Devices and Childhood Obesity Interventions

¶ … Devices and Childhood Obesity Interventions

When confronted with a child who needs to lose weight, a healthcare practitioner will likely pose two central questions: firstly, what factors caused and contribute to the child's obesity? Secondly, how to remedy the condition with appropriate dietary changes, exercise, and also change the child's fundamental relationship to food? To create an effective treatment plan to deal with these quandaries, the nurse may ask: does an absence of effective coping mechanisms with stress result in the child turning to food for comfort? If so, providing the child with other means of dealing with stress may be a possible therapeutic tool for the child. Is the child motivated to lose weight in the first place? If not, this must be addressed. or, if the child's family structure encourages overeating and a lack of activity, introducing new habits and changing familial rather than individual attitudes may be the priority.

Weight reduction in a child can be a difficult and complicated question to tackle, and a challenging subject to bring up and talk about with a child, especially if a very young child does not know the nurse particularly well. Using assessment tools can be useful and effective in generating dialogue about the child's life, sources of stress, and provide clues about why the child overeats. One such a device is Schoolagers' Coping Strategies Inventory (SCSI). The SCSI is a 25-item self-reported scale that assesses coping strategies in children 8-12 years of age and has the advantage of being relatively short in duration, lasting only ten minutes. Scoring is fairly easy. Children are presented with a series of possible of coping strategies, such as cuddling their pet. They rate the frequency with which they perform these coping mechanisms, ranging 0 (never), 1 (once in a while), 2 (a lot), or 3 (most of the time) (Skybo 2007). The possibilities are varied enough to ensure that a consistent pattern emerges of being able to cope with stress in a healthy manner. "Construct validity was supported by evidence that children with psychosomatic symptoms had lower coping frequency and effectiveness scores than children with no symptoms" (Skybo 2007).

The weakness of Schoolagers' test is that factor analysis suggests the SCSI is a one-factor instrument, meaning that it tests coping mechanisms alone. There are only low correlations between the SCSI and related but different constructs such as the presence of many or few stressors and self-esteem. (Ryan-Wenger 1990) in other words, children with poor coping mechanisms might still have strong self-esteem, and low levels of external stressors. A child might overeat in response to teasing, for example, but have a strong sense of self because of family support at home. Another child might use positive coping mechanisms to deal with stress, like practicing the piano or playing with the family pet, but have low self-esteem and a highly stressful life, but not be overweight. Regardless, for a health professional, administering the Schoolagers' instrument could be a positive step, in that the professional can better select if poor habits or coping mechanisms might be at the root of the child's psychological issues regarding weight gain.

The test's administration can also provide suggestions and facilitate dialogue about what does constitute effective coping mechanisms. Although some of its suggested mechanisms may seem culturally specific, Schoolagers' inventory has been used in cross-cultural settings. For example: a study of 331 Chinese children completed body mass index (BMI), Self-Perception Profile for Children, and Schoolagers' Coping Strategies Inventory in a recent study of gender differences regarding obesity. Results correlated strongly to American models studying children who used overeating as a coping mechanism (Chen et al. 2007).

To measure an internal quality like self-esteem, as opposed to the use of different types of external coping mechanism, requires a different assessment tool. The Health Self-Determinism Index for Children (HSDI-C) is also more useful in providing a way of encouraging positive thoughts as well as positive coping behaviors. Self-esteem and empowerment is often considered the critical factor in promoting weight loss: "Outcome directed activities" like weight loss "are the result of an empowered individual. The components that lead to the desired outcome may be the result of a positive self-esteem and an enabled or activated potential" (Cochran 2008). It is a more useful assessment device for older children, given that the relatively simple vocabulary and actions of the Schoolagers' may cause older children to grow impatient.

The Health Self-Determinism Index for Children was designed for children 7 to 13 years old to measure of intrinsic motivation of a variety of health behaviors, so the child's motivation to live a healthy lifestyle overall can be measured. "A nominated population of 21 third- through seventh-grade children known to practice positive health promotion behaviors had an HSDI-C mean score of 106.5 versus 76.5 in the general sample of children" (Cox 2009). Talking about motivation and empowerment can itself be helpful in encouraging weight loss in older children, and assessing why the child is or is not motivated to lose weight can provide clues as to why the child overate in the first place, and what strategies to use to help facilitate weight loss. Simply finding the motivation to lose weight may be a critical first step, as it cannot be assumed that merely because the child's parent and the child's pediatrician wants him or her to lose weight that the child wishes to do so as well.

The Calgary Family Assessment Model (CFAM), unlike the Schoolagers' Coping Strategies Inventory and Health Self-Determinism Index for Children is designed to assess the family as a unit, rather than just the individual child. It is designed as an assessment tool for families, not just children, and thus is not designed solely for a child's cognitive capacity and expressiveness. However, given the influence the family's attitude to weight and body image, along with its food and lifestyle choices, can have upon the child's physical development and attitude towards food, it can be useful, provided the family makes itself available for such an assessment.

The CFAM is grounded in systems and communications theory. It analyzes the family as a system, and attempts to understand the family's structural, developmental and functional status. Does the family make the child's weight a scapegoat for its problems? Do other family members have body image issues of their own? It also tries to identify strengths and resources of families. For example, a family that connects to its Latino heritage by watching European football on television and eating traditional, tasty, but fatty snacks can be encouraged to play the game as a family, enroll the child in a soccer league, and prepare healthier versions of traditional foods.