evidence & practice / behavioural treatment
PUBLIC HEALTH
Behavioural approaches to treating overweight and obesity in adolescents Alkhawaldeh A, Khatatbeh M, ALBashtawy M et al (2017) Behavioural approaches to treating overweight and obesity in adolescents. Nursing Children and Young People. 29, 9, 44-46. Date of submission: 6 March 2017; date of acceptance: 22 June 2017. doi: 10.7748/ncyp.2017.e918
Mohammad Al Qadire Associate professor, Al al-Bayt University, Mafraq, Jordan Omar ALOmari Associate professor, Jerash University, Jerash, Jordan Barakat Khasawneh Doctor of paediatric stomatology, Princess Basma Hospital, Irbid, Jordan Bayan ALBashtawy Medical student, Hashemite University, Zarqa, Jordan Sa’d ALBashtawy Medical student, Hashemite University, Zarqa, Jordan Hind Alshakh Clinical instructor, Al al-Bayt University, Mafraq, Jordan Correspondence
[email protected]
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adolescence, behavioural treatment, child health, obesity, overweight, public health
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Khetam Al-Awamreh Assistant professor, Al al-Bayt University, Mafraq, Jordan
Keywords
BEING OVERWEIGHT and obese in adolescence are significant public health issues globally, and rising incidence rates threaten the viability of basic healthcare delivery in many countries (Raj and Kumar 2010). Worldwide, 15 to 20% of adolescents are at risk of being overweight and an additional 15% are at risk of obesity (Raj and Kumar 2010, Mollerup et al 2017). In the UK and the US obesity and being overweight in adolescents has reached epidemic levels (Goran 2016). Being overweight and obese increases the risk of heart disease, hypertension, diabetes and asthma, as well as having social and psychosocial consequences such as depression, low self-esteem, bullying and teasing, emotional disorders and impaired quality of life (Raj and Kumar 2010, ALBashtawy 2017). Effective interventions to address this situation are urgently required. The behavioural treatment for adolescents who are overweight and obese refers to a set of principles and techniques designed to help reverse maladaptive eating and activity behaviours (Chan and Woo 2010, Karnik and Kanekar 2012). Comprehensive treatment programmes for children aged between 8-12 years, including meal timing, reduction in dietary sugars, portion sizes and behaviour modification, lead to an immediate decrease in weight of between 5-20% (Chan and Woo 2010, Karnik and Kanekar 2012).
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Mohammed ALBashtawy Dean/associate professor, Princess Salma Faculty of Nursing, Al al-Bayt University, Mafraq, Jordan
Being overweight and obese in adolescence are significant global public health issues which threaten the viability of basic healthcare delivery in many countries. The number of affected adolescents is growing at an alarming rate. Behavioural treatment, which refers to a set of principles and techniques designed to help people reverse maladaptive eating and activity habits, has become a crucial part of most programmes designed to address overweight and obesity. This article outlines three steps involved in the behavioural treatment of overweight and obesity in adolescents: antecedents, eating behaviour and the consequences of eating behaviour. Regular and consistent daily recording of food intake and the individual’s activities are foundations of behavioural management, and should form part of the nursing care plan.
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Moawiah Khatatbeh Assistant professor of public health, Yarmouk University, Irbid, Jordan
Abstract
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Abdullah Alkhawaldeh Assistant professor, Jerash University, Jerash, Jordan
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Butryn et al (2011) argued that behavioural management could be the first step in treating young people who are overweight and obese. Behavioural management can help adolescents alter their eating habits, increase their daily physical activity and make healthier choices in the long term (Karnik and Kanekar 2012, ALBashtawy 2015a, Mollerup et al 2017). This article outlines the behavioural treatment for overweight and obese adolescents.
Behavioural treatment
Behavioural treatments for overweight and obesity in adolescents can be divided into three steps (Figure 1) (Karnik and Kanekar 2012, Wadden et al 2014, ALBashtawy 2015a). Step 1: antecedents Determining the background of eating behaviour is important, including identification of the type of daily food intake and the setting in which eating occurs. Adolescents are taught to observe and break down the types of food eaten, the places and frequency of eating and the emotional circumstances in which food is eaten (Butryn et al 2011, Martin et al 2014). Using these records, adolescents, with the support of a healthcare professional or their parents, should be able to identify issues related to place and time of eating that they may be able to change. Regular, consistent
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Conflict of interest None declared Peer review This article has been subject to open peer review and has been checked for plagiarism using automated software
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Step 3: consequences of eating behaviour This step involves changing, in a skilful way, the consequences of eating as self-reward. It also includes daily assertiveness training to help adolescents learn when to say ‘no’ and to develop positive self-talk by using cognitive strategies. Techniques are developed to reinforce healthy eating behaviour rather than rewarding weight loss. Building sensible, reasonable, realistic and practical behavioural goals, and helping adolescents gain knowledge of problem-solving skills are other crucial aspects of behavioural treatment (ALBashtawy et al 2014, Wadden et al 2014, ALBashtawy 2015b, Erem 2015). It is important to select sensible and realistic non-food rewards for behavioural changes that are appropriate to the adolescent’s age and characteristics. Many types of rewards can be effective and are connected to factors such as age, gender and culture. For example, some programmes use vouchers for physical activity courses, while others offer clothing, hairstyling or travel vouchers.
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Step 2: eating behaviour Altering the behaviour of eating using motivational and stimulus control is essential. Stimulus control principles are used to modify the internal and external indications that can be coupled with some behaviours, such as eating and various physical activities. For example, adolescents can be advised to change their environment at home to a more dynamic and fun space while schools should install the infrastructure that promotes more physical activity. This will help make positive eating behaviour easier. The literature (Chan and Woo 2010, Karnik and Kanekar 2012, Martin et al 2014, Mollerup et al 2017) suggests that reducing recurrent exposure to particularly attractive high-calorie foods could decrease the rate of consumption. Techniques have been developed to afford stimulus control (Wadden et al 2014,
Hamad et al 2016). The simplest method involves restricting the number of utensils used and eating locations for each meal. Other techniques include drinking a full glass of water between each bite, eating more lowcalorie fruits and vegetables, chewing food many times and staying away from the dinner table for periods of time to reduce stimulus and thereby decrease the rate of consumption (Martin et al 2014, Wadden et al 2014, Mollerup et al 2017).
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recording of daily food intake and activities is a foundation of behavioural management. It is more effective to have feedback about some target behaviours, whether these are sustained, enhanced or reduced through self‑monitoring (Butryn et al 2011, Martin et al 2014, Mollerup et al 2017). Therefore, two different approaches to recording have been taken. The first records all the behaviours linked with eating, and the second focuses on every aspect of behaviour at the time of eating. Therefore, hunger, type of food, frequency and place of eating, as well as all food-related activities, are each recorded independently (Wadden et al 2014, Mollerup et al 2017).
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Figure 1. Behavioural treatment of overweight and obesity among adolescents Behavioural treatment of overweight and obesity among adolescents
Step 1: antecedents Determining the background of eating behaviour and physical activity among adolescents
Step 2: eating behaviour Altering eating behaviour and physical activity by using motivational and stimulus control
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Step 3: consequences of eating behaviour Involves changing behaviour in a skilful way and daily assertiveness training
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daily assertiveness training
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evidence & practice / behavioural treatment
Conclusion
This article has outlined behavioural treatments for overweight and obese adolescents based on three steps: antecedents, eating behaviour and the consequences of eating behaviour. Nurses who care for overweight and obese adolescents in all settings should focus on health education, eating behaviour and antecedents, the type of daily food intake, the time and the setting in which eating occurs. Regular and consistent daily recording of food intake and the individual’s activities are the foundations of behavioural management, which should be part of the nursing care plan.
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The rewards and incentives should be provided as close to the behavioural change as possible to support and strengthen their value (ALBashtawy et al 2014, ALBashtawy 2015b, Hadhood et al 2017, Mollerup et al 2017). The goals must be defined and measurable, and the time structure for reaching these goals must be acknowledged. It may be useful to recompense even partial changes along the way that lead to the final goal. Weight loss of more than 5% is an achievement, and sensible rewards and incentives should feature at this stage (Wadden et al 2014, Khamaiseh and ALBashtawy 2015, Alazzam et al 2016, Mollerup et al 2017).
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References
taught to observe and break down the types of food eaten, the places and frequency of eating and the emotional circumstances in which food is eaten. »» Parents should be encouraged to identify issues related to place and time of eating that they may be able to change. »» Nurses who care for overweight and obese adolescents in all settings should focus on health education, eating behaviour and antecedents, the type of daily food intake, and the time and the setting in which eating occurs. »» It is important to select sensible and realistic non-food rewards for behavioural changes that are appropriate to the adolescent’s age and characteristics. »» Reducing recurrent exposure to particularly attractive high-calorie foods could decrease the rate of consumption.
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Implications for practice »» Nurses should ensure that adolescents are
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