannon KR. Developing rigor in qualitative research: problems and opportunities within sport and exercise psychology. International Rev Sport and Exercise Psychology. 2018;11:101–21. https://doi.org/10.1080/1750984X.2017.1317357.CrossRef

56.

Bennett B, Sothern MS. Diet, exercise, behaviour: the promise and limits of lifestyle change. Semin in Pediatric Surg. 2009;18:152–8. https://doi.org/10.1053/j.sempedsurg.2009.04.005.CrossRef

57.

Skelton JA, Irby MB, Beech BM, Rhodes SD. Attrition and family participation in obesity treatment programs: Clinicians’ perceptions. Acad Pediatr. 2012;12:420–8. https://doi.org/10.1016/j.acap.2012.05.001.CrossRefPubMedPubMedCentral

58.

Harrist AW, Swindle TM, Hubbs-Tait L, Topham GL, Shriver LH, Page MC. The social and emotional lives of overweight, obese, and severely obese children. Child Dev. 2016;87:1564–80. https://doi.org/10.1111/cdev.12548.CrossRefPubMedPubMedCentral

59.

Salvy SJ, de la Haye K, Bowker JC, Hermans RC. Influence of peers and friends on children’s and adolescents’ eating and activity behaviours. Physiol & Behav. 2012;106:369–78. https://doi.org/10.1016/j.physbeh.2012.03.022.CrossRef

60.

Nicholas JC, Dimmock JA, Donnelly CJ, Alderson JA, Jackson B. “It’s our little secret… an in-group, where everyone’s in”: Females’ motives for participation in a stigmatized form of physical activity. Psychol Sport Exerc. 2018;36:104–13.CrossRef

61.

Michie S, Ashford S, Sniehotta FF, Dombrowski SU, Bishop A, French DP. A refined taxonomy of behaviour change techniques to help people change their physical activity and healthy eating behaviours: the CALO-RE taxonomy. Psychol Health. 2011;26:1479–98. https://doi.org/10.1080/08870446.2010.540664.CrossRefPubMed

62.

Deci EL, Ryan RM. Self-determination theory: a macrotheory of human motivation, development, and health. Can Psychol. 2008;49:182–5. https://doi.org/10.1037/a0012801.CrossRef

63.

Webber KH, Tate DF, Ward DS, Bowling JM. Motivation and its relationship to adherence to self-monitoring and weight loss in a 16-week Internet behavioural weight loss intervention. J Nutr Education and Behav. 2010;42:161–7. https://doi.org/10.1016/j.jneb.2009.03.001.CrossRef

64.

Dimmock J, Jackson B, Podlog L, Magaraggia C. The effect of variety expectations on interest, enjoyment, and locus of causality in exercise. Motivation and Emot. 2013;37(1):146–53.CrossRef

65.

Stamatakis E, Wardle J, Cole TJ. Childhood obesity and overweight prevalence trends in England: evidence for growing socioeconomic disparities. International J Obes. 2010;34:41–7. https://doi.org/10.1038/ijo.2009.217.CrossRef

66.

Clayton, Connelly, J., Ellington, M., Rojas, V., Lorenzo, Y., Trak-Fellermeier, M. A., & Palacios, C. Facilitators and barriers of children's participation in nutrition, physical activity, and obesity interventions: a systematic review. Obesity Reviews. 2021;22(12). https://doi.org/10.1111/obr.13335

67.

Zahry NR, Ling J. Parental perceived facilitators for and barriers to participating in a lifestyle intervention to reduce early childhood obesity: a qualitative evaluation. West J Nurs Res. 2020;42(6):405–14. https://doi.org/10.1177/0193945919866691.CrossRefPubMed

68.

Foster E, Bradley J. Methodological considerations and future insights for 24-hour dietary recall assessment in children. Nutr Res. 2018;51:1–11. https://doi.org/10.1016/j.nutres.2017.11.001.CrossRefPubMed

69.

O’Reilly M, Parker N. ‘Unsatisfactory Saturation’: a critical exploration of the notion of saturated sample sizes in qualitative research. Qualitative Research. 2013;2:190–7. https://doi.org/10.46743/2160-3715/2018.2940.CrossRef

70.

Budden T, Dimmock JA, Smith B, Beauchamp M, Rosenberg M, Jackson B. Overweight and obese men’s experiences in a sport-based weight loss intervention for men. Psychol Sport Exerc. 2020;50:101750. https://doi.org/10.46743/2160-3715/2018.2940.CrossRefPubMedPubMedCentral

71.

Irvine A, Drew P, Sainsbury R. ‘Am I not answering your questions properly?’Clarification, adequacy and responsiveness in semi-structured telephone and face-to-face interviews. Qual Res. 2013;13(1):87–106. https://doi.org/10.1177/1468794112439086.CrossRef

72.

Rabiee F. Focus-group interview and data analysis. Proceedings of the nutrition society. 2004;63(4):655–60. https://doi.org/10.1079/PNS2004399.CrossRefPubMed

73.

Smith B. Generalizability in qualitative research: Misunderstandings, opportunities and recommendations for the sport and exercise sciences. Qualitative Res in Sport, Exercise and Healt. 2018;10:137–49. https://doi.org/10.1080/2159676X.2017.1393221.CrossRef

Title: Perceptions of a family-based lifestyle intervention for children with overweight and obesity: a qualitative study on sustainability, self-regulation, and program optimization
Authors: Kaila C. Putter
Ben Jackson
Ashleigh L. Thornton
Claire E. Willis
Kong Min Bryce Goh
Mark R. Beauchamp
Nat Benjanuvatra
James A. Dimmock
Timothy Budden
Publication date: 01-12-2022
Publisher: BioMed Central
Keywords: Obesity
Obesity
Overweight
Published in: BMC Public Health / Issue 1/2022
Electronic ISSN: 1471-2458
DOI: https://doi.org/10.1186/s12889-022-13956-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Perceptions of a family-based lifestyle intervention for children with overweight and obesity: a qualitative study on sustainability, self-regulation, and program optimization

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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