Golan Moria
School of Nutritional Sciences, The Hebrew University of Jerusalem, Rehovot, Israel.
Int J Pediatr Obes. 2006;1(2):66-76. doi: 10.1080/17477160600644272.
The home environment is undoubtedly the most important setting in relation to shaping children's eating and physical activity behaviors. Family-based behavioral treatment is the most well-established intervention for the treatment of childhood obesity. Historically, family based interventions target the obese child and at least one or both parents. Presented here is a review of the literature on parents as exclusive agents of change, with the addition of some recent results indicating the effectiveness of this approach when implemented in public health programs. Targeting parents as the exclusive mediator has resulted in a better reduction in children's percentage overweight, and improvement in the obesogenic environment and behaviors, in comparison to a setting in which parents attended sessions with the obese child, or only children attended sessions. The findings from these studies were subsequently implemented in a national community-based survey. Both children's and parents' weight status were significantly improved, although only parents attended the group sessions. A significant reduction in the obesogenic load at home was also found. Permissive parenting style was associated with less reduction in obesogenic load at home (p < 0.01) and with less weight loss (p < 0.05). Omitting the obese child from direct intervention and targeting parents only is a cost-effective approach with integrated messages for the management of weight-related problems.
家庭环境无疑是塑造儿童饮食和身体活动行为方面最重要的环境。基于家庭的行为治疗是治疗儿童肥胖症最成熟的干预措施。从历史上看，基于家庭的干预措施针对肥胖儿童以及至少一位或两位家长。本文对将家长作为唯一改变因素的文献进行了综述，并补充了一些近期结果，这些结果表明该方法在公共卫生项目中实施时的有效性。与家长与肥胖儿童一起参加课程或仅儿童参加课程的情况相比，将家长作为唯一的调解人能使儿童超重百分比得到更好的降低，致胖环境和行为得到改善。这些研究结果随后被应用于一项全国性的社区调查中。尽管只有家长参加小组课程，但儿童和家长的体重状况都有显著改善。在家中致胖因素负荷也有显著降低。放任型育儿方式与家中致胖因素负荷降低较少（p < 0.01）以及体重减轻较少（p < 0.05）相关。将肥胖儿童排除在直接干预之外，仅针对家长是一种具有成本效益的方法，能提供与体重相关问题管理的综合信息。
