1.CHILDHOOD OBESITY A Family Centered Approach

2. Childhood Obesity has become an Epidemic Childhood obesity has more than doubled in the past 30 years In 2012, more than 1/3 of children and adolescents were overweight or obese, which is more than 23 million children 70% of obese youth have at least one risk factor for cardiovascular disease Long term effects of childhood obesity include: diabetes, heart disease, hypertension Obesity-related medical costs for children are about $14.8 billion 3. Individual Behaviors Contributing to Childhood Obesity 69% of high school students do not attend PE classes 32% of students watch 3 or more hours of TV on an average school day 11% of students drink 3 or more bottles of soda a day In teenage youth, children consume 700-1,000 more calories per day than what is needed for healthy growth 4. Family Elements that Impact Childhood Obesity 5. Involvement of parents in family interventions that combat childhood obesity exhibit great success. Utilizing the family paradigm in decreasing pediatric obesity is the gold standard for enabling changes in behavior to improve the weight and overall health of children. Family-centered approaches have been shown to reduce BMI and reduce the incidence of overweight children. The Importance of Family-Centered Interventions 6. Family Elements that Impact Childhood Obesity II. Parenting Styles High Demandingness Low Demandingness High Responsiveness Authoritative: Respectful of childs opinions but maintains clear boundaries Permissive: Indulgent without discipline Low Responsiveness Authoritarian: Strict disciplinarian Neglectful: Emotionally uninvolved and does not set goals Adapted from: Rhee, K. (2008) Childhood overweight and the relationship between parent behaviors, parenting style, and family functioning. AAPSS; 615: 12-32. DOI: 10.1177/0002716207308400. 7. Family Elements that Impact Childhood Obesity II. Parenting Styles continued An Authoritative style has been associated with positive childhood outcomes Increased self-regulatory ability Fewer depressive symptoms Fewer risk taking behaviors Greater fruit and vegetable intake Increased physical activity behaviors 8. Family Elements that Impact Childhood Obesity The other three parenting styles are associated with negative outcomes Lower levels of self-control Poorer psychosocial and emotional development Authoritarian style is associated with a 5-fold increase of having over- weight children in first grade than the Authoritative patterns 9. Permissive Neglectful 10. Family Elements that Impact Childhood Obesity III. Parental Modeling Children are more likely to choose healthier foods if the parents choose healthy foods for themselves. The impact of modeling is enhanced with positive comments and positive social affect. Modeling is also effective in promoting healthy activity. 11. Family Elements that Impact Childhood Obesity IV. Parental Control Over Food Consumption Negative factors Prompting to eat Use of food as rewards Restricting access to food Large portion sizes 12. Family Elements that Impact Childhood Obesity IV. Parental Control Over Food Consumption Positive factors Exposure and/or availability of certain foods Accessibility of specific foods Self-regulation or portion control Parent modeling of food consumption Parental warmth and sensitivity Family meals 13. Family Elements that Impact Childhood Obesity V. Relationship Dynamics Involving Food Negative: One-to-one relationship Food as a means to express love Using food to control the relationship Using food to compensate for the presence or absence of the parent Positive: Family group relationship Using a meal to promote family cohesion The staging of the meal as an indicator of family organization 14. Family Elements that Impact Childhood Obesity VI. Stress Responses Chronic stress diminishes self-regulatory capacity Deficits in emotional regulation also contribute to obesity Maladaptive stress response includes Internalizing behaviors: depression, anxiety, social withdrawal, isolation Externalizing behaviors: hyperactivity, conduct problems, low self-esteem, peer conflict, and peer interaction problems Uncontrolled eating behaviors: binge eating, all-or-nothing attitude towards forbidden food 15. Family Elements that Impact Childhood Obesity VI. Stress Responses Chronic stress diminishes self-regulatory capacity Deficits in emotional regulation also contribute to obesity 16. Family Elements that Impact Childhood Obesity VI. Stress Responses Maladaptive stress responses include: Internalizing behaviors: depression anxiety social withdrawal isolation 17. Family Elements that Impact Childhood Obesity VI. Stress Responses Externalizing behaviors: hyperactivity conduct problems low self-esteem peer conflict peer interaction problems 18. Family Elements that increase the likelihood Childhood Obesity VI. Stress Responses Uncontrolled eating behaviors: binge eating all-or-nothing attitude towards forbidden food 19. BARRIERS Provider Barriers Time constraints in practice Lack of reimbursement For preventative care and counseling Few opportunities to address obesity Short, infrequent visits between providers and children Ineffective communication Lack of education on strategies and techniques to address childhood obesity 20. BARRIERS Parent and Child Barriers Limited knowledge and health literacy Family lifestyle Lack of motivation Low income Sensitivity to the issue Lack of acknowledgement of the issue Lack of community resources Feeling judged or threatened 21. BARRIERS Community Barriers Lack of community resources Lack of education resources for parents and children Lack of spaces dedicated to physical activity for children: parks, gyms, recreation centers, jungle gyms Sociocultural environment Physical and social environment that does not facilitate healthy living for families 22. OVERCOMING BARRIERS What do practitioners need to effectively address obesity utilizing family dynamics? Tools for recognizing eating behaviors USDA Diet questionnaires- screen for fruit and vegetables, fat intake, healthy behavior changes related to eating, overall diet quality, healthy body My Plate Portion Sizes- count consumed calories, calorie content of common foods, identifies empty calories in food, label reading Eating disorder screening- SCOFF questionnaire screens for maladaptive eating behaviors 23. OVERCOMING BARRIERS Family knowledge in regards to healthy eating Healthy foods- USDHHS provides tools to help families better understand nutrition and how healthy eating plays a vital role in a healthy weight Cultural food differences- USDA provides different food pyramids for ethnic cuisines 24. OVERCOMING BARRIERS Reinforce positive strategies that the family is already employing Communication techniques to overcome barriers Verbal and non verbal communication Reflective listening ChangeTalk Non-threatening and non-judgmental verbal and non-verbal communication Patient centered realistic goals. 25. OVERCOMING BARRIERS Assessment tools for the family unit Motivational Interviewing Helps illicit motivations for behavior change ex. Asking questions that elicit change, such as, do you think you are ready to lose weight? SOFT: Standardized obesity family therapyTechnique Focuses on family interactions and their impact on lifestyle changes Only used for Obesity and utilizes medical and psychological support FCU: Family Check-up Utilization of FCU leads to increased quality of the parent and child relationship which reinforces healthy family eating habits by assessing and intervening in a systematic manner FCU focuses on broad areas of parenting in regards to involvement, monitoring and communication. 26. SOFT Van Ryzin, M. J., & Nowicka, P. (2013). Direct and indirect effects of a family-based intervention in early adolescence on parent-youth relationship quality, late adolescent health, and early adult obesity. Journal of Family Psychology, 27(1), 106-116 27. FAMILY CHECK UP Norwicka, P., & Flodmark, C. (2011). Family therapy as a model for treating childhood obesity: Useful tools for clinicians. Clinical Child Psychology and Psychiatry, 16(1), 129-143. 28. CONCLUSION Practitioners need to be ready to face barriers of childhood obesity at the family level and individual level Incorporating family to help aid in decreasing childhood obesity is more successful then focusing individually Recognizing the family styles, authoritative vs. permissive, will enable the practitioner to tailor interventions to the family needs Be able to recognize the elements that impact childhood obesity in a specific demographic and select the appropriate interventions and reinforce positive ones being practiced. Have the ability to identify the barriers types surrounding childhood obesity and overcome them Be able to locate and identify the appropriate tools that may assist the practitioner with childhood obesity interventions 29. RESOURCES Carlisle, K. L., Buser, J. K., & Carlisle, R. M. (2012). Childhood food addiction and the family. Family Journal: Counseling andTherapy for Couples and Families, 20(3), 332-339. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=eric&AN=EJ973 384&site=ehost-live; http://dx.doi.org/10.1177/1066480712449606 Centers for Disease Control and Prevention. (2013).Adolescent and School Health. Retrieved from http://www.cdc.gov/healthyyouth/obesity/facts.htm Chen,A.Y., & Escarce, J. J. (2013). Family structure and childhood obesity: An analysis through 8th grade. Maternal and Child Health Journal, doi:10.1007/s10995-013-1422-7 Davis, M.,Young, L., Davis, S. P., & Moll, G. (2011). Parental depression, family functioning, and obesity among african american children. ABNF Journal, 22(3), 53-57. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=26h&AN=6323 0017&site=ehost-live 30. RESOURCES Evans, G.W., Fuller-Rowell,T., & Doan, S. N. (2012).Childhood cumulative risk and obesity:The mediating role of self-regulatory ability. US:American Academy of Pediatrics. doi:10.1542/peds.2010-3647 Gerards, S., Dagnelie, P., Jansen, M.,Vries, N., & Kremers, S. (2012). Barriers to successful recruitment of parents of overweight children for an obesity prevention intervention: a qualitative study among youth health care professionals. BMC Family Practice , 13(37), 1-10. http://dx.doi.org/10.1186/1471-2296-13-37 Gundersen, C., Mahatmya, D., Garasky, S., & Lohman, B. (2011). Linking psychosocial stressors and childhood obesity. Obesity Reviews, 12, e54- e63. doi:10.1111/j.1467-789X.2010.00813.x Halliday, J.A., Palma, C. L., Mellor, D., Green, J., & Renzaho,A. M. N. (2014). The relationship between family functioning and child and adolescent overweight and obesity:A systematic review. International Journal of Obesity (2005), 38(4), 480-493. doi:10.1038/ijo.2013.213 31. RESOURCES Lachal, J., Speranza, M.,Taeb, O., Falissard, B., Lefvre, H., Moro, M., & Revah-Levy,A. (2012). Qualitative research using photo-elicitation to explore the role of food in family relationships among obese adolescents. Appetite, 58(3), 1099-1105. doi:http://dx.doi.org.libproxy.unh.edu/10.1016/j.appet.2012.02.045 Larsen, L., Mandleco, B.,Williams, M., & Tiedeman, M. (2006). Childhood obesity: prevention practices of nurse practitioners. Journal of the Academy of Nurse Practitioners , 18(2), 70-79. Morgan, J. F., Reid, F., & Lacey, J. H. (2000).The SCOFF questionnaire. Western Journal of Medicine, 172(3), 154-165. National Collaborative on Childhood Obesity Research. (2013). Childhood Obesity in the United States. Retrieved from http://www.nccor.org/downloads/ChildhoodObesity_020509.pdf National Heart, Lung, and Blood Institute. (2013). Nutrition Tools and Resources. Retrieved from http://www.nhlbi.nih.gov/health/public/heart/obesity/wecan/tools- resources/nutrition.htm Norwicka, P., & Flodmark, C. (2011). Family therapy as a model for treating childhood obesity: Useful tools for clinicians. Clinical CHild Psychology and Psychiatry, 16(1), 129- 143. 32. RESOURCES Puder, J. J., & Munsch, S. (2010). Psychological correlates of childhood obesity. International Journal of Obesity, 34, S37-S43. doi:10.1038/ijo.2010.238 Regber, S., Marlid, S., & Johansson, J. (2013). Barriers to and facilitators of nurse- parent interaction intended to promote healthy weight gain and prevent childhood obesity at Swedish child health centers. BMC Nursing , 12(27). http://dx.doi.org/10.1186/1472-6955-12-27 Rhee, K. (2008). Childhood overweight and the relationship between parent behaviors, parenting style, and family functioning. Annals of the American Academy of Political & Social Science, 615, 11-37. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=26h&AN=28788969&site=e host-live United States Department of Agriculture. (2014). My Plate Kids Place. Retrieved from http://www.choosemyplate.gov/KIDS/ United States Department of Agriculture. (2014). Dietary Assessment. Retrieved from http://fnic.nal.usda.gov/dietary-guidance/dietary-assessment United States Department of Agriculture. (2014). Ethnic/Cultural Food Pyramids. Retrieved from http://fnic.nal.usda.gov/dietary-guidance/past-food-pyramid- materials/ethniccultural-food-pyramids Van Ryzin, M. J., & Nowicka, P. (2013). Direct and indirect effects of a family-based intervention in early adolescence on parent-youth relationship quality, late adolescent health, and early adult obesity. Journal of Family Psychology, 27(1), 106-116.