Food For Thought: An Internet-based Treatment Program For Childhood Obesity

Jane Garbutt, M.B., Ch.B.


Project Overview:
One in five children in the US is now overweight and the prevalence of obesity is increasing in adults and children. The cause of this recent epidemic is thought to be unhealthy eating and sedentary lifestyle. After age 3, overweight children are more likely to become overweight adults.

Treatment of obesity is extremely difficult. Intensive treatment interventions for obese school-aged children that involve parents have led to marked and sustained weight loss for the child and the parent. However, such specialized treatment is not widely available and is expensive. The Internet is a way to efficiently deliver intensive behavioral modification and social support programs for obesity treatment, and Internet access is available in the majority of homes with children in the United States.

This project has two parts. First, we will develop Food for Thought, an integrated, Internet-delivered intervention that targets parents of overweight 3 to 6 year olds as the agent of change for the family. To develop Food for Thought, we will modify Student Bodies 2, a 16-week Internet-delivered intervention for adolescents with weight and body image problems. Food for Thought will include basic education on nutrition and physical activity for children and adults, parenting behaviors around eating, and healthy weight control. In addition, participants will learn how to use behavior change techniques to identify areas for improvement, set goals and make changes to reach those goals. Parents will access the program for about 2 hours a week, at times that are convenient for them. In addition, parents will record their own and their child’s weight, food intake, and amount of physical activity each week using a private, on-line journal and will receive individualized feedback from a moderator. The website will also serve as the forum for moderated discussion groups among participants. The discussion group will be available at all times for parents to post messages asynchronously. Participants will also receive a pedometer to self-monitor walking.

In the second part of the project, 20 parents of overweight 3 to 6 year olds (sex- and age-specific Body Mass Index greater than the 85th percentile) will participate in Food for Thought. Participants will be recruited through a practice-based research network of 66 pediatricians in the St Louis area. Before and after the intervention, the child’s pediatrician will measure the child and parent’s height and weight and we will calculate their body mass index (BMI). In addition, the parent will complete telephone interviews using validated instruments to measure the level of physical and sedentary activity, and dietary intake of fruit, vegetables and fat before and after the intervention for the parent and child.

We hypothesize that children and parents who participate in Food for Thought will experience weight loss (reduction in BMI z-score) and will demonstrate a reduction in high-fat food consumption and sedentary activity, and an increase in the amount of physical activity, fruit and vegetable consumption compared with their baseline status. Food for Thought is a novel approach to a significant problem. The program has broad applicability to other a large population, and could be adapted to target for other diseases or life-style risk factors.

Lay Summary:
There is an epidemic of obesity in children and adults in the United States. Obesity is associated with significant medical and psychological problems. In addition, overweight children are more likely to become overweight adults with an increased risk of early death. Prevention and treatment of obesity in children may reduce obesity related mortality, morbidity and treatment costs 
in adulthood.

Treatment of obesity is difficult. For children, effective programs target parents, and include intensive behavior change strategies and education about healthy diet, activity and parenting behaviors. Treatment is prolonged and expensive, but benefit can extend to include the parents and other family members. However, few effective programs are available. The Internet provides a way to efficiently deliver treatment programs for childhood obesity, and is available to many families.

This project has two parts. For the first 4 months of the project, we will develop Food for Thought, an Internet-based treatment program for childhood obesity. The program targets parents of overweight children who are between 3 and 6 years old. Food for Thought will run for 16-weeks and will include education about diet, activity and parenting. Participants will learn how to use behavior change techniques to identify areas for improvement, set goals and make changes to reach those goals. Parents will access the program for about 2 hours a week when it is convenient for them. In addition, participants will have access to a moderated bulletin board to post questions or comments about what they are learning, and to communicate with other participants. In similar programs for adolescents with eating disorders, this feature has been very popular and a source of social support. To develop Food for Thought, we will modify an existing internet-based program for adolescents called Student Bodies 2. The developer of this program is a consultant for this study.

In the second part of the study, we will recruit 20 parents from the St Louis community to participate. Eligible parents will have an obese child who is 3 to 6 years old, and will have access to the Internet. Parents will be recruited by their child’s pediatrician during an office visit, and will provide informed consent. They will participate in Food for Thought for 16-weeks. Before and after the program, the child and parent will have their height and weight measured by the child’s pediatrician, and their body mass indices will be calculated. In addition, the parent will complete a telephone interview to measure the diet and activity of the parent and child. We will compare these variables before and after the program to assess program effectiveness. We will also measure compliance and parent satisfaction with the program. The program will be modified as necessary and will be evaluated in a future randomized-controlled trial.

Final Report Abstract:
One in five children in the US is now overweight and the prevalence of obesity is increasing in adults and children. The cause of this recent epidemic is thought to be unhealthy eating and sedentary lifestyle. Treatment of childhood obesity is extremely difficult, but may reduce obesity-related morbidity and treatment costs in adulthood. Intensive treatment interventions for obese school-aged children that involve parents have led to marked and sustained weight loss. However, such specialized treatment is not widely available and is expensive. The Internet is a way to efficiently deliver obesity treatment, and Internet access is available in the majority of homes with children in the United States. Read the full Final Report.