Evaluation of a family-based behavioural intervention programme for children with obesity

LIST OF PAPERS ABBREVIATIONS INTRODUCTION ................................................................................................................1 BACKGROUND ...................................................................................................................3 Prevalence of overweight and obesity in childhood ........................................3 Definition and classification of obesity ............................................................3 Causes of obesity ..............................................................................................6 Eating habits .....................................................................................................8 Physical activity ................................................................................................8 Sedentary activity ..............................................................................................9 Genetic factors ..................................................................................................9 Consequences of obesity ..................................................................................9 Prevention and treatment of childhood obesity ............................................ 10 Importance of the family ............................................................................... 12 Self-esteem and coping .................................................................................. 13 Adherence ...................................................................................................... 14 Motivation for the study ................................................................................ 14 AIMS ................................................................................................................................... 16 MATERIALS AND METHODS ........................................................................................ 17 Design ............................................................................................................. 17 Participants and procedure (papers I and II) ............................................... 17 The family-based behavioural intervention programme ............................. 18 Group sessions ............................................................................................... 19 Data collection................................................................................................ 24 Anthropometric measures ................................................................................ 24 Blood tests ....................................................................................................... 25 Structured interviews ....................................................................................... 25 Statistical analysis .......................................................................................... 25 Ethical considerations.................................................................................... 26 RESULTS ........................................................................................................................... 28 Summary of studies I and II .......................................................................... 28 Characteristics ................................................................................................ 28 Programme adherence ..................................................................................... 28 Examination adherence ................................................................................... 28 Primary outcome ............................................................................................. 29 Waist/height ratio ............................................................................................ 32 Blood tests ....................................................................................................... 32 Lifestyle .......................................................................................................... 33 Agreement between the reports from the children and the parents.................... 34 Lifestyle change, change in child-parent agreement and change in z-BMI ....... 34 DISCUSSION ..................................................................................................................... 36 Methodological issues .................................................................................... 41 Clinical implications ..................................................................................... 42 CONCLUSIONS ................................................................................................................. 43 SUMMARY IN SWEDISH/ SVENSK SAMMANFATTNING ........................................ 44 ACKNOWLEDGEMENTS................................................................................................ 48 REFERENCES ................................................................................................................... 51 TABLES AND FIGURES Table 1 Classification of BMI and risk of health problems due to obesity........................4 Table 2 BMI cutoff points for overweight and obesity by sex in children between 2 and 18 years of age..................................................................................................5 Table 3 Details for papers I and II.....................................................................17 Table 4 Group sessions over the intervention period................................................21 Table 5 Description of the content of the group sessions...........................................23 Table 6 Z-BMI and WHtR for the study population, at baseline and 12 months after the FBIP ...............................................................................................................30 Table 7 Distribution of z-BMI and mean (SD) for boys and girls at baseline and 12 months after the FBIP..............................................................................................30 Table 8 Values of metabolic variables at baseline and at 36-month follow-ups.................33 Table 9 Agreement between child and parent reports ...............................................34 Table 10 Correlations between change in z-BMI 0-36 months and change in children’s and parents’ reports of the child’s lifestyle 0-24 months.................................................35 Table 11 Correlations between change in z-BMI 0-36 months and change in children’s and parents’ reports of the child’s lifestyle habits 0 to 24 months......................................35 Figure 1 Ecological model of predictors of childhood overweight.................................7 Figure 2 Changes in individual z-BMI in boys up to 12 months after the FBIP.................31 Figure 3 Changes in individual z-BMI in girls up to 12 months after the FBIP.................31