Using Cognitive Behaviour Therapy to Promote Behaviour Change in Overweight and Obese Adolescents

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Using Cognitive Behaviour Therapy to Promote
Behaviour Change in Overweight and Obese
Adolescents

• Leah Brennan, Ray Wilks, Jeff Walkley Steve
  Fraser.
• RMIT University
• leah.brennan_at_rmit.edu.au

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Why Treat Adolescent Obesity?

• Immediate and long-term physical consequences
• Adolescent obesity independent predictor of adult
  comorbidities (Must et al., 1992)
• Negative psychosocial consequences
• Adolescents at greater risk of low self esteem,
  disordered eating, depression (Lobstein et
  al., 2004).
• Tracking of obesity
• Adolescent obesity strong predictor of obesity in
  adulthood (r 0.5 - 0.9) (Whitaker, et al.,
  1997)
• Lack of research and few treatment options
• Adolescents fall through the gap between
  paediatric services and adult services (Lobstein
  et al., 2004, p. 50)

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Child Adolescent Obesity Treatment

• Review of Treatment Literature
• Majority of studies with younger children
• Small number of published studies
• Small sample sizes
• Varying attrition rates (0-56)
• Varying treatment measurement techniques
• Generally measured outcomes exclusively in terms
  of degree overweight
• Not possible to conduct a meta-analysis
• (Glenny et al. ,1997 Summerbell et al., 2004)

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Treatment Recommendations

• Behavioural modification
• Goal setting and self monitoring, influence the
  antecedents and consequences of the adolescents
  food choices, eating and physical activity
  habits.
• Family support and involvement
• Make changes to the family environment to promote
  behaviour change in the adolescent
• Developmentally appropriate
• Including both the adolescent and the parent, and
  a structured program that allows for the
  adolescent to make choices
• Dietary change
• Less prescriptive, healthy low energy diets
  encouraging sustainable changes in food and drink
  choices and eating habits
• Increased physical activity/Decreased sedentary
  behaviour
• Both planned and incidental/lifestyle activity
• Reduced screen time and inactive transport
• Motivation of the adolescent or an influential
  parent
• (Baur et al., 2003)

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The Role of Psychology

• Help overcome barriers to compliance with diet
  therapy and physical activity and thus improve
  long-term weight loss and adherence to treatment
  
• (NHMRC Clinical Practice Guidelines, 2003, p.119)
  

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Psychology Science of Human Behaviour

• Behavioural modification
• Goal setting and self monitoring, influence the
  antecedents and consequences of the adolescents
  food choices, eating and physical activity
  habits.
• Family support and involvement
• Make changes to the family environment to promote
  behaviour change in the adolescent
• Developmentally appropriate
• Including both the adolescent and the parent, and
  a structured program that allows for the
  adolescent to make choices
• Dietary change
• Less prescriptive, healthy low energy diets
  encouraging sustainable changes in food and drink
  choices and eating habits
• Australian Guide to Healthy Eating (NHMRC
  Clinical Practice Guidelines, 2003)
• Increased physical activity/Decreased sedentary
  behaviour
• Both planned and incidental/lifestyle
• Reduced screen time and inactive transport
• Motivation of the adolescent or an influential
  parent (Baur et al., 2003)

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Cognitive Behaviour Therapy (CBT)
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Cognitive Behaviour Therapy

• Behaviour Therapy
• Behaviour is learnt and can therefore be
  unlearnt
• Behaviour is influence by its triggers and
  consequences
• Changing the learning environment can change the
  behaviour

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Cognitive Behaviour Therapy

• Cognitive Therapy
• Behaviours emotions are influenced by thoughts
• Thoughts are not fact but we react as if they are
• We can learn more helpful ways of thinking
• Changing thinking will change behaviour

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The Choose Health Program

• Aim To examine the effectiveness of CBT in the
  treatment of adolescent overweight obesity

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Methodology

• Participants
• 63 overweight adolescents (Cole et al., 2000)
• 30 male and 33 females
• 11.7 to 18.9 years (M 14.39, SD 1.85)
• 23.3 to 41kg/m2 (M 31.8, SD 4.57)
• Assessments (pre, post follow-up)
• Initial Interview
• Monitoring
• Parent Adolescent Questionnaires
• Physical Assessment

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The Choose Health Program

• Causes Consequences of Overweight and Obesity
• Reducing Non Hungry Eating
• Reducing Sedentary Behaviour Increasing
  Physical Activity
• Healthy Food Choices (AGHE)
• Increasing Exercise
• Rewarding Behaviour Change Recognising Barriers
• Recognising Unhelpful Thoughts Negative
  Emotions
• Developing Helpful Thoughts Actions
• Using Assertive Communication
• Planning, Problem Solving Decision Making
• Maintaining Change
• Relapse Prevention
• (Maintenance Monitoring, phone calls and
  booster sessions)

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Food Choices

• Self Monitoring
• Recognising Discrepancy
• Goal Setting (bottom-up)
• Increasing Eating Awareness
• Environmental Change
• Behavioural Experiments
• Shaping of Behaviour
• Recognising Barriers
• Modifying Unhelpful Thoughts
• Planning
• Dealing with Other People
• Decision Making Problem Solving
• Planning for High Risk Situations

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Preliminary Outcomes

• Self reported changes
• eating habits, food choices physical activity
  habits
• client chosen measured treatment goals
• Visual analysis indicates improvement in
• eating activity habits
• body composition, fitness,
• Control group deteriorated

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Change in Energy Intake

• t(22) 4.14, p lt .001

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Change in Fat Intake

• t(22) 4.24, p lt .001

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Change in Total Intake

• t(21) 1.73, p gt .05

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Areas to be Explored

• Statistical analysis of outcome data?
• Effects of treatment components?
• Treatment attendance compliance?
• Completion rates?
• Facilitators barriers to treatment?
• Long term follow up?
• Use of motivational interviewing with adolescents?

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Future Directions
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Future Directions
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leah.brennan_at_rmit.edu.auhttp//www.courses.as.rm
it.edu.au/psychology/brennan

• This Research is Supported by
• RMIT University VicHealth