An Educational Program Based on Self-Determination Theory to Address Childhood Obesity in Primary Care Settings

Abstract

To test a nutrition education program implemented in primary care settings based on the self-determination theory (SDT) with motivational interviewing counseling techniques. Design was a pre- post- assessment, treatment/wait-listed control for 9-11 year old overweight/obese children and their parents (n=31 family pairs). The intervention was six-biweekly, hour-long individual sessions for family pairs over a 12-week period. Telephone calls were made on non-session weeks providing encouragement and problem-solving assistance. Parents participated in three, 90-minute group sessions. Child pre- post- measurements included anthropometrics (weight, height, waist circumference); blood pressure; Block Food and Physical Activity Screener; self-esteem; body image and the SDT constructs - motivation, autonomy, competence, relatedness. Adults received companion surveys for comparisons. Participants provided information on researcher’s support of autonomy. SPSS analysis included one-way ANOVA and paired t-tests. Treatment children (mean age=10.3±0.8 years) decreased from pre to post body mass index (BMI) percentile (P=0.015) and waist circumference (P=0.001); increased self-esteem (P=0.048) and autonomous motivation (P=0.048). Positive trends were reported in dietary intake and physical activity. Treatment parents reported increase in autonomous motivation (P=0.030); perceived competence (P=0.001); relatedness (P=0.025); self-esteem (P=0.031); and decreased controlled motivation (P=0.023). Children and parents reported feeling their autonomy was supported by the researcher. Wait-listed control children increased weight (P=0.001); BMI percentile (P=0.001) and waist circumference (P=0.004); and decreased body dissatisfaction (P=0.047). Positive outcomes were seen when using an SDT-based nutrition education program to support development of autonomy, motivation, competence, and relatedness. This family-centered intervention to address childhood obesity was successful in primary care settings.