Effectiveness of a Family-Based Behavioral Counseling Program among School-aged Children with Obesity: A Quasi-Experimental Study

Main Article Content

Kittiya Rattanamanee
Chintana Wacharasin


                Leading causes of obesity in school-age children are unhealthy eating and less physical activity. This study examined the effectiveness of the Family-based Behavioral Counseling Program on healthy eating behavior, physical activity, and body mass index in school-age children with obesity. Participants were 10-12-year-olds from municipal schools in a southern province of Thailand. Twenty-two participants were recruited into each group: intervention Group I receiving a 7-week family-based behavioral counseling program, intervention Group II receiving a 7-week group-based behavioral counseling program, and the control group receiving only a usual program. Data were collected using the Health Eating Behavior Questionnaire, the Physical Activity Questionnaire, and the Scale for Weight and Height. Repeated Measures ANOVA and ANCOVA were used to analyze data.

               The results revealed that after completing the interventions, healthy eating behaviors and physical activity of participants in Group I were significantly higher than those in Group II and the control group. Body mass index of the participants was not significantly different between these three groups but in Group I this decreased over time. The findings indicated that this program can enhance healthy eating behavior and physical activity, and decrease body mass index among children with obesity. This program should be further verified through being studied over a longer period and in different locations in Thailand. It has potential for school nurses to use as a modified health lifestyle leading to weight control among school-aged children with obesity.

Article Details

How to Cite
Rattanamanee K, Wacharasin C. Effectiveness of a Family-Based Behavioral Counseling Program among School-aged Children with Obesity: A Quasi-Experimental Study. PRIJNR [Internet]. 2021Jun.15 [cited 2021Sep.27];25(3):466-80. Available from: https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/242682
Original paper


1. World Health Organization. Tenfold increase in childhood and adolescent obesity in four decades: new study by Imperial College London and WHO. [Internet]. 2017 Oct 11. [cited 2018 Jan 12]. Available from: http://www. who.int/mediacentre/news/releases/2017/increase childhood-obesity/en/

2. Health KPI. Percentage of children aged 6-14 years old. [Internet]. 2020 Oct 26. [cited October 26, 2020]. Available from: http://healthkpi.moph.go.th/kpi2/kpi list/view/?id=1391

3. Hales CM, Carroll M D, Fryar CD, Ogden CL. Prevalence of obesity among adults and youth: United States, 2015–2016. [Internet]. 2017 Oct 17.[cited 2018 Sep1] Available from: https://www.cdc.gov/nchs/data/ databriefs/db288.pdf

4. Department of Health Thailand. Handbook of control and prevention in childhood overweight. Bangkok: The War Veterans Organization of Thailand Press; 2014.

5. Brown T, Moore TH, Hooper L, Gao Y, Zayegh A, Ijaz S. et al. Interventions for preventing obesity in children. Cochrane Database Syst Rev, 2019; 7(7): CD001871. doi: 10.1002/14651858.CD001871.pub4.

6. Sahoo K, Sahoo B, Choudhury AK, Sofi NY, Kumar R, Bhador AS. Childhood obesity: causes and consequences. J Family Med Prim Care. 2015; 4(2): 187–92. doi: 10.4103/2249-4863.154628.

7. Sabin MA, Kao K, Juonala M, Baur LA, Wake M. Viewpoint article: childhood obesity - looking back over 50 years to begin to look forward. J Paediatr Child Health. 2015; 51(1): 82-6. doi:10.1111/jpc.12819.

8. Xu S, Xue Y. Pediatric obesity: causes, symptoms, prevention and treatment. Exp TherMed. 2016;11(1): 15‐20. doi:10.3892/etm.2015.2853.

9. Wangge G. Obesity in school-age children. Med J Indones. 2019; 28(2):101-2. doi.org/10.13181/mji.v28 i2.4079.

10. Rolling TE, Hong MY. The effect of social cognitive theory-based interventions on dietary behavior within children. J Nutrition Health Food Sci. 2016; 4(5): 1-9. doi:http://dx.doi.org/10.15226/jnhfs.2016.00179

11. Bandura A, Adams, NE. Analysis of self-efficacy theory of behavioral change. Cognitive Ther and Res.1977;1(4): 287-310. doi:10.1007/bf01663995.

12. Ha SA, Lee SY, Kim KA, Seo JS, Sohn CM, Park, HR, et al. Eating habits, physical activity, nutrition knowledge, and self-efficacy by obesity status in upper-grade elementary school students. Nutr Res Pract. 2016; 10(6): 597–605. doi:10.4162/nrp.2016.10.6.597.

13. Alulis S. Grabowski D. Theoretical frameworks informing family-based child and adolescent obesity interventions: a qualitative meta-synthesis. Obes Res Clin Pract. 2017; 11(6): 627-39. doi: 10.1016/j.orcp.2017.08.001.

14. Hong SA, Peltzer K, Wimonpeerapattana W. Impact of self-efficacy and parenting practice on physical activity among school children. Nagoya J Med Sci. 2017;79: 339 - 49. doi:10.18999/nagjms.79.3.339.

15. Pbert L, Druker S, Barton B, Olendzki B, Andersen V, Persuitte G, et al. Use of a FITLINE to support families of overweight and obese children in pediatric practices. Child Obes. 2016; 12(1): 33-43. doi:10.1089/chi.2015.0101.

16. Ash, T, Agaronov, A, Young, T, et al.Family-based childhood obesity prevention interventions: a systematic review and quantitative content analysis. Int J Behav Nutr Phys Act. 2017;14(1):113. doi: 10.1186/s12966- 017-0571-2.

17. Egbo JOE. Need for guidance and counselling at the primary school level: early intervention strategies for school children. BJE. [Internet]. 2015 Jul. [cited 2018 Jan 12]; 3(6): 1-8. Available from: http://www.eajournals.org/wp-content/ uploads/Need-For-Guidance-And-Counselling-At-The Primary-School-Level-Early-Intervention-Strategies For-School-Children.pdf

18. Yackobovitch-Gavan M, Wolf D, Nagelberg N, et al. Intervention for childhood obesity based on parents only or parents and child compared to follow-up alone. Pediatr Obes.2018; 13(11): 647-55. doi:10.1111/ijpo.12263.

19. Elvsaas IKØ,, Giske L, Fure B, Juvet LK. Multicomponent lifestyle interventions for treating overweight and obesity in children and adolescents: a systematic review and meta analyses. J Obes. 2017;2017:5021902. doi:10.1155/ 2017/5021902.

20. Vandeweghe L, Moens E, Braet C, Van Lippevelde W, Vervoort L, Verbeken S. Perceived effective and feasible strategies to promote healthy eating in young children: focus groups with parents, family child care providers and daycare assistants. BMC Public Health. 2016; 16 (1045): 1-12. doi:10.1186/s12889-016-3710-9.

21. LiuS, Marques IG, Perdew MA, et al. Family-based, healthy living intervention for children with overweight and obesity and their families: a ‘real world’ trial protocol using a randomized wait list control design. BMJ Open 2019;9:e027183. doi:10.1136/ bmjopen- 2018- 027183.

22. Kelley CP, Sbrocco, G, Sbrocco T. Behavioral modification for the management of obesity. Prim Care. 2016; 43(1): 159–75. doi:10.1016/j.pop.2015.10.004.

23. Pamungkas RA, Chamroonsawasdi K. Home-based interventions to treat and prevent childhood obesity: a systematic review and meta-analysis. Behav Sci. 2019; 9(4): 2-20. doi:10.3390/bs9040038.

24. Bohlin A, Hagman E, Klaesson S, Danielsson P. Childhood obesity treatment: telephone coaching is as good as usual care in maintaining weight loss - a randomized controlled trial. Clin Obes. 2017; 7(4): 199-205. doi:10.1111/ cob.12194.

25. Maytapattana M. The effects of the parent training program for obesity reduction on anthropometric measures of school-age children. J Beh Scie [Internet]. 2014 [cited 2021 Feb.19];9(1):31-4. Available from: https://so06. tci-thaijo.org/index.php/IJBS/article/view/15650

26. Nawsuwan K, Kitrungrote T, Chotiban P, Rodniam J, Bua-ngam J, Nakaramontri S. Modification of health Behavior of elementary School students with overweight by the participation of community health Parties. Nurs J of Ministry of Public Health. [Internet]. 2013 Aug 13; [cited 2021 Feb19]; 23(2): 44-54. Available from: https:// he02.tci-thaijo.org/index.php/tnaph/article/view/ 11894/10719 (in Thai)

27. Wright LM, Leahey M. Nurses and families: a guide to family assessment and intervention. 6th ed. Philadelphia, PA: FA Davis Company; 2013.

28. Centers for Disease Control and Prevention . About child & teen BMI. [Internet]. 2013 Aug 13; [cited 2021 Feb19]; 23(2): 44-54. Available from: https://he02. tci-thaijo.org/index.php/tnaph/article/view/11894/ 10719 (in Thai)

29. Young KM, Northern, JJ, Lister KM, Drummond JA, O'Brien WH. A meta-analysis of family-behavioral weight-loss treatments for children. Clin Psychol Rev. 2007; 27(2): 240-9.

30. Polit DF, Beck CT. Nursing Research: generating and assessing evidence for nursing practice. Lippincott Williams & Wilkins; 2008.

31. Bureau of Nutrition. The Eating Behaviors Questionnaire for children 6-13 years. Department of Health, Ministry of Public Health, Nonthaburi. [Internet] 2016. [cited 2020 Aug 18]. Available from: http://nutrition.anamai.moph. go.th/ewt_news.php?nid=103

32. Kowalski KC, Crocker PR Donen, RM. The Physical Activity Questionnaire for Older Children (PAQ-C) and Adolescents (PAQ-A) manual [Internet]. 2004 [cited 2020 Aug 18]. Available from: https// www.researchgate.net/p ublication/228441462

33. Ar-yuwat S, Clark MJ, Hunter A, James KS. Determinants of physical activity in primary school students using the health belief model. J Multidiscip Healthc. 2013;6: 119-26. doi: 10.2147/JMDH.S40876.

34. Tucker S, Lanningham-Foster LM. Nurse-led school-based child obesity prevention. J Sch Nurs. 2015; 1-17. doi: 10.1177/1059840515574002.

35. Selmin K, Yildirim G. The effect of a nutrition education program on nutrition behavior and body mass index of secondary school students. Int J Caring Sci. 2020; 13(1): 573-82.

36. Scaglioni S, De Cosmi V, Ciappolino V, Parazzini F, Brambill, P, Agostoni C. Factors influencing children›s eating behaviours. Nutrients. 2018; 10(706): 1-17. doi.org/ 10.3390/nu10060706.

37. Satoba SMA, Flórez MLF. Self-efficacy in physical activity in children, body mass index and physical activity level of their parents. Salud Uninorte. Barranquilla [Internet]. 2018Aug [cited 2020 May 18] ; 34( 2 ): 393-408. Available from: http://www.scielo.org.co/scielo.php? script=sci_ arttext&pid=S0120-55522018000200393 &lng=en. http://dx.doi.org/10.14482/sun.34.2.612.04.

38. Wilfley DE, Saelens BE, Stein RI, Best JR, Kolko RP, Schechtman KB, et al. Content, and mediators of family-based treatment for childhood obesity a multisite randomized clinical trial. JAMA Pediatrics. 2017;171(12):1151- 1159. doi:10.1001/jamapediatrics. 2017.2960.

39. IOM (Institute of Medicine). Accelerating progress in obesity prevention: solving the weight of the nation. Washington, DC: The National Academies Press; 2012.