By Erica Lesperance, RD, LD

Our children are over-eating and under-exercising, resulting in a childhood obesity problem that has reached epidemic proportions.  It is frightening, and we must stop it.  However, to find a lasting solution, we must do more than simply encourage healthier eating habits and additional exercise. If overweight children are to become healthier, prevent their weight from climbing, or lose weight (if appropriate), we must examine the barriers that stop them from adapting healthier habits.  Behavior modification therapy provides ways to overcome barriers to dietary treatment or physical activity. 

Behavior modification therapy for obesity

The purpose of behavior modification therapy in obese people is to help change behaviors that contribute to obesity and initiate new dietary and physical activity behaviors that are needed to lose weight. Behavioral therapy for obesity should involve:

1. Developing specific and realistic goals that can be easily measured (e.g. walking for 20 minutes, three times per week)
2. Developing a reasonable plan for reaching those goals
3. Making incremental changes (rather than large changes) to promote successful experiences that can be used as a foundation for additional lifestyle alterations 

Below are a few behaviors associated with healthy and normal-weight children.  Therefore, they are potentially appropriate goals for your family and your overweight child. 

• Keeping a food journal (research has shown that keeping track of food intake is associated with weight loss)
• Keeping an exercise journal
• Eating family meals together
• Limiting television/computer/video game time to one to two hours per day (the strategy of reducing children’s sedentary behavior can be more effective than a strategy of promoting physical activity)
• Limiting drinks to water, milk and a small amount of 100% fruit juice
• Limiting fast food consumption to once per week
• Getting at least 60 minutes of physical activity each day
• Eating a low sugar, low-fat breakfast every day

Characteristics of a good behavior modification plan

A good behavior modification plan for obesity has the following characteristics:

• Sets reasonable goals
• Includes frequent contact with the health care provider
• Includes self-monitoring
• Rewards for achieving goals 
• Rewards can be decided by children and parents together, and should revolve around something that encourages positive behavior. For example, giving sporting equipment as a reward may encourage more physically active behavior.
• Avoids using food as a reward 
• Encourages verbal praise
• Attempts to change false beliefs about weight loss and body image to realistic and positive ones
• Develops a social support network (family, friends and neighbors) that can encourage healthy eating and exercise habits

Conclusion: parents need to be involved for behaviour modication therapy to be successful

Behavioral modification therapy has been effective when applied appropriately to overweight children.  As with any attempt to change children’s behavior, it is considerably more effective for children when parents are included in the plan.  Talk with your dietitian or other health care provider about setting some behavior change goals for your entire family.