Effects of a Planned Behavioral Modification and Family Support Program on Weight Control Behaviors and Muscle Mass in Overweight Late School-aged Children

Abstract

Introduction Overweight and obesity among school-aged children are significant public health problems at both national and global levels. Previous studies on various weight management programs for school-aged children have found that children exhibit inconsistent food consumption behaviors and physical activity. Therefore, promoting weight control in school-aged children with overweight, along with family support, will result in appropriate food consumption behaviors and physical activity. This approach can help children maintain healthy and sustainable behaviors into adulthood. 

Objective This study aimed to investigate the effects of a Planned Behavioral Modification and Family Support Program on weight control behaviors and muscle mass among overweight late school-aged children. 

Design This quasi-experimental study with a two-group repeated measures design applies the Theory of Planned Behavior to promote positive attitudes towards weight control in children. The children developed positive beliefs and attitudes towards their weight control behaviors due to receiving specific, individualized information. Additionally, the study considered the subjective norms, including the opinions of significant individuals such as caregivers or parents and peers, which are crucial for children’s weight-control behaviors. Furthermore, the children’s control beliefs about their ability to manage their weight were expressed with confidence and intention, leading to appropriate weight control behaviors.

Methodology The sample consisted of overweight children studying in grades 4-5 at schools under the jurisdiction of a provincial primary education office in northeastern Thailand during the 2022 academic year. A multi-stage sampling method was used, with schools randomly selected to form one experimental and one control group. Classrooms and students were selected to ensure similar characteristics and assessed using the weight-for-height reference charts for Thai children aged 6-19 years from the Department of Health, Ministry of Public Health, 2021. The sample size was calculated using G Power, resulting in 54 participants, divided into 27 for the experimental group and 27 for the control group, matched by gender. Research instruments included: 1) a child information questionnaire, 2) a weight control behavior questionnaire, 3) a food consumption and physical activity behavior log, 4) a weight, height, and muscle mass record form, and 5) a 4-week Planned Behavioral Modification and Family Support Program, developed by the researchers based on the Theory of Planned Behavior. The content validity of each instrument was confirmed with a content validity index of 1. The reliability of the weight control behavior questionnaire was tested with a Cronbach’s alpha coefficient of .73. Data were collected from June 7 to August 14, 2023. The experimental group received the program, consisting of two activities: 1) a 3-hour training session for primary caregivers, providing knowledge on their roles and guidelines for managing overweight children and promoting family support for weight control, and 2) four 2-hour weekly training sessions for overweight children over 4 weeks. The control group received usual care from their families. Data on weight control behaviors were collected 2 and 4 weeks after the program (weeks 6 and 8), and muscle mass was assessed immediately after the program. Data were analyzed using descriptive and inferential statistics, including Chi-square test, Independent t-test, Paired t-test, and Two-way repeated measures ANOVA, with a significance level set at .05.

Results The experimental group had a mean age of 10.4 years (SD=0.52), a mean weight of 59.48 kilograms (SD=10.64), and a mean height of 145.93 centimeters (SD=7.13). They were classified as overweight (44.44%) and obese (55.56%). Most of them were from nuclear families, with mothers being the primary food providers (63%). The control group had a mean age of 9.96 years (SD=0.71), a mean weight of 58.89 kilograms (SD=11.60), and a mean height of 147.67 centimeters (SD=7.99). This group was classified as overweight (63.00%) and obese (37.00%). Most children were also from nuclear families, with mothers being the primary food providers (51.85%). Comparing characteristics between the experimental and control groups showed no statistically significant differences (p>.05). After participating in the program, weight control behaviors were significantly different over time (F=728.927, p<.001). The interaction between the program and time significantly affected the weight control behaviors of the participants (F=316.027, p<.001). When analyzing between groups, the control and experimental groups showed statistically significant differences in weight control behaviors (F=734.303, p<.001). Additionally, the experimental group had a statistically significant increase in muscle mass compared to before the program (t=2.635, p=.014), but there was no significant difference compared to the control group (t=0.077, p>.05).

Recommendation The results of this study indicate that the Planned Behavioral Modification and Family Support Program is effective in weight management among late school-aged children who are overweight. The experimental group demonstrated improved weight control behaviors and increased muscle mass. Therefore, school health nurses or teachers can implement this program for weight management by involving primary caregivers, to promote appropriate weight control behaviors in those children.