The effect of reinforcement or stimulus control to reduce sedentary behavior in the treatment of pediatric obesity

Department of Pediatrics, State University of New York at Buffalo, Buffalo, NY 14214, USA.
Health Psychology (Impact Factor: 3.59). 08/2004; 23(4):371-80. DOI: 10.1037/0278-6133.23.4.371
Source: PubMed


Obese children were randomly assigned to a family-based behavioral treatment that included either stimulus control or reinforcement to reduce sedentary behaviors. Significant and equivalent decreases in sedentary behavior and high energy density foods, increases in physical activity and fruits and vegetables, and decreases in standardized body mass index (z-BMI) were observed. Children who substituted active for sedentary behaviors had significantly greater z-BMI changes at 6 (-1.21 vs. -0.76) and 12 (-1.05 vs. -0.51) months, respectively. Substitution of physically active for sedentary behaviors and changes in activity level predicted 6- and 12-month z-BMI changes. Results suggest stimulus control and reinforcing reduced sedentary behaviors are equivalent ways to decrease sedentary behaviors, and behavioral economic relationships in eating and activity may mediate the effects of treatment.

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    • "The prevalence of childhood obesity in China has gradually increased to the point where it is now similar to developed countries [5], [6]. Improvements in the economy and the ‘modernization’ of society have led to a continuous increase in obesity rates in preschool and school children over the past decade [7]–[9]. It has been reported that the changing pace of obesity prevalence in urban Chinese children [10]. "
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    ABSTRACT: Objectives We examined the prevalence of and trends in obesity among children and adolescents in China (1985–2010). Methods We used data from the 1985, 1991, 1995, 2000, 2005, and 2010 Chinese National Surveys on Students’ Constitution and Health (CNSSCH). The CNSSCH is a national survey of physical fitness and health status in Chinese students that uses multistage stratified sampling of 31 provinces and municipalities. A subject was considered obese or overweight if weight-for-height exceeded the 20% or 10% of standard weight-for-height. The standard weight-for-height was the 80th percentile for sex- and age-specific growth charts. Results The age-adjusted prevalence of obesity and of overweight and obesity combined was 8.1% (95% CI, 8.0–8.3%) and 19.2% (95% CI, 19.1–19.4%) among children and adolescents 7–18 years in age. Obesity was more likely to be present among children or adolescents who were male (RR, 1.93; 95% CI, 1.90–1.97), urban (RR, 1.99; 95% CI, 1.95–2.02), or 10–12 years (RR, 1.43; 95% CI, 1.40–1.46). Trend analyses of the 25-year period revealed a significant increasing trend in males (RR, 1.59; 95% CI, 1.58–1.60) and in females (RR, 1.49; 95% CI, 1.48–1.50). The rate of increase in obese or overweight prevalence was highest in boys from rural areas (9% annual increase). Conclusions During 1985–2010, there was a significant and continuous increase in the prevalence of obesity in children and adolescents. Obesity is epidemic in China, but may be reduced with evidence-based interventions (e.g., school intervention programs).
    PLoS ONE 08/2014; 9(8):e105469. DOI:10.1371/journal.pone.0105469 · 3.23 Impact Factor
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    • "The other group received training in goal setting and self-monitoring and used stimulus control to reduce sedentary screen behaviors. Both groups used the following behavior modification techniques to help change their diet: goal setting, preplanning, positive reinforcement, and self-monitoring [60]. "
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    ABSTRACT: Previous research suggests that reducing sedentary screen behaviors may be a strategy for preventing and treating obesity in children. This systematic review describes strategies used in interventions designed to either solely target sedentary screen behaviors or multiple health behaviors, including sedentary screen behaviors. Eighteen studies were included in this paper; eight targeting sedentary screen behaviors only, and ten targeting multiple health behaviors. All studies used behavior modification strategies for reducing sedentary screen behaviors in children (aged 1-12 years). Nine studies only used behavior modification strategies, and nine studies supplemented behavior modification strategies with an electronic device to enhance sedentary screen behaviors reductions. Many interventions (50%) significantly reduced sedentary screen behaviors; however the magnitude of the significant reductions varied greatly (-0.44 to -3.1 h/day) and may have been influenced by the primary focus of the intervention, number of behavior modification strategies used, and other tools used to limit sedentary screen behaviors.
    Journal of obesity 01/2012; 2012(2090-0708):379215. DOI:10.1155/2012/379215
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    • "To date, most interventions aimed at reducing sedentary behaviors in children have focused primarily on reducing time spent watching TV. Some have been conducted in community settings such as schools [17,18], preschool centers [19] and primary care centers [20], whilst other small studies have been conducted in individual households [21-24]. Generally, results thus far have been encouraging with reductions observed in TV watching, body weight and dietary intake [18,21,23,25]. "
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    ABSTRACT: Approximately one third of New Zealand children and young people are overweight or obese. A similar proportion (33%) do not meet recommendations for physical activity, and 70% do not meet recommendations for screen time. Increased time being sedentary is positively associated with being overweight. There are few family-based interventions aimed at reducing sedentary behavior in children. The aim of this trial is to determine the effects of a 24 week home-based, family oriented intervention to reduce sedentary screen time on children's body composition, sedentary behavior, physical activity, and diet. The study design is a pragmatic two-arm parallel randomized controlled trial. Two hundred and seventy overweight children aged 9-12 years and primary caregivers are being recruited. Participants are randomized to intervention (family-based screen time intervention) or control (no change). At the end of the study, the control group is offered the intervention content. Data collection is undertaken at baseline and 24 weeks. The primary trial outcome is child body mass index (BMI) and standardized body mass index (zBMI). Secondary outcomes are change from baseline to 24 weeks in child percentage body fat; waist circumference; self-reported average daily time spent in physical and sedentary activities; dietary intake; and enjoyment of physical activity and sedentary behavior. Secondary outcomes for the primary caregiver include change in BMI and self-reported physical activity. This study provides an excellent example of a theory-based, pragmatic, community-based trial targeting sedentary behavior in overweight children. The study has been specifically designed to allow for estimation of the consistency of effects on body composition for Māori (indigenous), Pacific and non-Māori/non-Pacific ethnic groups. If effective, this intervention is imminently scalable and could be integrated within existing weight management programs. ACTRN12611000164998.
    BMC Public Health 06/2011; 11(1):524. DOI:10.1186/1471-2458-11-524 · 2.26 Impact Factor
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