An Interdisciplinary Model for the Treatment of Obesity in Young Girls

The effectiveness of an interdisciplinary model in treating obesity in three young girls, ages 4 to 8, was studied over a 20-week period. Three subjects were selected from physician referrals and newspaper advertisement respondents. All of the subjects were clinically obese as indicated by weight and fatfold measures and had no apparent medical complications which would contraindicate treatment. Two of the subjects were white and one was of mixed racial background. One or both parents were obese in all subjects but none had obese siblings. The mother of each subject was the primary family member attending meetings.

Treatment effects were measured in terms of weight, height, fatfold, and behavioral changes. A single-case experimental design, utilizing a multiple baseline, across subjects format, was employed to demonstrate experimental control. The baseline phase of this design lasted 3, 4, and 5 weeks with Subjects 1, 2, and 3, respectively, while treatment occurred over 17, 16, and 15 weeks. The treatment package included the major components of dietary intervention, physical activity, and behavior therapy. Specific procedures were employed to implement each of the components.

All of the subjects demonstrated decreases in body weight in terms of pounds lost, a reduction in percent overweight, and a weight reduction index (RI). Subject 3 showed the greatest change followed by Subjects 1 and 2. All of the subjects maintained a linear pattern of growth during the study as indicated by changes in height.

Subject 1 demonstrated the greatest improvement in fatfold followed by Subjects 3 and 2. Differences in the order of response to fatfold and weight changes may be associated with (1) individual variations in activity level, (2) measurement error, or (3) an inadequate correlation between fatfold and obesity. All of the subjects showed an improvement in the degree of obesity as demonstrated by a weight-for-length index. The rank order of improvement paralleled that for weight change. All of the subjects modified inappropriate eating and exercise behaviors as indicated by reports of self-reported and observable change.

The results of this study have several implications for future childhood obesity treatment programs. The use of a single-case experimental design overcomes many of the limitations inherent in group comparison studies which include: (1) ethical issues, (2) problems in collecting a large enough group of subjects with appropriate characteristics, (3) a tendency to neglect reporting individual outcome results, and (4) less control over within-subject variability. The importance of maintaining adequate growth in children while attempting to treat their obesity emphasizes a reliance on clinical vs. statistical significance. Treatment models which allow long-term maintenance of treatment effects need to be identified. The components included in the treatment package need to be isolated to determine the critical elements. Finally, the model should be tested by other investigators, in different settings, on a variety of subjects, to identify the extent of generality. The single-case design may be utilized to accomplish this task either through a similar multiple baseline approach, or with larger groups of subjects.