The influence of preschoolers' emotional and behavioural problems on obesity treatment outcomes: Secondary findings from a randomized controlled trial.

Maria Somaraki, Pernilla Sandvik, Stef Kremers, Ester Sleddens, Elodie Eiffener, Karin Eli, Anna Ek, Paulina Nowicka

Journal: Pediatric obesity 2020;14(11):e12556

PMID: 31290278

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Abstract

BACKGROUND

Few studies have explored the influence of preschoolers' behavioural problems on obesity treatment.

OBJECTIVES

To assess emotional and behavioural problems before and after an obesity intervention and examine relationships between changes in child behaviour and changes in weight status.

METHOD

The study included 77 children (4-6 years old, 53% girls, mean body mass index [BMI] z-score of 3.0 [SD 0.6]) who participated in the More and Less Study, a randomized controlled trial. Families were randomized to a parenting program or to standard treatment. The children's heights and weights (BMI z-score, primary outcome) were measured at baseline and 12 months post baseline. Parents rated their children's behaviours (secondary outcome) on the Child Behavior Checklist (CBCL) for ages 1.5 to 5 years, a questionnaire that measures psychosocial health and functioning, encompassing emotional and behavioural problems. Changes in child behaviour during treatment were examined through paired samples t tests; the influence of child behaviour on treatment effects was examined through linear regressions.

RESULTS

Child emotional and behavioural problems significantly improved after obesity treatment. Lower scores were found for Emotional Reactivity, Sleep Problems, Affective Problems, Aggressive Behaviour, Externalizing Behaviours, Oppositional Defiant Problems, and Total Problems. Child behaviour significantly affected obesity treatment results: Attention Problems and attention deficit hyperactivity disorder (ADHD) at baseline contributed to increasing BMI z-scores, whereas Oppositional Defiant Problems, Externalizing Behaviours, and a higher number of behavioural problems predicted decreasing BMI z-scores.

CONCLUSIONS

Child behaviours at baseline influenced treatment results. Child emotional and behavioural problems improved post treatment. The results suggest that obesity treatment may help in reducing emotional distress among preschoolers.

Address: Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, the Netherlands.; Unit for Biocultural Variation and Obesity, Institute of Social and Cultural Anthropology, University of Oxford, Oxford, UK.; Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK.; Unit of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.; Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden.

DOI: 10.1111/ijpo.12556

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MeSH Terms: Attention Deficit Disorder with Hyperactivity, Child, Child Behavior Disorders, Child, Preschool, Female, Humans, Male, Obesity, Problem Behavior, Psychological Distress