Application of Empirically Supported Treatments to Clinical Settings

  • Craig A. Johnston
  • William T. DaltonIII
Part of the Issues in Clinical Child Psychology book series (ICCP)

Approximately 17 percent of all school-aged children are either classified as at-risk of overweight or as overweight in the United States, and the prevalence of overweight has been increasing for decades (Ogden et al., 2006). Furthermore, more overweight has been seen in children at younger ages over the past two decades (e.g., Ogden et al.). Not only is there an increased prevalence of overweight in children, but overweight children have consistently been getting heavier (Jolliffe, 2004). These rates of overweight in children are not only seen in the United States. Over 22 million children under the age of five are estimated to be overweight worldwide (Deckelbaum & Williams, 2001). In light of the incidence and prevalence of overweight in children (Ogden et al.), and the impact it can have on their lives (e.g., Schwimmer, Burwinkle, & Varni, 2003; Zeller, Roehrig, Modi, Daniels, & Inge, 2006; Zeller, Saelens, Roehrig, Kirk, & Daniels, 2004), the need for successful and feasible treatments is clear.

In terms of treatment of pediatric overweight, numerous studies have been conducted examining weight-management programs for children. Most treatments take a multidisciplinary approach and include strategies for improving eating habits, increasing physical activity, and decreasing sedentary behavior. In terms of empirical support, behaviorally based therapies have consistently reported the best outcomes (e.g., Summerbell et al., 2003). In fact, behavior-based treatments have long been described as the state-of-the-art approach for child weight management (Robinson, 1999).


Sedentary Behavior Eating Disorder Childhood Obesity Glycemic Index Overweight Child 


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  1. Ball, S. D., Keller, K. R., Moyer-Mileur, L. J., Ding, Y., Donaldson, D., & Jackson, W. D. (2003). Prolongation of satiety after low versus moderately high glycemic index meals in obese adolescents. Pediatrics, 111, 488–494PubMedCrossRefGoogle Scholar
  2. Beech, B. M., Klesges, R. C., Kumanyika, S. K., Murray, D. M., Klesges, L., McClanahan, B., et al. (2003). Child- and parent-targeted interventions: The Memphis GEMS pilot study. Ethnicity and Disease, 13(Suppl. 1), 40–53Google Scholar
  3. Berkowitz, R. I., Fujioka, K., Daniels, S. R., Hoppin, A. G., Owen, S., Perry, A. C., et al. (2006). Effects of Sibutramine treatment in obese adolescents: A randomized trial. Annals of Internal Medicine, 145, 81–90PubMedGoogle Scholar
  4. Braet, C., Van Winckel, M., & Van Leeuwen, K. (1997). Follow-up results of different treatment programs for obese children. Acta Paediatrica, 86, 397–402PubMedCrossRefGoogle Scholar
  5. Brownell, K. D., Kelman, J. H., & Stunkard, A. J. (1983). Treatment of obese children with and without their mothers: Changes in weight and blood pressure. Pediatrics, 71, 515–523PubMedGoogle Scholar
  6. Chorpita, B. E., Barlow, D. H., Albano, A. M., & Daleidan, E. L., (1998). Methodological strategies in child clinical trials: Advancing the efficacy and effectiveness of psychosocial treatments. Journal of Abnormal Child Psychology, 26, 7–16PubMedCrossRefGoogle Scholar
  7. Dao, H. H., Frelut, M. L., Oberlin, F., Peres, G., Bourgeois, P., & Navarro, J. (2004). Effects of a multidisciplinary weight loss intervention on body composition in obese adolescents. International Journal of Obesity, 28, 290–299PubMedCrossRefGoogle Scholar
  8. Davison, K. K., & Birch, L. L. (2001). Childhood overweight: A contextual model and recommendations for future research. Obesity Reviews, 2, 159–171PubMedCrossRefGoogle Scholar
  9. Deckelbaum, R. J., & Williams, C. L. (2001). Childhood obesity: The health issue. Obesity Research, 9, 239s–243sPubMedCrossRefGoogle Scholar
  10. Elliot, R. (1998). Editor's introduction: A guide to the empirically supported treatments controversy. Psychotherapy Research, 8, 115–125CrossRefGoogle Scholar
  11. Epstein, L. H. (1996). Family-based behavioural intervention for obese children. International Journal of Obesity, 20, 14–21Google Scholar
  12. Epstein, L. H., McCurley, J., Wing, R. R., & Valoski, A. (1990). Five-year follow-up of family-based behavioral treatments for childhood obesity. Journal of Consulting and Clinical Psychology, 58, 661–664PubMedCrossRefGoogle Scholar
  13. Epstein, L. H., Myers, M. D., Raynor, H. A., & Saelens, B. E. (1998). Treatment of pediatric obesity. Pediatrics, 101, 554–570PubMedGoogle Scholar
  14. Epstein, L. H., Paluch, R. A., Gordy, C. G., Saelens, B. E., & Ernst, M. M. (2000). Problem solving in the treatment of childhood obesity. Journal of Consulting and Clinical Psychology, 68, 717–721PubMedCrossRefGoogle Scholar
  15. Epstein, L. H., Paluch, R. A., Saelens, B. E., Ernst, M. M., & Wilfley, D. E. (2001). Changes in eating disorder symptoms with pediatric obesity treatment. The Journal of Pediatrics, 139, 58–65PubMedCrossRefGoogle Scholar
  16. Epstein, L. H., Valoski, A. M., Kalarchian, M. A., & McCurley, J. (1995). Do children lose and maintain weight easier than adults: A comparison of child and parent weight changes from six months to ten years. Obesity Research, 3, 411–417PubMedGoogle Scholar
  17. Epstein, L. H., Valoski, A., Vara, L. S., McCurley, J., Wisniewski, L., Kalarchian, M. A., et al. (1995). Effects of decreasing sedentary behavior and increasing activity on weight change in obese children. Health Psychology, 14, 109–115PubMedCrossRefGoogle Scholar
  18. Epstein, L. H., Valoski, A., Wing, R. R., & McCurley, J. (1990). Ten-year follow-up of behavioral family-based treatment for obese children. Journal of the American Medical Association, 264, 2519–2523PubMedCrossRefGoogle Scholar
  19. Epstein, L. H., Valoski, A., Wing, R. R., & McCurley, J. (1994). Ten-year outcomes of behavioral family-based treatment for childhood obesity. Health Psychology, 13, 373–383PubMedCrossRefGoogle Scholar
  20. Epstein, L. H., Wing, R. R., Koeske, R. R., Andrasik, F. & Ossip, D. (1981). Child and parent weight loss in family-based behavior modification programs. Journal of Consulting and Clinical Psychology, 49, 674–685PubMedCrossRefGoogle Scholar
  21. Epstein, L. H., Wing, R. R., Steranchak, L., Dickson, B., & Michelson, J. (1980). Comparison of family-based behavior modification and nutrition education for childhood obesity. Journal of Pediatric Psychology, 5, 25–37PubMedCrossRefGoogle Scholar
  22. Epstein, L. H., Wisniewski, L., & Weng, R. (1994). Child and parent psychological problems influence child weight control. Obesity Research, 2, 509–515PubMedGoogle Scholar
  23. Fagot-Campagna, A. (2000). Emergence of type 2 diabetes mellitus in children: Epidemiological evidence. Journal of Pediatric Endocrinology and Metabolism, 13, 1395–1402PubMedGoogle Scholar
  24. Favaro, A., & Santonastaso, P. (1995). Effects of parents' psychological characteristics and eating behaviour on childhood obesity and dietary compliance. Journal of Psychosomatic Research, 39, 145–151PubMedCrossRefGoogle Scholar
  25. Flodmark, C., Ohlsson, T., Ryden, O., & Sveger, T. (1993). Prevention of progression to severe obesity in a group of obese schoolchildren treated with family therapy. Pediatrics, 91, 880–884PubMedGoogle Scholar
  26. Fossati, M., Amati, F., Painot, D., Reiner, M., Haenni, C., & Golay, A. (2004). Cognitive-behavioral therapy with simultaneous nutritional and physical activity educat i o n i n obese patients with binge eating disorder. Eating and Weight Disorders, 9, 134–138PubMedGoogle Scholar
  27. Fulton, J. E., McGuire, M. T., Caspersen, C. J., & Dietz, W. H. (2001). Interventions for weight loss and weight gain prevention among youth. Sports Medicine, 31, 153–165PubMedCrossRefGoogle Scholar
  28. Gaston, J. E., Abbott, M. J., Rapee, R. M., & Neary, S. A. (2006). Do empirically supported treatments generalize to private practice? A benchmark study of a cognitive-behavioural group treatment programme for social phobia. British Journal of Clinical Psychology, 45, 33–48PubMedCrossRefGoogle Scholar
  29. Golan, M., & Crow, S. (2004). Parents are key players in the prevention and treatment of weight-related problems. Nutrition Reviews, 62, 39–50PubMedCrossRefGoogle Scholar
  30. Golan, M., Fainaru, M., & Weizman, A. (1998). Role of behavior modification in the treatment of childhood obesity with the parents as the exclusive agents of change. International Journal of Obesity, 22, 1217–1224PubMedCrossRefGoogle Scholar
  31. Haddock, C. K., Shadish, W. R., Klesges, R. C., & Stein, R. J. (1994). Treatments for childhood and adolescent obesity. Annals of Behavioral Medicine, 16, 235–244Google Scholar
  32. Israel, A. C. (1999). Commentary: Empirically supported treatments for pediatric obesity: Goals, outcome criteria, and the societal context. Journal of Pediatric Psychology, 24, 249–250PubMedCrossRefGoogle Scholar
  33. Israel, A. C., Guile, C. A., Baker, J. E., & Silverman, W. K. (1994). An evaluation of enhanced self-regulation training in the treatment of childhood obesity. Journal of Pediatric Psychology, 19, 737–749PubMedCrossRefGoogle Scholar
  34. Israel, A. C., Silverman, W. K., & Solotar, L. C. (1988). The relationship between adherence and weight loss in a behavioral treatment program for overweight children. Behavior Therapy, 19, 25–33CrossRefGoogle Scholar
  35. Israel, A. C., Stolmaker, L., & Andrian, C. A. (1985a). The effects of training parents in general child management skills on a behavioral weight loss program for children. Behavior Therapy, 16, 169–180CrossRefGoogle Scholar
  36. Israel, A. C., Stolmaker, L., & Andrian, C. A. (1985b). Thoughts about food and their relationship to obesity and weight control. International Journal of Eating Disorders, 4, 549–558CrossRefGoogle Scholar
  37. Jeffrey, R. W., Drewnowski, A., Epstein, L. H., Stunkard, A. J., Wilson, G. T., & Wing, R. R. (2000). Long-term maintenance of weight loss: Current status. Health Psychology, 19(Suppl. 1), 5–16CrossRefGoogle Scholar
  38. Jelalian, E., & Saelens, B. E. (1999). Empirically supported treatments in pediatric psychology: Pediatric obesity. Journal of Pediatric Psychology, 24, 223–248PubMedCrossRefGoogle Scholar
  39. Johnson, S. L., & Birch, L. L. (1994). Parents' and children's adiposity and eating style. Pediatrics, 94, 653–661PubMedGoogle Scholar
  40. Johnston, C. A., & Steele, R. G. (2007). Treatment of pediatric overweight: An examination of feasibility and effectiveness in an applied clinical setting. Journal of Pediatric Psychology, 32, 106–110PubMedCrossRefGoogle Scholar
  41. Johnston, C. A., Tyler, C., Fullerton, G., Poston, W. S. C., Haddock, K., McFarlin, B., et al. (in press). Results of an intensive school-based weight loss program with overweight Mexican American children. International Journal of Pediatric Obesity Google Scholar
  42. Jolliffe, D. (2004). Extent of overweight among U.S. children and adolescents from 1971 to 2000. International Journal of Obesity, 28, 4–9PubMedCrossRefGoogle Scholar
  43. Kanfer, F. H. (1970). Self-monitoring: Methodological limitations and clinical applications. Journal of Consulting and Clinical Psychology, 35, 148–152CrossRefGoogle Scholar
  44. Kazdin, A. E., & Weisz, J. R. (1998). Identifying and developing empirically supported child and adolescent treatments. Journal of Consulting and Clinical Psychology, 66, 19–36PubMedCrossRefGoogle Scholar
  45. Keller, C. S., Gonzales, A., & Fleuriet, K. J. (2005). Retention of minority participants in clinical research studies. Western Journal of Nursing Research, 27, 292–306PubMedCrossRefGoogle Scholar
  46. Kirschenbaum, D. S., Harris, E. S., & Tomarken, A. J. (1984). Effects of parental involvement in behavioral weight loss therapy for preadolescents. Behavior Therapy, 15, 485–500CrossRefGoogle Scholar
  47. Kitzmann, K. M., & Beech, B. M. (2006). Family-based interventions for pediatric obesity: Methodological and conceptual challenges from family psychology. Journal of Family Psychology, 20, 175–189PubMedCrossRefGoogle Scholar
  48. Kumanyika, S., & Grier, S. (2006). Targeting interventions for ethnic minority and low-income populations. The Future of Children, 16, 187–207PubMedCrossRefGoogle Scholar
  49. Levine, M. D., Ringham, R. M., Kalarchian, M. A., Wisniewski, L., & Marcus, M. D. (2001). Is family-based behavioral weight control appropriate for severe pediatric obesity? International Journal of Eating Disorders, 30, 318–328PubMedCrossRefGoogle Scholar
  50. McLean, N., Griffin, S., Toney, K., & Hardeman, W. (2003). Family involvement in weight control, weight maintenance and weight loss interventions: A systematic review of randomized trials. International Journal of Obesity, 27, 987–1005PubMedCrossRefGoogle Scholar
  51. Nesbitt, S. D., Ashaye, M. O., Stettler, N., Sorof, J. M., Goran, M. I., Parekh, R., et al. (2004). Overweight as a risk factor in children: A focus on ethnicity. Ethnicity and Disease, 14, 94–110PubMedGoogle Scholar
  52. Norgren, S., Danilesson, P., Jurold, R., Lotborn, M., & Marcus, C. (2003). Orlistat treatment in obese prepubertal children: A pilot study. Acta Paediatrica, 92, 666–670PubMedCrossRefGoogle Scholar
  53. Nova, A., Russo, A., & Sala, E. (2001). Long-term management of obesity in paediatric office practice: Experimental evaluation of two different types of intervention. Ambulatory Child Health, 7, 239–248CrossRefGoogle Scholar
  54. Ogden, C. L., Carroll, M. D., Curtin, L. R., McDowell, M. A., Tabak, C. A., & Flegal, K. M. (2006). Prevalence of overweight and obesity in the United States, 1999–2004. Journal of the American Medical Association, 295, 1549–1555PubMedCrossRefGoogle Scholar
  55. Plato (translated 2004). Republic (C. D. C. Reeve, Trans.). Indiana: Hackett PublishingGoogle Scholar
  56. Redmon, J. B., Raatz, S. K., Reck, K. P., Swanson, J. E., Kwong, C. A., Fan, Q., et al. (2003). One-year outcomes of a combination of weight loss therapies for subjects with type 2 diabetes: A randomized trial. Diabetes Care, 26, 2505–2511PubMedCrossRefGoogle Scholar
  57. Resnicow, K., Yaroch, A., Davis, A., Wang, D. T., Carter, S., Slaughter, L., et al. (2000). Go girls! Results from a nutritional and physical activity program for low-income, overweight African-American adolescent females. Health Education Research, 5, 616–631Google Scholar
  58. Robinson, T. N. (1999). Behavioral treatment of childhood and adolescent obesity, International Journal of Obesity, 23(Suppl. 2), 52–57CrossRefGoogle Scholar
  59. Rosenbloom, A. L., Joe, J. R., Young, R. S., & Winter, W. E. (1999). Emerging epidemic of type 2 diabetes in youth. Diabetes Care, 22, 345–354PubMedCrossRefGoogle Scholar
  60. Schwimmer, J. B., Burwinkle, T. M., & Varni, J. M. (2003). Health-related quality of life of severely overweight children and adolescents. Journal of the American Medical Association, 289, 1813–1819PubMedCrossRefGoogle Scholar
  61. Steele, R. G., & Roberts, M. C. (2003). Therapy and interventions research with children and adolescents. In M.C. Roberts & S.S. Ilardi (Eds.), Methods of Research in Clinical Psychology: A Handbook. Oxford: BlackwellGoogle Scholar
  62. Stein, R. I., Epstein, L. H., Raynor, H. A., Kilanowski, C. K., & Paluch, R. A. (2005). The influence of parenting change in pediatric weight control. Obesity Research, 13, 1749–1755PubMedCrossRefGoogle Scholar
  63. Summerbell, C. D., Ashton, V., Campbell, K. J., Edmunds, L. D., Kelly, S., & Waters, E. (2003). Interventions for treating obesity in children. Cochrane Database of Systematic Reviews, 3, Article CD001872Google Scholar
  64. Tauman, R., O'Brien, L. M., Ivanenko, A., & Gozal, D. (2005). Obesity rather than severity of sleep-disordered breathing as the major determinant of insulin resistance and altered lipidemia in snoring children. Pediatrics, 116, E66-E73Google Scholar
  65. Tershakovec, A. M. (2004). Psychological considerations in pediatric weight management. Obesity Research, 12, 1537–1538PubMedCrossRefGoogle Scholar
  66. Uzark, K. C., Becker, M. H., Dielman, T. E., Rocchini, A. P., & Katch, V. (1988). Perceptions held by obese children and their parents: Implications for weight control behaviors. Health Education Quarterly, 15, 185–198PubMedGoogle Scholar
  67. Violante-Ortiz, R., Del-Rio-Navarro, B. E., Lara-Esqueda, A., Perez, P., Fanghanel, G., Madero, A., et al. (2005). Use of sibutramine in obese Hispanic adolescents. Advances in Therapy, 23, 506–507Google Scholar
  68. Wang, Y., & Zhang, Q. (2006). Are American children and adolescents of low socioeconomic status at increased risk of obesity? Changes in the association between overweight and family income between 1971 and 2002. American Journal of Clinical Nutrition, 84, 707–716PubMedGoogle Scholar
  69. Westen, D., Novotny, C. M., & Thompson-Brenner, H. (2005). EBP ≠ EST: Reply to Crits-Christoph et al. (2005) and Weisz et al. (2005). Psychological Bulletin, 131, 427–433CrossRefGoogle Scholar
  70. Wilson, G. T. (1994). Behavioral treatment of childhood obesity: Theoretical and practical implications. Health Psychology, 13, 371–372PubMedCrossRefGoogle Scholar
  71. Wing, R. R., Tate, D. F., Gorin, A. A., Raynor, H. A., & Fava, J. L. (2006). A self-regulation program for maintenance of weight loss. The New England Journal of Medicine, 355, 1563–1571PubMedCrossRefGoogle Scholar
  72. Zeller, M. H., Roehrig, H., Modi, A. C., Daniels, S. R., & Inge, T. H. (2006). Health-realted quality of life and depressive symptoms in adolescents with extreme obesity presenting for bariatric surgery. Pediatrics, 117, 1155–1161PubMedCrossRefGoogle Scholar
  73. Zeller, M. H., Saelens, B. E., Roehrig, H., Kirk, S., & Daniels, S. R. (2004). Psychological adjustment of obese youth presenting for weight management treatment. Obesity Research, 12, 1576–1586PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2008

Authors and Affiliations

  • Craig A. Johnston
    • 1
  • William T. DaltonIII
    • 1
  1. 1.USDA/ARS Children's Nutrition Research CenterBaylor College of MedicineHouston

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