Shaping Behaviour and Attitude in Childhood Obesity

Original Editors - Catriona Bartholomew, Brandon Koetsier, Gemma Donohoe, Jessica French and Patrick Holohan

Lead Editors - Your name will be added here if you are a lead editor on this page.  Read more.

Introduction 

Background

The negative health consequences experienced by overweight and obese children are wide ranging and include an increased risk of hypertension, type 2 diabetes and asthma. Children's mental wellbeing has also been shown to be negatively affected by overweight and obesity. The health risks of an unhealthy weight in childhood continue into adulthood and can result in an increased risk of conditions in life including cardiovascular disease..................

Epidemiology

The Scottish Health Survey 2011 reports that:

• 65.6% of children aged 2-15 had a healthy weight, a small decrease from 70.3% in 1998. 
• 31.6% of children were overweight or obese, a slight increase since 1998 when the prevalence was 28.0%. 
• 15.7% of children were obese or morbidly obese, representing a small rise in prevalence from 13.0% in 1998.
• Boys were significantly less likely than girls to be a healthy weight (65.1% compared with 69.8%) and were more likely to be overweight or obese (32.7% compared with 28.0%). 
• Healthy weight prevalence was significantly associated with age though not in a linear fashion. Prevalence was generally highest in the early years (aged 2-7) and was lowest among boys aged 10-11 (56.6%) and girls aged 12-13 (62.9%). 
• Boys aged 10-11 and girls aged 12-13 had the highest prevalence of overweight or obesity (41.9% and 33.4%, respectively). 
• There is a strong association between parental BMI and child BMI. Children with parents who are either a healthy weight or underweight are less likely to be overweight or obese than children of obese parents (21.0% compared with 40.1%). 
• Boys in the lowest income households were more likely than those in other household income groups to be obese (19.7% compared with 14.2% in the highest income group). 
• Area deprivation was significantly associated with obesity. Girls and boys in the most deprived quintile were less likely to be a healthy weight and more likely to be obese than girls and boys in the least deprived areas. Children living in the 15% most deprived areas in Scotland had a significantly higher prevalence of obesity than those living elsewhere (18.7% compared with 14.5%).
  

 Learning Outcomes

By the end of this Wiki the reader will be able to:

• Recognize demographic and psycho-social aspects underpinning childhood obesity.
• Describe theories that shape and influence behaviour and attitudes.
• To apply behavioural/attitudinal theories to effectively implement strategies to combat childhood obesity in (primary) school. 
• To evaluate the effectiveness of your strategy to change the behaviours of the children.
  

 Theories of Behaviour Change and Attitude 

Theory of Planned Behaviour:

The theory of planned behaviour (TPB) is an extension of the theory of reasoned action (TRA). It suggests that behaviour is dependent on one’s intention to perform the behaviour. Intention is determined by an individual’s attitude and subjective norms.
Behaviour is also determined by an individual’s perceived behavioural control, defined as an individual’s perceptions of their ability or feelings of self-efficacy to perform behaviour. This relationship is typically dependent on the type of relationship and the nature of the situation.

How can this theory shape your teaching?

• Intention has been shown to be the most important variable in predicting behavior change. Intentions are assumed to capture the motivational factors that influence a behaviour and to indicate how hard people are willing to try or how much effort they would exert to perform the behaviour.
• This suggests that it may be important to present information to help shape positive attitudes towards the behavior and stress subjective norms or opinions that support the behavior.
• For perceived behavioral control to influence behavior change, much like with self-efficacy, a person must perceive that they have the ability to perform the behavior. Therefore, perceived control over opportunities, resources, and skills needed is an important part of the change process.

Transtheoretical (Stages of Change) Model:

In the transtheoretical model, there are six stages that together form a progression for change. Precontemplation: This stage is where the individual is not even considering attempting or thinking about a change in the next six months. Contemplation: The idea of change has been planted in their heads, but they aren’t ready to start right away. They plan to change within the next six months. They have identified the pro’s to change, but also are aware of the cons. Preparation: This stage consists of the individual forming a plan of action to change within the very near future. (within 1 month). Action: The stage where the individual begins to make their change Maintenance: the continuation of their plan, and trying to avoid relapse. The majority of individuals stay in this stage. Termination: the final stage, where individuals have 100 percent efficacy and will maintain their behavior. Seldom individuals reach this stage, because it is so difficult to maintain. These changes are described as "spiraling or cyclical", rather than a straight forward progression. This is due to the fact that individuals progress through the stages at different rates, and it is very common for individuals to move back and forth along the chain, before eventually reaching the desired goal of maintenance.

Moving forward through the stages are influenced by a set on independent variables known as "processes of change". These process of change are a major contributing factor that allows us to understand how the shift in behaviour occurs. These processes are internal and external factors  (such as activities and experiencs) that individuals take on when they attempy to change their problem behaviours. There are 10 different processes that contain multiple techniques, methods, and interventions. Numerus studies reveal that in order to have succesful behavioural change, these different processes should be used at particular stages of change. The first five of the stages are classified as "Experiential Processes" and are used for the early stage transitions. The last five stages are known as "behavioural processes" and are used primarily for later stage transitions. 

Processes of Change: Experiential
1. Consciousness Raising (Increasing awareness)
     a. “I remember some information that people gave me on how to not be obese”
2. Dramatic Relief (Emotional arousal)
     a. “I react emotionally to warnings about obesity and the dangers it can cause to my health”
3. Environmental Reevaluation (Social reappraisal)
     a. I consider the view that obesity can be harmful to myself and others
4. Social Liberation (Environmental Opportunities)
     a. I see how society is changing in ways that make it easier to help with obesity
5. Self Reevaluation (self reappraisal)
     a. Seeing how obese I am makes me feel disappointed in myself.
Processes of Change: Behavioral
6. Stimulus Control (Re-engineering)
     a. I remove things from my home that may contribute to my obesity
7. Helping relationship (supporting)
     a. I have someone who listens when I need to talk about my obesity habits
8. Counter Conditioning (substituting)
     a. I find that doing other things instead of eating and sitting around are good for my obesity
9. Reinforcement Management (rewarding)
     a. I will give myself a reward when I lose some weight
10. Self Liberation (committing)
     a. I make commitments not to be obese anymore.

How can this theory shape your teaching?

• It is very important to match behavior change interventions to people's stages. (ex. If the student is in the precontemplation stage, it is important to provide to them the information about the pro's and con's about loosing weight).
  
• Without a planned intervention, people will remain stuck in the early stages due to lack of motivation to move through the stages