Læknablaðið - 01.03.2014, Blaðsíða 17

LÆKNAblaðið 2014/100 145
R A N N S Ó K N
ENGLISH SUMMARY
introduction: Childhood obesity has become a worldwide epidemic
and Icelandic children have not been exempt from increasing rates
of obesity. Epstein´s family-based behavioral treatment for childhood
obesity has demonstrated favorable outcomes in research settings,
but research in clinical settings has been called for. The objective of
this study was to replicate and confirm the effects observed in the US
research setting.
Material and methods: Participants were 84 obese children (age-
range: 8-13 years) and a participating parent. Sixty-one families
completed a 12 week treatment lasting 18 weeks, and were followed for
one and two years post-treatment. Measurements at baseline and end
of treatment included height and weight, daily activity, daily fruit and
vegetable consumption, blood pressure, blood profiles and measures of
psychological well-being. Measurements also included parental height,
weight and depression scores.
Results: Among treatment completers BMI-SDS (body-mass index
standard deviation score) decreased significantly from pre- to post-
treatment (F(2.60)=110.31, p<0.001) which was maintained at one-year
(F(2.60)=1.33, p=0.253) and two-years (F(2.60)= 3,19, p=0.079) post
treatment. There was a significant reduction in blood pressure (upper:
t(59)=-2.01, p<0.05, lower: t(59)=-4.00, p<0.001). Among a subsample
(n=23) of participants, significant reductions were observed in fasting
insulin levels, (t(22)=6.1, p<0.05), triglycerides (t(22)=0.31, p<0.05) and
total cholesterol (t(22)=0.35, p<0.05). Significant improvements were
observed for measures of psychological well-being (depressive symp-
toms: (F(1.59)=6.67, p<0.05); anxiety: (F(1,57)= 4.54, p<0.05) and child-
ren´s self-concept (F(1.59)=19.2, p<0.001). A significant reduction was
observed in parental BMI scores from pre- to post- treatment (F(1.59)=
71.54, p<0.001) but a significant increase was evident at one year post-
treatment (F(1.59)=41.87, p<0.001). Improvements were observed for
measures of parental depression from pre- to post- treatment (F(1.60)=
12.93, p<0.01).
Conclusion: Epstein´s family-based behavioural treatment showed
promising effects on weight status, and emotional as well as physical
markers, both in the short and long term in a clinical sample of obese
Icelandic children.
Correspondence: Thrudur Gunnarsdottir, thrudur.gunnarsdottir@ucdenver.edu
keywords: childhood, obesity, family-based, treatment
1Department of Pediatrics, University of Colorado, 2BUP dogn – enhet for ungdom, Elverum, Sykehuset Innlandet, Norge, 3University of Iceland, School of Health Sciences, 4University
of Iceland, School of Education, 5Landspítali University Hospital, Reykjavík, 6Department of pediatrics, Landspítali University Hospital, Reykjavík, Iceland.
Family-based behavioral treatment for obese children
– Results and two year follow up
Thrudur Gunnarsdottir1, Svavar Mar Einarsson2, Urdur Njardvik3 , Anna Sigridur Olafsdottir4,6, Agnes Bjorg Gunnarsdottir5,
Tryggvi Helgason6, Ragnar Bjarnason3,6
22. Gunnarsdottir T, Njardvik U, Olafsdottir AS, Craighead
LW, Bjarnason R. Teasing and social rejection among obese
children enrolling in family-based behavioural treatment:
effects on psychological adjustment and academic
competencies. Int J Obesity 2012; 36: 35-44. doi: 10.1038/
ijo.2011.181.
23. Karlberg J, Luo ZC, Albertsson-Wikland K. Body mass
index reference values (mean and SD) for Swedish child-
ren. Acta Paediatr 2001; 90: 1427-34.
24. Kovacs M. Children’s Depression Inventory: Manual.
Multi-Health Systems, New York 1992.
25. March JS, Parker JD, Sullivan K, Stallings P, Conners
CK. The Multidimensional Anxiety Scale for Children
(MASC): factor structure, reliability, and validity. J Am
Acad Child Adolesc Psychiatry 1997; 36: 554-65.
26. Piers E. Piers-Harris Children Self-Concept Scale, Revised
Manual. Western Psychological Services, Los Angeles
1984.
27. Smucker MR, Craighead WE, Craighead LW, Green BJ.
Normative and reliability data for the children’s depress-
ion inventory. J Abnormal Child Psychol 1986; 14: 25-39.
28. Craighead. Relationship of Childrens Depression
Inventory factors to major depression among adolescents.
Psychol Assessm 1995; 7: 171.
29. Arnarson EO, Smari J, Einarsdottir H, Jonasdottir E. The
prevalence of depressive symptoms in pre-adolescent
school children in Iceland. Scand J Behav Ther 1994; 121-
30.
30. Olason DT, Sighvatsson MB, Smari J. Psychometric pro-
perties of the Multidimensional Anxiety Scale for Children
(MASC) among Icelandic schoolchildren. Scand J Psychol
2004; 45: 429-36.
31. Gresham FM, Elliott, SN. The Social Skills Rating System.
Circle Pines, MN: American Guidance Service; 1990.
32. Beck AT, Steer RA, Brown GK. BDI-II, Beck’s Depression
Inventory II: Manual. 2nd Edition ed. The Psychological
Corporation, Harcourt, Brace, and Company, Boston 1996.
33. Arnarson TO, Olason DT, Smari J, Sigurdsson JF. The
Beck Depression Inventory Second Edition (BDI-II):
psychometric properties in Icelandic student and patient
populations. Nord J Psychiatry 2008; 62: 360-5.
34. Gunnarsdottir T, Njardvik U, Olafsdottir AS, Craighead
LW, Bjarnason R. The role of parental motivation in
family-based treatment for childhood obesity. Obesity
(Silver Spring) 2011; 19: 1654-62. doi: 10.1038/oby.2011.59
35. Gunnarsdottir T, Njardvik U, Olafsdottir AS, Craighead L,
Bjarnason R. Childhood obesity and co-morbid problems:
effects of Epstein’s family-based behavioural treatment in
an Icelandic sample. J Eval Clin Pract 2011; 18: 465-72. doi:
10.1111/j.1365-2753.2010.01603.x.
36. Epstein LH, Roemmich JN, Raynor HA. Behavioral
therapy in the treatment of pediatric obesity. Pediatr Clin
North Am 2001; 48: 981-93.
37. Hamill PV, Drizd TA, Johnson CL, Reed RB, Roche AF,
Moore WM. Physical growth: National Center for Health
Statistics percentiles. Am J Clin Nutr 1979; 32: 607-29.
38. Panagiotopoulos C, Ronsley R, Al-Dubayee M, Brant
R, Kuzeljevic B, Rurak E, et al. The centre for healthy
weights--shapedown BC: a family-centered, multidiscipl-
inary program that reduces weight gain in obese children
over the short-term. Int J Environ Res Public Health 2011;
8: 4662-78.
39. Hodges EA. A primer on early childhood obesity and
parental influence. Pediatr Nurs 2003; 29: 13-6.
40. Ráðleggingar um mataræði og næringarefni fyrir full-
orðna og börn frá tveggja ára aldri. Lýðheilsustöð, Reykja-
vík 2006.
41. Rolls BJ, Drewnowski A, Ledikwe JH. Changing the
energy density of the diet as a strategy for weight manage-
ment. J Am Diet Assoc 2005; 105 (5 Suppl 1): S98-103.
42. Drevenhorn E, Kjellgren KI, Bengtson A. Outcomes
following a programme for lifestyle changes with people
with hypertension. J Clin Nurs 2007; 16(7B): 144-51.
43. Poirier P, Giles TD, Bray GA, Hong Y, Stern JS, Pi-Sunyer
FX, et al. Obesity and cardiovascular disease: pathop-
hysiology, evaluation, and effect of weight loss: an
update of the 1997 American Heart Association Scientific
Statement on Obesity and Heart Disease from the Obesity
Committee of the Council on Nutrition, Physical Activity,
and Metabolism. Circulation 2006; 113: 898-918.
44. Grundy SM. Obesity, metabolic syndrome, and cardiovas-
cular disease. J Clin Endocrinol Metab 2004; 89: 2595-600.