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>>> Treatment >>> Behavior  

Family Influence- A Major Contributory Cause to Obesity

Parental behavioral patterns concerning shopping, cooking, eating and exercise, have an important influence on a child's energy balance and ultimately their weight. When we are children we are taught by our parents to associate rewards with food. For example when we do well in school, pay attention to our parents, do our chours etc. We are given praise by our parents and then rewarded by candy, cookies or McDonalds.

This reward system begins to change the child's outlook of food. Instead of seeing food as a simple way of giving our body the energy that it needs we begin to look towards food as a reward. As adults this behavior stays with us and we reward ourselves with food.

For some, it was in childhood, when they were told to finish their plate (regardless of how full they were), or were punished or rewarded by food. For others, food became a way of dealing with stress, of avoiding or putting off difficult tasks or dealing with difficult people, or a way of comforting themselves in good and bad times.

If you accept that your habits or behaviors have contributed to weight gain, then it makes sense to use an approach that goes beyond just reducing calories to lose weight. To make permanent changes in your body weight, you must change the behaviors that caused the problem in the first place.

Behavior modification is an approach that has been used very successfully to change life habits like smoking, overeating, stress management, and exercise. Over the past 35 years, much has been learned about how to apply behavior modification more successfully and it is now accepted as a very important part of a good weight control program.

Behavior Therapy

Including behavioral therapy helps with weight loss program compliance.

Behavior therapy is a useful adjunct to planned adjustments in food intake and physical activity. Specific behavioral strategies include the following: self-monitoring, stress management, stimulus control, problem-solving, contingency management, cognitive restructuring, and social support. Behavioral therapies may be employed to promote adoption of diet and activity adjustments; these will be useful for a combined approach to therapy. Strong evidence supports the recommendation that weight loss and weight maintenance programs should employ a combination of low-calorie diets, increased physical activity, and behavior therapy. For more evidence on Behavior therapy

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 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

By learning behavior-modification techniques that will help you to redefine your attitudes and beliefs about food as well as your self-esteem, you can use behavior therapy to treat compulsive overeating.


Examples of Strategies Used in Behavioral Treatment Programs
Strategies focusing on behavior
Self monitoring Patients record eating and exercise in a daily diary: calories and fat grams in each food; calories expended through physical activity.
Goal setting Patients are given short- and long-term goals for intake, exercise, and weight loss (e.g., to lose 2 lb/week). Goals are attainable, but challenging.
Strategies focusing on changing antecedents (cues)
Stimulus control Patients are taught to remove cues for inappropriate behaviors and to increase cues for appropriate behavior (e.g., to refrain from bringing ice cream into the house, to put the exercise bike where it can be more easily seen and used).
Cognitive restructuring Patients learn to counter negative self-statements with positive ones (e.g., instead of “I ate that candy; now I might as well eat the whole box,” patients learn to say to themselves, “Eating candy is no big deal. I’ll just make sure I follow my meal plan closely for the rest of the day.”)
Strategies focusing on changing consequences (reinforcers)
Self-reinforcement Patients are taught to reward themselves for behavior changes (e.g., putting aside $1.00 each time they take a walk to save for a new blouse).
Contingency contracts Patients sign a written statement with a therapist or friend, indicating a specific behavior or short-term weight loss and and a specific reward if and only if they achieve their goal.