Evaluating Parents and Adult Caregivers as ‘Agents of Change’ for Treating Obese Children – Evidence for Parent Behavior Change Strategies and Research Gaps: A Scientific Statement from the American Heart Association
Circulation 125.9 (2012): 1186-1207
36 Pages Posted: 30 Jul 2014
Date Written: March 21, 2011
This Scientific Statement addresses Parents and Adult Caregivers (PACs) as ‘agents of change’ for obese children. Evidence is reviewed to support the notion that PACs can leverage behavior change and reduce positive energy balance in obese youth, and research opportunities for the field are discussed. The Statement has three specific aims: First, the core behavior change strategies for PACs as used in family-based treatment programs are reviewed. These strategies reduce childhood overweight compared to no treatment or nutrition education alone, although their limited potency is recognized. Second, the strength of evidence is evaluated for the hypothesis that greater parental ‘involvement’ in treatment is associated with greater reductions in child overweight. Drawing upon randomized clinical trials that varied the degree/nature of parental involvement, and observational analyses that assessed parental adherence to behavioral strategies, we report limited and inconsistent support. For example, only 17% of the intervention studies reported differential improvements in child overweight as function of parental involvement after treatment. On the other hand, greater parental adherence predicted better child weight outcomes after 2 and 5 years in certain studies. Third, research gaps identified throughout this review process are delineated and new opportunities for the field are proposed. For example, the assessment of refined parenting phenotypes, cultural tailoring of interventions, examination of family relationships, and incorporating new technologies in treatment represent topics needing further study. A conceptual model is proposed to guide research on understanding the determinants of parental feeding and physical-activity parenting practices. The Statement strives to innovate the scope and potency of PAC treatments for childhood obesity.
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